After a two-year moratorium on Medicare’s outpatient therapy caps in 2004 and 2005, Congress reinstated the caps at the beginning of last year and allowed for exceptions to the payments caps for one calendar year, ending Dec. 31, 2006. But numerous questions have arisen on the process that lets Medicare beneficiaries obtain additional therapy, and the Centers for Medicare and Medicaid Services has published an article in MLN Matters to clarify it.
Some Medicare beneficiaries are automatically excepted from the therapy cap (if their conditions are listed in the Medicare Claims Processing Manual), while others must request an exception if they require more therapy than the cap allows, up to a maximum of 15 treatment days. The article covers in detail the requirement and steps for granting exceptions. If an exception is not granted, however, the beneficiary will be liable for any services above the cap. The exception process ends on Dec. 31, 2006.
