tci Medicare Compliance & Reimbursement - 2006 Issue 20

OUTPATIENT THERAPY: Use The Right Form For Therapy Cap Communications

Confusion reigns when it come to ABNs.If the ABN and its cousin the NEMB are throwing you for a loop, you're not alone. Here's a guide to finding the right form when therapy caps are involved.Scenario: A resident exceeds or is about to exceed the therapy cap(s) and does not qualify for any exceptions.You may use the Notice of Exclusions from Medicare Benefits form, though the Centers for Medicare and Medicaid Services does not require its use.In this case, the Advance Beneficiary Notice does not apply because "therapy over the cap is not considered a...

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