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16 Feb 2016 with a system for manual medical reviews for physical therapy and other services that exceed the therapy cap. Last week, CMS announced that it has contracted with Strategic Health Solutions to serve as a supplemental medical review contractor (SMRC) to conduct a "targeted review process" for claims
As you are aware, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enacted in April contained provisions to replace the problematic Part B therapy Manual Medical Review (MMR) process which required 100 percent review of all claims above a $3700 annual per-beneficiary threshold with a targeted
21 Mar 2016. On February 9th, 2016, CMS announced changes to the Manual Medical Review process for therapy claims above the $3,700 threshold. As you will recall, the Manual Medical Review process has gone through several changes since its inception in 2012 as a provision of the Middle Class Tax Relief and Job
Requests for Exceptions to the Therapy Threshold: Manual Medical Review Process. Why is CMS doing this? This process is required by Section 1833(g)(5)(C) of the (d) IMPLEMENTATION.—The Secretary of Health and Human Services shall implement such claims processing edits and issue such guidance as may be.
17 Apr 2013 3. Q. What triggers the manual medical review process? A. Claims at or above $3700 where the beneficiaries therapy services have exceeded the threshold cap for the year will require manual medical review. The trigger of one or both of two separate thresholds initiates this process. The separate caps are:.
24 May 2016 New Targeted Manual Medical Review System: 6 Things You Should Know The much-anticipated changes to the way the Centers for Medicare and Medicaid Services (CMS) conducts its manual medical reviews (MMRs) are under way, with Home health part B claims aren't a part of the review process.
The manual medical review could apply to all Part B outpatient therapy settings, including: Private practice—therapy and/or physician offices. Part B skilled nursing facility care. Home Health agencies (Type of Bill 34X) Outpatient Rehabilitation Facilities. Comprehensive Outpatient Rehabilitation Facilities.
7 Sep 2012 The Middle Class Tax Relief and Job Creation Act of 2012 (H.R. 3630) was signed into law on February 22, 2012. The law extends the Medicare Part B Outpatient Therapy Cap Exceptions Process through December 31, 2012. The statutory Medicare Part B outpatient therapy cap for Occupational Therapy
MACRA extended through December 31, 2017, the exceptions process for therapy caps, set at $1,960 for occupational therapy and $1,960 for physical therapy and speech therapy combined in 2016, and directed CMS to target certain therapy claims over $3,700 for manual medical reviews rather than review every claim

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