CHA News Article

RACs to Review Therapy Claims
OP therapy services webinar offers update on new RAC role

The Centers for Medicare & Medicaid Services (CMS) has announced that, effective April 1, recovery audit contractors (RACs) will conduct prepayment reviews for Part B physical therapy, occupational therapy, and speech/language pathology services above the $3,700 threshold. Manual medical review of all therapy services above this threshold is required by the American Taxpayer Relief Act of 2012. In California, RACs will conduct the mandated reviews on a pre-payment basis.When claims for therapy services exceeding $3,700 are submitted, providers will receive an additional development request from the Medicare administrative contractor (MAC) unless an alternative process has been established. The RAC will conduct the prepayment review within 10 days of receiving the additional documentation and will notify the MAC of the payment decision. CHA will host a webinar March 27 from 10 a.m. – noon (PT) to provide practical advice and direction on how to implement the new regulations, including claims processing and denial management.

Wednesday webinar to cover therapy services documentation, G-codes, and new RAC prepayment review process

Therapy cap expansion, manual medical review and recent CMS-issued regulations for claims-based data collection (G-codes) will require significant process changes for providers of Medicare Part B therapy services, and the new RAC role in the prepayment review process adds more complexity.  CHA will host a webinar March 27 from 10 a.m. – noon (PT) to provide practical advice and direction on how to implement the new regulations, including claims processing and denial management. For more information or to register, visit www.calhospital.org/op-therapy-services-web.

 

 

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