Home Health & Hospice Week

Home care providers that are furnishing Part B therapy services in the home should pay attention to some advice CMS is handing out on therapy caps.

If you know a patient has exceeded the therapy cap and the patient still wants you to provide a therapy service, your best bet is to have the patient sign an advance beneficiary notice (ABN) to confirm that he knows he will have financial responsibility for the service.

"We are encouraging providers to supply the voluntary ABN to their patients," a CMS rep said during an April 17 Open Door Forum for health professionals.

Reminder: The therapy caps apply only to outpatient therapy furnished under Part B, to patients who are not homebound or otherwise not eligible for home care services. The caps do not apply to therapy services furnished under a home health plan of care. For 2012, the therapy caps are $1,880 for occupational therapy (OT) services and $1,880 for combined physical therapy (PT) and speech language pathology (SLP).

And don't expect CMS to do your educating for you. When a caller to the April 17 forum asked whether CMS would be informing Medicare beneficiaries of changes to the therapy cap, Streimer said no, noting that providers will have to let patients know the details of the cap.

"It will be up to the therapist to basically work with the beneficiary and advise them of their rights and what the potential is in terms of having their services paid for," said CMS's Stewart Streimer during the call.