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Therapy Cap, ABN, and Multiple Procedure Payment Reduction Policy

presented by Rick Gawenda, PT

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Disclosure Statement:

Financial: Rick Gawenda receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Rick Gawend has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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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.

Meet Your Instructor

Rick Gawenda, PT

Rick Gawenda, PT, is founder and President of Gawenda Seminars & Consulting, Inc. He graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Rick is Director of Finance for a physical-therapist-owned private practice with multiple offices located in Southern California. In addition, he was Director of Physical…

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Chapters & Learning Objectives

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1. Therapy Cap and Exception Process

This chapter will teach participants the current status of the annual Part B therapy cap and therapy cap exception process. This chapter will also discuss therapy services that exceed $3,000 in a calendar year for physical and speech therapy combined, and a separate $3,000 for occupational therapy. It will also teach participants the criteria the supplemental medical review contractor will use to select claims that exceed $3,000 for review.

2. ABN for Outpatient Therapy Services

This chapter will teach participants when it is and is not appropriate to issue an ABN to a Medicare beneficiary receiving outpatient therapy services, as well as how to properly complete an ABN and how to bill for services that are provided under a completed ABN. This chapter will also discuss the use of an ABN for services that are statutorily non-covered by the Medicare program such as supplies, fitness and wellness programs, and post-therapy exercise programs.

3. Multiple Procedure Payment Reduction Policy

This chapter will teach participants the MPPR, its impact on payment, and its effect on the annual therapy cap dollar threshold. This chapter will use real-life case scenarios to 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.

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