The Centers for Medicare and Medicaid Services (CMS) has released the provider lists for Phase 1 and Phase 2 of the mandated manual medical review process for Medicare Part B therapy services that is being implemented for claims that exceed a $3,700 threshold. According to CMS officials, letters will be sent to providers next week informing them of the Phase assignment. The manual medical review process was mandated by the Middle Class Tax Relief and Job Creation Act of 2012 and includes the total allowed charges per beneficiary for speech-language pathology and physical therapy services furnished under Medicare Part B.
The Phases identify when providers will be responsible for requesting pre-approval for services above $3,700. (Under the process, claims not pre-approved will be stopped and a pre-payment medical review process will apply.) Providers in Phase 1 and Phase 2 are listed on the website and will receive a letter mailed to the address enrolled with the NPI number. The Phases are:
- Phase I: Oct. 1, 2012–Dec. 31, 2012
- Phase II: Nov. 1, 2012–Dec. 31, 2012
- Phase III: Dec. 1, 2012–Dec. 31, 2012
In addition to the list, CMS has included resources for the manual medical review in the "Download" section of the Therapy Cap page and will host an Open Door Forum in September.
For a comprehensive list of resources and information regarding manual medical review, visit the new ASHA webpage, Manual Medical Review Process for Therapy Claims. As CMS updates its website and offers more information, ASHA will post the information on this webpage. Members are encouraged to view online content for CMS (see links on the ASHA page) and its local Medicare Administrative Contractors, who will be providing direct support throughout the process.
For more information, please contact Lisa Satterfield, ASHA's director of health care regulatory advocacy, at [email protected].