Home Health & Hospice Week

What you don't know could cost your Part B therapy business thousands.

The new Medicare reimbursement caps for outpatient therapy could drastically limit the therapy services you provide under Part B--unless you know the ropes.

Congress originally passed the caps, which apply only to outpatient rehabilitation therapy provided under the Part B benefit, in the Balanced Budget Act of 1997. The caps do not apply to therapy furnished under the home care benefit.

But then Congress relented and repeatedly postponed the therapy caps. Finally, the caps took effect Jan. 1.

However, in the Deficit Reduction Act passed in January, Congress allowed for an exceptions process to the two caps. One $1,740 cap applies to combined physical therapy and speech-language pathology services for one patient in one year, while the other applies to occupational therapy services annually.

"The cap is a result of perceived overutilization," believes Cindy Krafft, director of rehabilitation with OSF Home Care in Peoria, IL. OSF delivers Part B therapy services in the home in addition to its home care services. "Slowing down the visits and cost is an intention of making a cap."

The hard part for therapy providers is knowing how much room a patient really has under the cap, Krafft notes. "It is a combined cap," meaning outpatient therapy services from different providers all count toward it.

"We would need to know how much has been used before we get patients [which is] a logistical challenge that our reimbursement staff are trying to hammer out," Krafft tells Eli. Caps Hit Home Care Providers While the caps hit outpatient therapy practices the hardest, home care providers furnishing outpatient therapy in the home that will feel the pinch too. OSF's Part B therapy program "meets the needs of patients that slip between home health and outpatient therapy," Krafft explains.

OSF serves patients who are no longer homebound but need therapy at home because they don't have transportation to a therapist or refuse to drive to a therapist who is too far away, Krafft relates. Part B therapy in the home also works well for patients who need to work on activities of daily living and meal preparation at home.

The American Physical Therapy Association, for which Krafft is vice president of the home health section, has lately received "more questions about how to set up a Part B program," she notes. However, implementation of the caps may "stifle" growth in this area, Krafft predicts.

Utilize Automatic Exceptions The Centers for Medicare & Medicaid Services has now spelled out the detailed exceptions process for the therapy caps, and the automatic option looks to be the most promising tool for home health agencies. The process goes into effect March 13.

To qualify for the automatic exception to either therapy [...]