Medical Billing Caps for Therapy Addressed

New treatment methods and less surgical procedures has made therapy medical billing dramatically rise. Not only are there more physical therapy claims, but there are also many more speech therapy and rehab claims sent in to payers. To decrease the deficit, the House of Representatives recently passed an act that puts a cap on therapy medical billing.

The Deficit Reduction Act of 2005 was passed on December 21,2005 with a very narrow vote by the Senate. Senators were split in a 51-50 vote to cap therapy medical billing reimbursements. As a matter of fact, the vice president of the senate cast the tie breaking vote for the act.

Although there is a therapy cap in place, the act addresses some major issues. Now it will be allowed for patients to extend their care and go beyond the medical billing cap limits if therapy is medically necessary. However, this extension will only be valid for one year. So far, it has not been discussed if speech therapy and physical therapy medical billing will fall under this same cap.

The therapy medical billing act also addresses Medicare Part B payments. Now, physician amounts for 2006 will increase for Part B. To make up for this medical billing reimbursement increase, Medicaid will have significant cuts. Medicaid will also install a higher co-payment to it’s beneficiaries.

The fear with these medical billing cuts is that patients may not get the care that they desperately need. Ben F. Massey Jr. from the American Physical Therapy Association states, “We intend to work with the Secretary of Health and Human Services to ensure that this exemptions process allows patients to receive the physical therapy they need.”

Some changes are expected in the October 2007 update of CMS that will benefit therapy caps but it is unknown if additional speech and physical therapies will be directly affected.

View all Articles by: Melissa Clark, CCS-P