tci Medicare Compliance & Reimbursement - 2006 Issue 10

REIMBURSEMENT: Providers Bear The Burden Of Proof For Outpatient Therapy Exceptions

A new modifier provides the key that unlocks automatic exceptions.There are nearly 100 diagnoses and clinical conditions that can buy providers an exception to the new $1,740 annual spending caps on outpatient therapy services. But to receive automatic reimbursement when a qualifying service exceeds the caps, providers must know the proper way to bill them.For starters, the automatic exceptions process, which the Centers for Medicare & Medicaid Services released Feb. 15, involves a new modifier requirement. When a physical, speech-language or occupational therapy service exceeds the caps, providers and suppliers must indicate that the service is...

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