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Question on Medicare therapy cap

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  • Sujoy Basu
    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
    Message 1 of 5 , Jun 5, 2003
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      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
    • Daniel Seidler
      Great questions. I d like to know the answers as well. DS ... From: Sujoy Basu To: physical_therapists_in_business@yahoogroups.com Sent: Thursday, June 05,
      Message 2 of 5 , Jun 11, 2003
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        Great questions.
        I'd like to know the answers as well.
         
        DS
        ----- Original Message -----
        Sent: Thursday, June 05, 2003 2:52 PM
        Subject: [physical_therapists_in_business] Question on Medicare therapy cap

        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
        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
        Message 3 of 5 , 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




          To Post a message, send it to:   physical_therapists_in_business@...
          To Unsubscribe, send a blank message to: physical_therapists_in_business-unsubscribe@...


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          Evelyn Capdevila MPT, CWS


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        • Puja Charaipotra
          I would definitely be interested in what advice/info anyone has on this as well. ... __________________________________ Do you Yahoo!? Yahoo! Calendar - Free
          Message 4 of 5 , Jun 11, 2003
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            I would definitely be interested in what advice/info
            anyone has on this as well.

            --- 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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          • kenmarx
            Answers: 1. Patients that are currently on caseload will begein their therapy cap on July 1st. You need to track the amount of money used starting July 1st
            Message 5 of 5 , Jun 12, 2003
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              Answers:
              1. Patients that are currently on caseload will begein
              their therapy cap on July 1st. You need to track the
              amount of money used starting July 1st only.

              2. If the patients that are currently on caseload
              continues to July 1st, you have 2 options, you can
              either d/c them on June 30th and do a Eval/Re-eval on
              July 1st, or you can just continue treatments without
              doing a d/c or an eval/re-eval of the patients, but on
              both option you need to track the amount of money
              used.

              Hope this helps.







              --- Daniel Seidler <wspt4@...> wrote:
              > Great questions.
              > I'd like to know the answers as well.
              >
              > DS
              > ----- Original Message -----
              > From: Sujoy Basu
              > To:
              > physical_therapists_in_business@yahoogroups.com
              > Sent: Thursday, June 05, 2003 2:52 PM
              > Subject: [physical_therapists_in_business]
              > Question on Medicare therapy cap
              >
              >
              > 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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              >
              > To Post a message, send it to:
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              > To Unsubscribe, send a blank message to:
              >
              physical_therapists_in_business-unsubscribe@...
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              >
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              > Terms of Service.
              >
              >


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