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Medicare Outpatient Therapy: Implementation of the 2012 Manual Medical Review Process
Kathleen M. King (au)
In 2011, Medicare paid about $5.7 billion to provide outpatient therapy services for 48 million beneficiaries. Rising Medicare spending for outpatient therapy services -- physical therapy, occupational therapy, and speech-language pathology -- has long been of concern. Congress established per person spending limits, or äóģtherapy caps,äó¯ for nonhospital outpatient therapy, which took effect in 1999. In response to concerns that some beneficiaries needing extensive services might be affected adversely, Congress imposed temporary moratoria on the caps several times until 2006, when it required the Centers for Medicare & Medicaid Services (CMS) to implement an exceptions process. CMS was required to conduct manual medical reviews (MMRs) of requests for exceptions for outpatient services provided on or after Oct. 1, 2012, over an annual threshold of $3,700. This report describes (1) CMSäó»s implementation of the 2012 MMR process, and (2) the number of individuals and claims subject to MMRs and the outcomes of these reviews. Figures. This is a print on demand report.
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