Medicare Therapy Caps
Started by GreyhoundPT
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
It's huge. It amounts to us seeing medicare pts approximately 12-15 visits/year no matter the injury/diagnosis/surgery. So it does a disservice to patient care and recovery. With the lack of visits, that means a lack of reimbursement revenue. As the medicare population is the majority of most outpatient facilities, this is a huge blow. If it continues to hold up, it may affect our salaries as PTs.
It sucks. We have patients who have already maxed out their 1860 cap.
But Congress is supposed to reinstate the exceptions list soon (hopefully). I'm not going to worry about it just yet. It's happened in the past where there was a cap with no list of exceptions, and then they added the list and all was right with the world again.
Although if they don't add the exceptions list at all, then that'll be bad because other insurance companies tend to follow Medicare's footsteps.
But Congress is supposed to reinstate the exceptions list soon (hopefully). I'm not going to worry about it just yet. It's happened in the past where there was a cap with no list of exceptions, and then they added the list and all was right with the world again.
Although if they don't add the exceptions list at all, then that'll be bad because other insurance companies tend to follow Medicare's footsteps.
Advertisement - Members don't see this ad
...and yes, other insurance companies follow medicare trends. bad bad bad.
Legislation is continually proposed but republicans usually block everything.
Funny since I just saw a CSM post showing that functional capacity was a much better predictor of decreased hospital readmissions compared to multiple comorbidities
Last edited:
The cap will never be lifted, too much fraud going on.
I don't think its the Republicans blocking things, I think that they just don't get to it because it is a very very small piece of the budget pie. To us its a big deal, to them it is a rounding error.
It failed in 2015 for repeal by two votes. It's up now this year for another run. The spread was 58 to 42 and it needed 2 more for sixty. If you look at the vote spread it was split down the middle with republicans voting no repeal and demos voting repeal with a few outliers. They definitely got to it. They just didn't repeal it.
How's it looking now?
Republicans are running the show. Probably not looking so hot based on that alone.
Predicting repeal of ACA and maintenance of the cap. Outcome data would have to be shown that extra funding from Medicare would reduce readmission rates and thus save the system money by keeping patients independent and healthy overall. On the flip side, if there happens to be heavy fear of fraud then it wouldn't be lifted.
Prediction is hard since therapy services aren't usually life and death but they do increase independence. This is going to need heavy tracking and analytics over a period of years to do anything with politicians.
While at CSM, the first outcomes registry was proposed. That would be a step in the right direction
....on the other other flip side.......republicans barely know what it is and probably won't really do anything to repeal it anyway. I don't believe that any other special interest groups would be against it though since this is strictly within the rehab field and doesn't increase scope but rather rewards work as long as practice is ethical, efficient, and outcome driven
Last edited:
