Home Health & Hospice Week

If you furnish Part B outpatient therapy in the home, there’s no longer a way to avoid prepayment review of therapy claims that exceed the threshold. “Therapy cap claims no longer require prior authorization,” HHH Medicare Administrative Contractor Palmetto GBA explains on its website. “Once a claim is received that has outpatient therapy services that exceed the $3,700 threshold, the claim will suspend and the provider will receive an additional development request (ADR).”

In response to the ADRs, HHH MAC CGS wants to see a range of documentation including measurable goals, it says on its website. “Objectives and goals should also include an estimation of reasonable time frame in which the patient could be expected to achieve the stated goals,” CGS adds.