This week, we have been notified that phase 2 and phase 3 providers are receiving ADRs for October claims for resident’s who were at or over the $3,700 threshold.  Phase 1 providers who have pre-approval are receiving ADRs as well.


So, we are approaching December 1st.  Do you see light at the end of the tunnel for the Manual Medical Review?  Well, if you were in phase 1, you have been working diligently to obtain pre-approval of therapy visits for


Phase 2 providers are approaching their debut for submitting their pre-approval requests for part B therapy residents who have met or will meet the $3700 threshold for OT and $3700 threshold for PT/ST.  You may have already submitted your pre-approval

What’s In Store for Quarter Four?

The manual medical review of therapy claims is well on its way for phase 1 providers.  I am going to take a break from the Manual Medical Review this week and talk about our focus for the fourth quarter—coding and

Are You Surviving?

Are you surviving the manual medical review process?  Are you preparing for your phase-in date by working on the process in your facility? I just had a challenging last two weeks rolling out trainings company-wide discussing all of the MAC/FI

Threshold Pre-Approval Processes Posted!

MAC/FI Links Below for the Manual Medical Review process. Functional Pathways’ training will begin the week of September 10th. Palmetto: Palmetto Outpatient Therapy Caps and Threshold Process CGS: CGS Therapy Cap Exception Cahaba:   Cahaba GBA Manual Medical Review Process of

To Post or Not to Post—-Will They Post?

Well, if you are anything like me, you are anxiously awaiting the famous Medicare Manual Review of Therapy Services process from your MAC/FI.  When are they going to post on their website on how to request approval for therapy treatment days


Phase information is now available!! CMS has developed a tool which will allow providers to search by their NPI (National Provider Number) to determinae their phase. Providers can now identify which Phase they are in for rollout of the manual medical review


Latest news regarding Medicare Part B Outpatient Therapy Cap and Exceptions Process:  CMS held a conference on Tuesday August 7th to announce the “manual review process” for Part B therapy claims above the $3700 threshold.  The $3700 threshold for PT and

Who Is Looking Out for You

Have you asked this question?   Well, who is looking out for you?  As a national provider of therapy services in Skilled Nursing Facilities and in CCRCs, we know who is watching! CERTS, MACS, RACS, and ZPICS are penetrating more and

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