The Medicare Part B therapy cap exceptions process will expire December 31, 2013. 


Contact your members of Congress ASAP asking them to include a long term fix for the Medicare therapy cap in the Sustainable Growth Rate (SGR) formula reform legislation.  If the SGR legislation doesn’t progress, ask them to at least extend the therapy exceptions process.  In addition, Congress should review CMS’ manual medical review (MMR) process as it is not working and this process is in dire need of change.

Please make your voice heard—it only takes less than one minute to complete the information!  By clicking on the link below from NASL, you can advocate for those folks who pay to have Medicare Part B coverage and deserve an uncapped benefit amount!!!!

Gina Tomcsik

Director of Compliance

Functional Pathways

Comments (2)
  • We deserve an uncapped benefit

    • Thank you Louise for your comment. You are absolutely right! If you pay for the Medicare Part B benefit, then you should be able to receive the therapy services you need. Congressional leaders and CMS need to develop an improved payment system so therapy care that is required is available to those who need it. Most Medicare Part B recipients do not realize that there is a cap on how much can be spent per calendar year for therapy services under the Medicare part B benefit. Therapy providers have to jump through hoops to obtain payment for necessary services. One of many examples is: some states have a pre-payment review by Medicare contractors to review the case BEFORE they pay the therapy provider for services over a certain dollar amount that is rendered; some states are in a post-payment review by Medicare contractors to review the case (again over a certain dollar amount) AFTER they have already paid the provider for the therapy services rendered. If the Medicare Contractor doesn’t feel the services were medically necessary, they will deny payment (pre-payment) or ask for the money back (post-payment). My opinion- Congress isn’t taking care of the American people—our valued folks 65 years of age and older that worked hard all of their lives and are still paying for coverage so they can stay as independent as possible and/or regain function. Congress continues to cut reimbursement in settings who provide the most acuity of care without a second thought. Gina

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