MDI eNewsletter

Therapy Cap Exceptions to Expire on Monday, June 30th
Under the legislation that created it, the Medicare B Therapy Cap Exceptions Process will expire on Monday, June 30th. Several bills had been on the table to extend it, but Congress failed to pass them before adjourning for their 10-day Independence Day recess. Therefore, Therapy Cap Exceptions will indeed expire next Monday. For details, please visit the CMS website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0815.pdf.

This means that Med B claims billed with the KX modifier for services performed after June 30th in excess of therapy limits will be rejected.

In order to ensure proper billing, RNet users will need to turn off the automatic KX modifier capabilities. It is important that this be completed before any therapy minutes are entered for services performed after June 30th.

Run the Medicare B Y-T-D Charges report for your location/all locations for listing of all residents.
For each resident listed, determine if an "exception" has been selected by checking:
a. Facility Admission, Payor Source screen - Automatic exception - if automatic is selected, right mouse click to deselect.
b. Evaluation - each discipline - Basic Information screen under Treatment Diagnosis codes, if either "exception" option is indicated as "Yes", click on the Yes to change to "No".
Under Administration, Access Control Screen - run the Access Control Information - All Users; this will indicate all Users in RNet that have Med B Cap Unlock access.
Go into the Access Control screen for each User listed with Med B Unlock access and deselect the Med B Cap Unlock.

Once these steps have been completed, if a User attempts to enter treatment minutes that exceed the Medicare B Therapy Cap they will receive a STOP message in the PAL.

As always, if you have any questions, please call our Client Support hotline at 800-552-9846.

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