How Changes to Medicare Have Affected Therapy in Skilled Nursing Facilities

Part Three:  Med B Cap Extension

It took a few months to work the bugs out of the Medicare Part A changes, but, we’ve done a pretty good job in minimizing its effects.  From 2000 to 2006, there was a moratorium to the caps while Congress and CMS considered alternative ways to pay for therapy services.  The exception process was devised to enable beneficiaries with Medical Necessity for services beyond the cap, to still retain access to services; in the first year,  a Manual and Automatic Exception Process was established, and then the automatic exception became the only mode.  Each year since then, Congress has extended the exception process.  In 2010 the financial limit on the cap was $1860 and has been increased to $1870 for 2011.  Every year since the implementation of Medicare Part B Caps and the Exception Process, we wait to see if the government will come up with a better alternative, or, extend the Cap while further research is conducted. 

Well, there was Good News and Bad News!  The Good News:  The Part B Cap has been extended through December 2011.  The Bad News:  MPPR was implemented on January 1st 2011.  Can things get any worse?

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2 Responses to How Changes to Medicare Have Affected Therapy in Skilled Nursing Facilities

  1. John clark says:

    Medicaid beneficiaries are at greater risk of eviction because Medicaid reimbursement rates are as little as half of what nursing homes make from residents who pay their bills
    out-of-pocket.
    Daybreak Medicare Facilities Pilot Point

  2. Ester Jones says:

    John- I agree that this is a great concern. It appears that you are from Texas. As Medicaid is a “state” program, I am curious how “Casemix” applies to your facilities? In West Virginia, it is extremely important for therapy departments to work together with nursing and the MDS coordinator, to make sure therapy minutes are captured as appropriate. This can lead to increased reimbursement dollars for Medicaid residents for a period of time.

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