Therapy Cap, ABN, and Multiple Procedure Payment Reduction Policy

Course overview

This course will teach the participants the current status of the therapy cap, therapy cap exception process, and what is occurring with claims that exceed $3,700 in a calendar year. This course will discuss when it is and is not appropriate to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary receiving outpatient therapy services. The course will discuss routine use of the ABN and provide completed examples of the ABN for outpatient therapy services. 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.