History of Medical Billing Therapy Caps

History of Medical Billing Therapy Caps

The issue of therapy caps is not a new topic in medical billing. The on again, off again nature of therapy caps has left medical billing staff members spinning. To fully understand the reasons for these limits, it is important to understand the history. Looking back into the history of therapy cap medical billing can give us a glimpse into the future.

Perhaps the first introduction of therapy caps was in 1997. This is when Medicare implemented outpatient therapy caps in the Balanced Budget Act of 1997. However, like any other medical billing policy, there are always exceptions. Certain providers and beneficiaries were protected from these therapy caps.

2003 was the peak year for therapy caps in medical billing. At first, therapy caps ended. However, this did not last very long. Congress quickly passed a moratorium in the Medicare prescription drug and modernization act of 2003. This act lasted for a long time in the medical billing world. As a matter of fact, it expired on December 31, 2005. This is when the deficit reduction act was being debated in Congress.

It appears that medical billing therapy caps are here to stay. The past shows us that even if therapy caps expire, there is always legislation to pick up the slack. It is obvious that therapy caps are necessary for the longevity of the Medicare and Medicaid program. Most people would agree that therapy caps are much better than a program that does not exist.

Although it is quite obvious that there be caps are here to stay, that does not mean your practice can relax. Make sure your medical billing staff say on their toes with new changes and regulations. With each coming year there seems to be new policies that everyone must adhere to. Medical billing is a sensitive topic that must be treaded on softly.

View all Articles by: Melissa Clark, CCS-P