GRS Regulatory Update: 

Expired Medicare Legislative Provision


Issued January 17, 2018; Revised January 22, 2018

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Background

Congressional activity continues to work toward legislation that provides a full repeal of the Therapy Cap or the resumption of the Therapy Cap Exception Process.  In the meantime, CMS has posted the below communication to fee-for-service providers.

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CMS Communication

The following was posted to the “All Fee-For Service Providers.”  This CMS Spotlight is available on the CMS.gov site accessible via https://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Center.html


"CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing.  Several Medicare legislative provisions affecting providers and beneficiaries recently expired, including exceptions to the outpatient therapy caps, the Medicare physician work geographic adjustment floor, add-on payments for ambulance services and home health rural services, payments for low volume hospitals, and payments for Medicare dependent hospitals.  CMS is implementing these payment policies as required under current law.

"However, CMS is taking steps to limit the impact on Medicare beneficiaries by holding claims affected by the therapy caps exceptions process expiration for a short period of time beginning on January 1, 2018. [CMS text – revised 1/19/18] - Only therapy claims containing the KX modifier are being held; claims submitted with the KX modifier indicate that the cap has been met but the service meets the exception criteria for payment consideration. Currently if claims are submitted without the KX modifier and the beneficiary has exceeded the cap the claim will be denied.

"CMS is not holding any other claims except those affected by the therapy caps.  If legislation regarding the therapy caps is not enacted in this short period of time, then CMS will release and process the therapy claims accordingly.  Under current law, CMS may not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the date of receipt, but generally pays clean claims within 30 days of receipt."


GRS Action

  • It’s recommended GRS team members continue to Advocate for Action on the Therapy Caps. 
  • GRS will continue to work diligently with industry and professional leaders toward elimination of the Therapy Cap.  This includes regular communications and daily verification of the Congressional agenda and voting activity. 
  • As soon as Congress acts on the Therapy Cap, GRS will promptly inform all employees and business partners.


Questions

If you have questions, please contact the Genesis Rehab Services (GRS)/ Respiratory Health Services (RHS) email inquiry system at GRSASK@genesishcc.com.

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About GRS/RHS Regulatory Administration

The Regulatory Administration department of GRS/RHS closely monitors legislative and regulatory notices, and continues to work with Congress, CMS and industry leaders regarding changes in government regulations that may impact patient care and service delivery.