Medicare Compliance & Reimbursement

Eleventh-hour decision delays dreaded reimbursement cap-but will the delay be long enough?

Rehab providers got another reprieve on a much maligned reimbursement policy June 30, but it looks like they'll have to rely on Congress or the courts to give them permanent relief.

In a July 3 program memorandum (AB-03-097), the Centers for Medicare & Medicaid Services advised fiscal intermediaries and carriers that the implementation of the $1,590 cap on outpatient therapy services is postponed from July 1 to Sept. 1. The move was sparked by a lawsuit filed by the American Parkinson Disease Association, Easter Seals and the Medicare Rights Center, all of whom oppose the cap.

Rehab providers are now looking to Congress to pass legislation eliminating the cap, which could take a big toll on rehab providers, nursing homes and other health care organizations.

Lesson Learned: Even if the cap does go into effect, providers can still bill for the full $1,590 amount between Sept. 1 and Dec. 31 - it won't be prorated or retroactively applied.

To see the program memorandum, go to http://cms.hhs.gov/manuals/pm_trans/AB03097.pdf.