Jackson Jambalaya

Medicare imposes a cap on therapy services Monday. The American Physical Therapists Association reports on it website:

"The annual per beneficiary therapy cap amount for 2012 is $1880 for physical therapy and speech language pathology services combined (PT/SLP). There is a separate $1880 amount allotted for occupational therapy services." Website

However, Medicare does not impose the cap until October 1, 2012. Just one slight problem: Its retroactive to the beginning of the year and there is no way for health care providers to check in real-time how much money a patient has spent on therapy under Medicare. There have been caps in the past but what is different this year is it applies to hospitals:

"Effective January 1, 2012, the $1880 therapy cap with an exceptions process, applies to services furnished in the following outpatient therapy settings: physical therapists in private practice, physician offices, skilled nursing facilities (SNF) (Part B), rehabilitation agencies (or ORFs), and comprehensive outpatient rehabilitation facilities (CORFs). In addition, the therapy cap with an exceptions process will apply to hospital outpatient departments no later than October 1, 2012, until the end of 2012."

The change was part of HR 3630, The Middle Class Tax Relief and Job Creation Act of 2012. What will change is prior to 2012, there was no cap on therapy for a patient if he sought therapy at a hospital. Thus if a stroke patient recovered at St. Dominic's, he could keep going to their outpatient clinics for therapy without worrying about a cap. If he had gone to Genesis or a similar clinic that was not part of a hospital, then the cap applied. The hospitals are now placed under the cap until the end of the year. It is not known if Congress will extend the cap on hospitals past this year. The Web PT blog stated:

"For example, a Medicare beneficiary receives therapy in a hospital outpatient department from March 5 through April 11, 2012, and July 20 through August 15, 2012, and uses $2,128 toward the Medicare therapy cap. That same Medicare beneficiary now comes to your private practice for outpatient physical therapy beginning on October 17, 2012. During the intake process, you ask the Medicare patient if they have had therapy at all this year. They answer “yes” and tell you XYZ hospital provided therapy during the aforementioned dates. Because the hospital provided therapy services prior to October 1, 2012, you believe the Medicare patient has not used any of their $1,880 therapy cap. On the contrary, those services ($2,128) will be retroactively applied toward the cap on October 1, 2012. Post

Another problem is that while Congress and Medicare imposed caps in the past, they didn't make them retroactive in nature. One can only imagine the confusion that will begin next week with Medicare patients and health care providers.