Members in the News
McKnight's Staff, 8/8/2012
Officials from the Center for Medicare & Medicaid Services on Tuesday
clarified how the Middle Class Tax Relief and Job Creation Act of 2012 will
affect the therapy cap exceptions process.
Class Tax Relief and Job Creation Act of 2012 allows providers to continue
to receive payment from Medicare Part B for services above the therapy cap
amount of $3,700. The law, however, requires providers to submit exceptions
requests to a Medicare Administrative Contractor by one of three phased-in
deadlines this fall, said George Mills, the director of the Provider Compliance
Group within the Centers for Medicare and Medicaid Services. Mills explained the
provider process for exception requests in a Skilled Nursing Facility Open Door
Providers will be told when their deadline is, but Phase 1 will have an Oct.
1 deadline. Mills said that providers can start submitting exceptions process
requests in mid-September.
Requests for exceptions can be made in 20-day increments, and MACs have 10
days to conduct a review and make a decision. If a provider doesn't hear back
from their MAC in that time, the request is automatically approved. If a claim
is denied, the MAC must explain why and give providers a chance to resubmit.
“I feel like CMS is trying hard to make this work for all parties,” Cynthia
Morton, executive vice president for the National Association for the Support of
Long-Term Care told McKnight's. “But we have to remember that the
patients needing over $3,700-worth of therapy are often the sickest and frailest
patients. Having to wait for approval can be a setback for their recovery.”
here for a CMS therapy cap exception process fact sheet. Providers can email
CMS with therapy cap exception process questions at email@example.com. To
access a podcast of the Open Door Forum and a transcript, click here.