Congress Passes New Medicare Laws
Our politicians managed to prevent an extended government shutdown. Yeah!…? Of course, that also means that they passed some new laws that affect healthcare, especially Medicare. If you are on Medicare or know someone on Medicare keep reading. If not, pass this on to someone who looks like they might be on Medicare. You’ll know who they are by their years of wisdom and experience! For 20 years Congress passed temporary fixes to Medicare regarding Physical therapy. (17 times if you’re counting.) They have finally eliminated a “hard cap” on physical therapy that limited the total dollars Medicare would spend for PT every year. So now we have no limitations on how much care a Medicare patient can receive! Not so fast…Let’s take a look at exactly what really passed into law. As it now stands, there is no maximum dollar amount Medicare will pay per year. However, any treatment beyond $2010 requires proof of medical necessity. That’s the easy part. What they did next was lower the threshold to $3000 (from $3700) when a “Targeted Medical Review” may be triggered.
Once we hit $3000, Medicare can randomly trigger a review to determine if your care still qualifies as medically necessary. Of course, they contract these reviews out to a third party and the requests have a history of being more interested in saving money than helping the patient. So, What Does This Really Mean? Keep Reading… We may not have a hard cap, but going beyond $3000 per year requires more work and more risk of potential denials. Since this used to be $3700, it’s hard to call this a victory for the average Medicare patient. Who it does benefit are those individuals with significant health concerns who really do need physical therapy above and beyond the “average” Medicare patient. Oh…did I mention how this affects Medicare and how they bill your secondary insurance, if you have one? Typically, Medicare has billed secondary insurances under a “coordination of benefits” set of rules. With no hard cap, we really have no idea what changes will occur with secondary insurance benefits. Wow. That was a lot of information! Call your local clinic today if you have any questions!
Confused? You’re not alone. Here is my take on this change.
The first $2010 dollars is covered with no extra requirements. The next $990 dollars requires us to add a special code to our billing that tells Medicare your treatment is still medically necessary.
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