Medical Billing Exceptions Are Put In Place

Medical Billing Exceptions Are Put In Place

Shortly after the deficit reduction medical billing act was signed, Medicare created and exception process. February 8, 2006 marked a day that will go down in history for physical therapy. It was the day therapy that caps were installed for Medicare beneficiaries. To combat this, the Centers for Medicare and Medicaid services created exceptions for this medical billing legislation.

The magic number for therapy medical billing is $1740. The deficit reduction act says that no one can get therapy over $1,740.00 a year. However, Medicare has made some exceptions to this rule. There are some people who will automatically fall under the exceptions category. Certain diagnoses will be able to fly through Medicare medical billing without problem.

There are other diagnoses that may need to exceed the therapy cap. Some of these diagnoses may not fall under the automatic exception rule. In these cases, a written request may be performed. Medicare released information that explained specific documentation needed to overrule the medical billing cap.

If a therapy providers performs an exception request, Medicare must respond within ten business days. If there is no response to the medical billing request, it will automatically be considered medically necessary. The medical billing therapy caps will disappear.

Although these medical billing cap exceptions will not take place until march or April, your practice should be ready. Make sure you fully understand all documentation needed to make an exceptions request. Although time will be needed for documentation submission, at least reimbursement will be made. Most practices would rather spend the extra time on documentation and paperwork than to be denied entirely. If you are ready for the medical billing exceptions process, it will be a snap. Jumping through governmental and legislation hoops should not seem new to your Healthcare therapy practice.

View all Articles by: Melissa Clark, CCS-P