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Medicare Part B Outpatient Therapy Caps: Effective October 1st, 2012 ^

Posted on 09/18/2012 6:13:58 AM PDT by NoobRep

The statutory Medicare Part B outpatient therapy cap for Occupational Therapy (OT) is $1,880 for 2012, and the combined cap for Physical Therapy (PT) and Speech-Language Pathology Services (SLP) is also $1,880 for 2012. This is an annual per beneficiary therapy cap amount determined for each calendar year. Medicare allowable charges, which includes both Medicare payments to providers and beneficiary coinsurance, are counted toward the therapy cap. In outpatient settings, Medicare will pay for 80 percent of allowable charges and the beneficiary is responsible for the remaining 20 percent of the amount.

The therapy cap applies to all Part B outpatient therapy settings and providers including: » private practices, » skilled nursing facilities, » home health agencies, » outpatient rehabilitation facilities, and » comprehensive outpatient rehabilitation facilities.

Beginning this year, the therapy cap will also apply to therapy services furnished in hospital outpatient departments until December 31, 2012. Before 2012, therapy provided in hospital outpatient departments did not count towards the therapy cap.

TOPICS: Government; News/Current Events; Politics/Elections; Your Opinion/Questions
KEYWORDS: medicare; obamacare
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This doesn't technically appear to be tied to Obamacare. It's part of the Middle Class Tax Relief and Job Creation Act of 2012, which Obama signed in Feburary. Reason I bring this up is my mom works in a Physical Therapy Rehab center and she said they are meeting to go through the new requirements. It looks to me like Part B caps for outpatient therapy have always been exempted but as of October 1st, the caps go in to place at $1880 per year. Know how much a single visit involving speech therapy and rehab costs? In the neighborhood of $650. Now there won't be any part B reimbursements above that anymore. Maybe someone else can elaborate?
1 posted on 09/18/2012 6:14:06 AM PDT by NoobRep
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To: NoobRep
"You gotta pass it to know what's in it..."

But, what they don't tell you is "watch the other hand"!

2 posted on 09/18/2012 6:17:05 AM PDT by WVKayaker (I'm more than happy to be Obama's "enemy of the week" - Sarah Palin)
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To: NoobRep

I can elaborate.

Like any of the other names Obama chooses for his mandates, the irony in “Middle Class Tax Relief and Jobs Creation Act” is so thick you can cut it with a chainsaw.

3 posted on 09/18/2012 6:21:11 AM PDT by snowrip (Liberal? You are a socialist idiot with no rational argument.)
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To: NoobRep

The government is broke and the people can’t afford to pay more. Every spending cut is going to gore someone’s ox. It really doesn’t matter though, because once we roll off the fiscal cliff and hit bottom, all benefits will be cut.

4 posted on 09/18/2012 6:27:12 AM PDT by Bryanw92 (Sic semper tyrannis)
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To: snowrip

Most of the clientele for where my mom works relies on their Medicare to cover these expenses. Luckily she’s near retirement because IMO they will simply go out of business.

5 posted on 09/18/2012 6:31:06 AM PDT by NoobRep
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To: NoobRep

There have been caps for Medicare Part B OP therapy for a long time though the amounts have changed and PT, OT and SP have not been exempt.
What a facility will charge for an OP visit may be $650 but what is allowable and reimbursed under Medicare is significantly less.

The total reimbursed amount will vary depending on the CPT-4 coding that the therapist use.

6 posted on 09/18/2012 6:40:45 AM PDT by ebersole
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To: Bryanw92

There are new rules and regulations in healthcare that come out every fiscal year. I’ve worked in rehab management for over 20 years and we go through billing and coding changes every September CMS releases their new coding and diagnosis
guidelines and how billings can be coded etc. Every department in the hospital who charges patients has to go
through this process. Some years suck because of the changes, and others are not so bad.
And just a fun little fact, the reason that PT and ST are lumped together is that when they originally came out with the ruling for the caps (years ago),
that when CMS was typing up the ruling, they forgot the comma and would not make a correction to separate the two
There is a lot we can hang on Obama’s head, but this is not one of them

7 posted on 09/18/2012 6:45:33 AM PDT by ebersole
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To: NoobRep

If Bush did this the DU would have melted down...

8 posted on 09/18/2012 6:46:44 AM PDT by GeronL (The Right to Life came before the Right to Pursue Happiness)
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To: ebersole

That is not what the gov site says. It says with Balanced Budget Act of 1997, caps for other services were added but not for Outpatient centers.

9 posted on 09/18/2012 6:47:00 AM PDT by NoobRep
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To: ebersole

I know there are new regulations every year. My wife is a coding specialist.

But, the elephant in the room is this: our government-paid health care is based on a prosperity model where we can afford to pay for whatever people want (OT for a retired person???). When the economy could support it, this was acceptable; but now we can’t afford it. We simply do not have the money.

As I said, its too hard to make cuts because someone’s ox will always be gored, so lets just keep going until the whole system crashes then we can do 100% cuts across the board.

10 posted on 09/18/2012 6:57:47 AM PDT by Bryanw92 (Sic semper tyrannis)
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To: NoobRep

If a single outpatient visit involving speech therapy and rehab costs $650 that’s criminal. It’s highway robbery and the government (that is, taxpayers) shouldn’t be paying it.

11 posted on 09/18/2012 7:03:58 AM PDT by 9YearLurker
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To: 9YearLurker

Don’t get too worked up over what is billed. The government barely pays for the cost of services. In a number of instances, it doesn’t even do that.

That’s why it’s such a hoot when you hear some government figures saying something like, “Health care providers will simply have to do with less profits.” What profits?

Most hospitals are working on a razor thin margin as it is.

Just ask that political figure who is paying the bills of the illegal alien and the indigent? Say what?????

12 posted on 09/18/2012 7:09:25 AM PDT by DoughtyOne (Imagine how bad these global protests would be, if Obama hadn't won us so many new friends.)
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To: NoobRep

Gotta replace those three year old executive chairs in the administration wing....

13 posted on 09/18/2012 7:34:07 AM PDT by ArmstedFragg (hoaxy dopey changey)
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To: Bryanw92

That’s a correct assumption if the OT was working at an Workman’s Comp/Occupational Health clinic or as an workplace ergonomics specialist.
If the retired person were to have a stroke or a major orthopaedic event, they’d want an OT to help them with relearn
or learn compensatory strategies for their ADLs (activities of daily living) such as dressing, showering, eating, toileting etc. It’s tough for anyone to learn to live with only one side of their body working properly, it’s even harder for the geriatric population.

14 posted on 09/18/2012 7:45:31 AM PDT by ebersole
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To: NoobRep

The only area of Part B which these caps do not apply is in the facilities that are classified as Critical Access which are found in rural areas.

15 posted on 09/18/2012 8:14:09 AM PDT by ebersole
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To: DoughtyOne

There are many services provided that the government payors don’t come close to covering the actual cost of providing care.
I love when people think hospitals (profit or not for profit) are making money hand over fist. The largest realized profit margin I’ve ever seen in the organizations I’ve worked for was 5.1%

Tens of millions of dollars each and every year are written off as bad debt due to illegals, and this is per hospital in a 5 hospital system in Denver.

16 posted on 09/18/2012 8:21:12 AM PDT by ebersole
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To: ebersole

I was in PT and OT after kneee surgery. It was ridiculous. After the first session, I had learned everything I needed. After that, it was just a $40 co-pay three times a week so I could go do my own exercises in their facility with a “range of motion” check every few sessions. They wanted me to do it for 6-8 weeks (which coincided with my limits of benefits by a strange coincidence.)

Following a neck injury, it was the same thing, different clinic.

If you have a stroke and lose half your body, I think its a worthwhile expenditure from the people’s treasury. But, most of the people I saw at the PT/OT clinic were healthy enough to do stretches at home without expensive supervision. We have to stop this “one size fits all” approach to benefits. The needs of the stroke victim do not justify $10,000 worth of PT/OT for a knee surgery.

But, by all means. Let’s keep the spending going. It will end eventually one way or the other, but if we run out of money, then your stroke victim will not get any help because we spent all the money on the 30 year old Medicaid recipient who weighs 400 pounds and had her knees collapse and is now on SSI getting treatment for everything under the sun.

17 posted on 09/18/2012 8:23:53 AM PDT by Bryanw92 (Sic semper tyrannis)
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To: NoobRep
It's part of the Middle Class Tax Relief and Job Creation Act of 2012

Who comes up with these names?

18 posted on 09/18/2012 8:26:04 AM PDT by Jim Noble (Diseases desperate grown are by desperate appliance relieved or not at all.)
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To: Bryanw92

That’s great you were able to do your HEP and obtain the benefits you needed and your therapist should’ve discharged you when you demonstrated independence, and not when you benefit limits were reached.

You are the rare bird that actual listened and did what was asked of you. Not every clinic or every therapist is ethical, and that is one of the major reasons why the cap
for medicare was put in place.

19 posted on 09/18/2012 8:34:46 AM PDT by ebersole
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To: Jim Noble
The more benevolent sounding the name of a piece of legislation - the more onerous it usually is.

Who could be against patriotism? I call ‘the Patriot Act’ the “Patriotism is the last refuge of a scoundrel Act”.

The ‘Affordable Care and Patient Protection Act’ is obviously the “Death-panel Act”.

The ‘Middle Class tax Relief and Job Creation Act’ is now dubbed the “Target tax breaks for favored constituents and crony capitalism Act”.

I swear to God that someday we shall see the “Motherhood and Apple Pie for America Act” or some such overinflated verbal garbage meant to obscure and distract.

20 posted on 09/18/2012 8:43:29 AM PDT by allmendream (Tea Party did not send GOP to D.C. to negotiate the terms of our surrender to socialism)
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