In the latest Medicare clampdown on therapy payments, CMS says when your therapy gets denied as a result of hitting the annual payment cap ($3,700), you can’t bill the patient for the denied amount unless you have had the patient sign an advance beneficiary notice of non-coverage (ABN).
As if that weren’t bad enough, Medicare contractors have been transmitting the incorrect remittance advice information on that so far this year,
CMS announced in its weekly email to fee-for-service providers.
It appears the American Taxpayer Relief Act of 2012 (ATRA) changed the rules on payment liability for therapy services as of Jan. 1 this year to shift the burden to practices, not patients. But there’s a good chance your Medicare contractor has not been sending the correct denial code on you remittance advice.
“These denials incorrectly report on RAs beneficiary liability (Group Code ‘PR’) when liability legally rests with the provider (Group Code ‘CO’),” CMS states.
Even though it won’t require your carrier to update these denial codes until Jan. 1, 2014, for professional claims, the rule takes effect now – in fact it’s retroactive to Jan. 1, 2013. That means if you’ve collected any money from beneficiaries for services beyond the annual cap so far this year, you need to refund them, CMS says.
And stop collecting payments for therapy cap denials from now on unless you had the beneficiary sign an ABN prior to performing the service.