Therapy Cap, ABN, and Multiple Procedure Payment Reduction Policy
Presented by Rick Gawenda
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This course will explain the MPPR and its implication on payment for your services and your bottom line profit margin. Case scenarios will be used to show participants how therapists are paid a lower rate once they bill more than one unit of any modality or intervention on the same day. Case scenarios will also teach participants how their payment is reduced when a Medicare beneficiary is seen by two or all three disciplines on the same date of service.
Meet your instructor
Rick Gawenda
Rick Gawenda is founder and president of Gawenda Seminars & Consulting, Inc. He graduated in 1991 with a Bachelor of Science in physical therapy from Wayne State University in Detroit. Rick is director of finance for a physical therapist–owned private practice with multiple offices located in Southern California. In addition,…
Chapters & learning objectives
1. Therapy Cap and Exception Process
This chapter will teach participants the current status of the annual Part B therapy cap and therapy cap exception process. This chapter will also discuss therapy services that exceed $3,000 in a calendar year for physical and speech therapy combined, and a separate $3,000 for occupational therapy. It will also teach participants the criteria the supplemental medical review contractor will use to select claims that exceed $3,000 for review.
2. ABN for Outpatient Therapy Services
This chapter will teach participants when it is and is not appropriate to issue an ABN to a Medicare beneficiary receiving outpatient therapy services, as well as how to properly complete an ABN and how to bill for services that are provided under a completed ABN. This chapter will also discuss the use of an ABN for services that are statutorily non-covered by the Medicare program such as supplies, fitness and wellness programs, and post-therapy exercise programs.
3. Multiple Procedure Payment Reduction Policy
This chapter will teach participants the MPPR, its impact on payment, and its effect on the annual therapy cap dollar threshold. This chapter will use real-life case scenarios to teach participants how their payment is reduced when a Medicare beneficiary is seen by two or all three disciplines on the same date of service.