John A. Miller

As of January 1, 2010, there was a $1,860 annual limit on occupational therapy services and a $1,860 annual limit on a combination of physical therapy and speech and language pathology services that a beneficiary could receive during the 2010 calendar year, with no process for obtaining exceptions. H.R. 4691 reinstates the exceptions process, also making it retroactive to January 1, 2010, but only through March 31, 2010.

The Centers for Medicare & Medicaid Services (CMS) is recommending providers that have been holding 2010 Part B therapy claims should submit the claims for payment. Providers who submitted claims and had services denied as a result of the therapy cap should determine whether the criteria for an exception to the therapy cap has been met. If appropriate, providers would need to adjust the denied claims for payment to be made.

Any provider who charged beneficiaries for services that exceeded caps should refund the fees collected from the beneficiaries and contact their Medicare Administrative Contractor (MAC) for an adjustment.

Physician Fee Schedule Update

The U.S. Senate also passed a bill that extends the temporary delay of the 21.2 percent cut in the 2010 Medicare physician payments until March 31, 2010. The bill will provide Congress with an additional 30 days to address the issues before the cuts take effect.

Questions & Concerns

If you have questions, contact CMS or your BKD advisor for more information.