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157Re: [physical_therapists_in_business] Question on Medicare therapy cap

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  • Evelyn Capdevila
    Jun 11, 2003
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      Well, I've been reading the Medicare part B Bulletin and they have stated that the cap is for DOS from July 1st and on.  The cap has been slightly raised to $1590.  From here they take the $100 deductible (if the patient has not already met it) and then they pay you 80%.  Example:  $1590-100=1490 x 80%= $1192 (amount reimbursed).  If they have already met their deductible then you would get reimbursed $1272. 
      It is not clear how they would divide the benefits for DOS before and after the cap.  However, you can probably get more info from CMS website at http://www.cms.hhs.gov/medlearn.refabn.asp.   There is a Program Memo Transmittal number is AB-03-057, that might explain this. 
      Good news is that the APTA has met w/ CMS to try to postpone the cap.  No word yet.
      Hope some of this helps

      Sujoy Basu <basu69@...> wrote:
      Dear all,

      I have a question reg. those medicare patients that are being
      evaluated in free standing outpatient clinics as of this time, say,
      June, 03. Will the cap on services be applicable from the July date
      onwards or will it be retro-active back to the June start date.

      Also, If treatment is to be continued into July, 03, what is the
      best procedure to handle such patients? Should we discharge, then re-
      evaluate the patient in July or should we just continue to treat
      them per initial plan?

      Any thoughts to help my understanding on this matter is appreciated
      in advance.

      Thanks much,

      Sujoy Basu PT

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      Evelyn Capdevila MPT, CWS

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