Bill Myers, Provider Long Term and Post-Acute Care, 12/9/2013
Long term and post-acute care advocates are taking aim at what they say is the dangerously slow pace of Medicare’s therapy reviews.
In a survey released Tuesday, the National Association for the Support of Long Term Care (NASL) said that at least one-third of claims subjected to the Manual Medicare Review (MMR) process since the beginning of the year are still somewhere in the ether. And even those claims that have been processed have rarely been done so within the 10 days required by Congress.
“Clearly claims are not reviewed in a timely manner. The MMR process as it is today is very troubling for providers—typically therapists—and patients and it has a disproportionate impact on beneficiaries in skilled nursing centers,” says Cynthia Morton, executive vice president of the association. “Excessive delays in medical review processing will eventually cause a very real access to therapy problem.”
Nearly three quarters of physical and speech therapy claims come from nursing home residents. More than four-fifths of occupational therapy claims come from nursing home residents.
Congress has allowed federal officials to review claims above $3,700 but requires the reviews to be completed “timely.”
Advocates say Tuesday’s survey demonstrates that “the system is not working.”
“There are serious systemic flaws in the current MMR process that need to be fixed to assure that beneficiaries with complex health issues will continue to receive necessary therapy services, and that providers are paid in a timely manner for such services,” says Greg Crist, spokesman for the American Health Care Association.
NASL, AHCA, and other advocates are teaming up to lobby Congress to tighten up the 10-day deadline, to simply standardize and automate the review process, and to require federal auditors to review the review process for other flaws.
Crist says the recommendations are “common-sense” and Congress should act on them immediately.
“The bottom line is that Congress must insist on timely MMR review as patients exceeding the exceptions cap are the most vulnerable Medicare beneficiaries,” Morton says in a news release Tuesday.