New CMS Rules on Manual Medical Reviews in Outpatient Therapy

The Centers for Medicare & Medicaid Services (CMS) has published new information on manual medical review (MMR) processes for outpatient therapy services over the $3,700 threshold ($3,700 for occupational therapy and $3,700 for physical therapy and speech-language pathology, combined). See: CMS Therapy Cap Web page. Medicare Administrative Contractors (MACs) will continue to conduct prepayment review of claims above $3,700 until March 31 (with the agency “requesting” that MACs complete reviews within 10 business days). On April 1, Recovery Audit Contractors (RACs) will take over the process, conducting a prepayment review demonstration for Florida, California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina and Missouri and postpayment review in all other states. Neither the MACs nor the RACs are precluded from reviewing therapy services below the $3,700 threshold.

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