CHA News Article

Therapy Claims Processing Delayed

The Centers for Medicare & Medicaid Services (CMS) has announced it will delay processing of current claims for physical, speech and occupational therapy for a limited period. The delay, which took effect Jan. 1, is the result of the expiration of several Medicare legislative provisions at the end of 2017, including the exceptions process for outpatient therapy caps. CMS further notes that if legislation on therapy caps is not enacted “in this short period of time,” it will proceed to release the claims for processing. 

The current outpatient therapy cap is $2,010 per year for physical therapy and speech/language pathology combined, and $2,010 per year for occupational therapy. Absent the exceptions process, beneficiaries whose therapy exceeds these caps will be responsible for payment. 

When the caps were implemented in the Balanced Budget Act of 1997, most hospital outpatient departments (HOPDs) were excluded. Subsequent legislation established the exceptions process and expanded the caps to include HOPDs. If Congress does not act to extend current law, most HOPDs will be exempt from the caps. However, legislation on this issue has been introduced in Congress and may result in re-establishing the caps for 2018. CHA will monitor this issue closely and share information with members as soon as it is available.