Industry Insights

Changes to Part B Therapy Manual Medical Review

February 2016
Author:  Suzy Harvey

Suzy Harvey

Managing Consultant

Consulting

Health Care

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)

Springfield
417.865.8701

The April 2015 passing of the Medicare Access and CHIP Reauthorization Act (MACRA) changed the review requirements for Part B therapy claims exceeding the $3,700 therapy threshold. Prior to MACRA, all claims beyond the threshold were subject to mandatory review. This was not only a burden to therapy providers, including skilled nursing facilities, but also resulted in payment delays and miscommunication between contractors. Under MACRA, claims above the therapy threshold will be subject to a targeted post-payment review process, eliminating the requirement for 100 percent review.

MACRA also prohibits the use of recovery audit contractors to conduct medical review for therapy threshold claims. As a result, Medicare has contracted with StrategicHealthSolutions to be the supplemental Medicare review contractor. Facility staff should look for mail from StrategicHealthSolutions and promptly respond to any review requests. Claims will be selected for review based on outliers, including providers billing a high percentage of therapy claims that exceed the threshold as compared to their peers.

If you have questions about these new review requirements and how they could affect you, contact your BKD advisor.

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