Limited Outpatient Therapy Medical Billing Payments

In an effort to limit medical billing reimbursement, the Centers for Medicare & Medicaid Services has taken action. Beginning on January 1, 2006, The Centers for Medicare & Medicaid Services will reinstate the outpatient therapy cap. This medical billing change may negatively effect your bottom line, but is the best option in the long run.

The new medical billing limits for outpatient therapy will be $1,740 for occupational therapy and $1,740 for physical therapy and speech pathology combined. However, these two caps do not affect any therapy provided through home health care.

The reason for this medical billing cap is because of the increase in outpatient therapy charges in the recent years. More and more ailments and injuries are curable with outpatient therapy, therefore, more outpatient therapy charges are submitted to CMS each year. The Centers for Medicare & Medicaid Services decided that to increase the longevity of the program, the medical billing cap must be instated.

Although it would be a waste of your time to submit claims for patients who have already reached their cap, no harm will be done. If you medical billing staff make a mistake and submit a claim for a patient who has exceeded their limit, the claim will merely be denied by CMS. The only thing this will do is waste your valuable time and energy once the claim gets sent back to your office.

It is in your best interest to keep close records and files on your patients to keep track of their outpatient therapy payments. Medical billing firms can assist your with this task. You can utilize their services for consulting work and for claims responsibilities. The experienced staff members at these companies can streamline your medical billing into the well oiled machine it was meant to be.

View all Articles by: Melissa Clark, CCS-P