skip to Main Content
Written by: Mediware on Friday, February 22, 2013 Posted in:

Late last week Amit M (LinkedIn member), posted that a bill to repeal outpatient therapy caps had been discussed on Valentines Day. Wouldn’t that beat all boxed chocolates and a few dozen roses when it comes to gifts on a beloved gift card holiday? I immediately went to the Government Printing Office and searched for all discussions that occurred in the Congressional Record Index files. Although not immediately apparent, I asked Amit to provide the direct source link if he could and he pointed me to Sen. Cardin’s Web page.  Today, upon looking again through the Congressional Record Index I found several posts that record ‘Introduction of Bills and Joint Resolutions.’

Was it a dream? No, it was fact! Sens. Benjamin L. Cardin (Maryland) and Susan M. Collins (Maine) indeed did introduce a bill to amend title XVIII of the Social Security Act to the Committee on Finance. Just how far might this go?


Could this be a reason CMS is slowly reacting to the fact that we NEED a Manual Medical Review process outlined for 2013?  Is this the reason why a PT in Ohio, who just recently posted to the PTManager list serve, was told that all Medicare payment is being held on Part B’s over the $1,900 cap regardless of modifier or need and that an apparent ‘non-payment’ is being invoked ‘at this time?  Is there hope that even with Sequestration looming ahead of us in just a few short weeks that a total recall of therapy caps can and will occur? Is there hopes that DOPTA may help to alleviate this administrative nightmare? Will it include all therapy caps (all outpatient therapy whether private practice or hospital-based physician fee schedule)? No one knows the answer just yet, but it’s time to begin speaking to your representatives in Congress about the support of the repeal.

Remember though, G-Codes  and outcomes reporting and therapy caps are two entirely different initiatives; don’t get them confused and don’t be lax in preparation for July 1 when mandated outcomes reporting will occur for Medicare part B.

Stay tuned, I am sure more information and discussion on the topic are not far off!

Back to top