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tci Medicare Compliance & Reimbursement - 2006 Issue 4
OUTPATIENT THERAPY: Vague Claims Data Poses Challenge To Therapy Trends And Coverage Assumptions
Therapy cap controversy renews focus on coverage and spending growthNotable growth in outpatient therapy spending has led providers and physician groups to question just who and what Medicare covers, as well as the positive effects that coverage has stimulated.The Medicare Payment Advisory Commission defines outpatient therapy as the collective term for physical therapy, occupational therapy and speech-language pathology services in a recent 'Medicare Basics' report. Medicare covers 80 percent of all Part B outpatient therapy services, and beneficiaries are responsible for the remainder. To receive coverage, patients must obtain a physician's referral and receive follow-up evaluations.Medicare covers...
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