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Re: [physical_therapists_in_business] Question on Medicare therapy cap

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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 1 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




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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 2 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 3 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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