Medicare Ruling
Vital Stim
Tobacco-Free on Sept. 1, 2006
Mid-Missouri Stroke Support Group
Brain Injury Support Group
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Effective January 1, 2006, Medicare implemented a $1,740 outpatient
therapy limit for beneficiaries receiving physical therapy, speech
therapy or occupational therapy. The cap includes the Medicare payment
and patient co-pay. This means that patients are limited in the amount
of therapy services that will be reimbursed by Medicare over the course
of a year. Physical therapy and speech therapy are included under one
$1,740 cap and occupational therapy will have its own $1,740 cap. If a
patient requires both physical and speech therapy, either simultaneously
or separately, during the course of the year, he/she will very quickly
reach the therapy maximum. The cap does not distinguish by diagnosis or
by episode of care. Therefore, if a patient has an injury or illness that
requires treatment early in the year and this patient exhausts the therapy
benefit, they will have no remaining benefits for further therapy,
regardless of the reason, for the remainder of the year. Additionally, a
patient who is in mid-course of therapy and reaches the cap will have a
painful decision to make – whether to continue with therapy and pay out of
pocket, or discontinue a needed service. Current legislation includes a
clause that allows patients to apply to the Centers for Medicare &
Medicaid Services (CMS) for additional therapy services if their treatment
is expected to exceed the $1,740 cap for 2006, however CMS has yet to
provide details about how the exceptions process will work.
The therapy cap applies in all outpatient therapy settings with the exception
of hospital-based outpatient departments. Rusk Rehabilitation Center
is fortunate to have rehabilitation facilities
that meet the designation of hospital-based outpatient therapy departments.
With the designation of hospital-based outpatient departments, our patients'
treatments do not apply against the cap, and patients who have exhausted their
cap at other providers can receive medically necessary services from Rusk.
Marilyn Earley
Director of Clinical Services
573-817-2703 |
