In an Open Door Forum Wednesday, September 26, the Centers for Medicare and Medicaid Services (CMS) announced that they would not have the necessary data downloaded into the patient eligibility files on October 1, as indicated in previous public communications.
Instead, officials stated, it will take approximately a week to update the patient history and download the therapy dollars that have been reimbursed through September 30. CMS also reminded participants that the "true picture" is only as good as the claims that have been submitted, acknowledging that the total therapy dollar amount is a moving target based on claims submission and reimbursement. Once the system changes are completed, providers will be able to access the total amount of dollars reimbursed on therapy, per beneficiary, to all Part B outpatient facilities, including hospital outpatient departments. The total includes the amount reimbursed by Medicare and deductibles or co-insurance paid by the beneficiary.
Providers are encouraged to seek additional information from the Medicare Administrative Contractors (MACs) where they submit claims. ASHA has created MAC Resources for Therapy Claims for members, including the MAC links to their provider eligibility systems and pages on the therapy cap pre-approval process.
For more information, please contact ASHA's health care economics and advocacy team at [email protected].