On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This law extends several expiring provisions including Section 103-Extension of Therapy Cap Exceptions Process. The new law extends the exceptions process for outpatient therapy caps through March 31, 2015. Providers of outpatient therapy services are required to continue to submit the KX modifier on their therapy claims, when an exception to the cap is requested for medically necessary services.
The new law also extends the mandate that Medicare perform Manual Medical Review of therapy services furnished January 1, 2014 through March 31, 2015 for claims over the threshold amount of $3,700 for therapy services; however at this time, the Recovery Audit Contractors have placed a "Pause" on the Manual Medical Reviews until new contracts are awarded. Once the new contracts are awarded, claims over the threshold will be subject to post pay review.
Other extension include the following:
- Section 101-Physician Payment Update- The new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014. This new law maintains the 0.5 percent update for such services that applied from January 1, 2014 through March 31, 2014 for the period April 1, 2014 through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015.
- Section 102 - Extension of Work GPCI Floor
- Section 104 - Extension of Ambulance Add-On Payments
- Section 105 - Extension of Increased Inpatient Hospital Payment Adjustment for Certain Low-Volume Hospitals