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Hi OT-ADVANTAGE.COM members,

Since the NBCOT exam is a hot topic on this website, a study group was developed.  Please go to 'search profiles' (http://ot-advantage.com/ota/searchprofiles.aspx).  You will see 2 groups, one for the OTR exam and for the OTA exam.  Feel free to add information on study tips, good study materials, blog, add documents, and more.  Consider this your group.  Comment below if you have other ideas on how OT-ADVANTAGE.COM can help prepare you for the BIG exam!

As many Occupational Therapy clinicians worried about their patients needing to pay for costly therapy services, as well as tracking OT charges, the weight has been lifted.  On July 15, 2008, the U.S. House of Representatives and Senate voted to override and pass HR 6331.  Therefore, Occupational Therapy services through December 31, 2009, fall under the 18 month extension of the therapy cap exceptions process. 

For more information on Medicare and Medicaid coverage and the therapy exceptions process, please visit:

www.cms.hhs.gov

Here is more helpful information that may help you with your communication with Occupational Therapy clients, as well as for Occupational Therapy practitioners.

Follow this link to provide a handout for your Occupational Therapy clients: http://www.medicare.gov/Publications/Pubs/pdf/10988.pdf

If you are still trying to make sense of the Medicare Physician Fee ScheduleUpdate for 2008, and how it applies to Occupational Therapy, read below for helpful information.

• The recent 10.6% reduction goes into effect July 1, 2008.  Occupational Therapy clients who received services, and were provided services under the exceptions process, will have that amount counting toward their annual limit ($1810 for Occupational Therapy).  However, CMS does not plan to collect any amount provided from 1/1/2008-6/30-2008 for amounts falling under the exceptions rule.
• Services provided on or after 7/1/2008 will be held by CMS for 10 business days.  After 7/15/2008, if Congress does not pass the necessary legislation, CMS will process the claims.  If Congress passes legislation after 7/15/2008, and CMS has already processed the submitted claims, it may be necessary to resubmit claims.
• No longer use the KX modifier for Occupational Therapy clients who require therapy past their annual limit.
• Occupational Therapists and Occupational Therapy Assistants are in a dilemma.  Some possibilities to work around the current situation may be to educate the client on paying out of pocket, decrease the frequency of treatment or treatment time or delay treatment, or have the client seek care in an outpatient department (e.g., hospital) where the mentioned therapy cap does not apply.  CMS is offering competitive billing through select vendors for certain DME equipment (e.g., wheelchairs, prosthetics), that may benefit the client in the meantime.  Your current employer may be willing to pay for the costs that exceed clients annual limit, until Congress passes the needed legislation.  Please communicate with your rehab manager to find the options available regarding this matter.
• How can you help?  AOTA has a letter on their website that you can complete and submit via their site to the U.S. Congress.  Go to: http://capwiz.com/aota/issues/alert/?alertid=11547586

The above information was obtained from: http://www.cms.hhs.gov/.  Please visit this site for additional information.

As Occupational Therapy practitioners you need to stay informed of changes to Medicare.  Staying abreast of the changes will allow you to better communicate with your client.  As of 6/30/2008, CMS (Centers for Medicare and Medicaid Services) denied a delay on the therapy cap exceptions process.

Please visit: http://www.cms.hhs.gov/physicianfeesched/downloads/cms-1385-FC.pdf for detailed information regarding the therapy cap. 

What does this mean? 

• Your client, if they are at their Medicare cap (Occupational Therapy cap is $1810), may be responsible for paying for services after 6/30/2008. 
• If you have a student, determine if the application of the Medicare Part B policies to Part A settings will effect their supervised treatments.
• If in a hospital or SNF, a plan may need to be established prior to initiation of treatment.  This is specific to the payment policy and CMS will provide further info.
• Originally a re-certification for treatment needed to be certified by a physician each 30 days.  It has now been extended to 90 days.

What should you do in the meantime?  Speak with your rehab manager about action you should take to inform your client of the possibility they may pay out of pocket for Outpatient Occupational Therapy treatments.  You may need to issue your client a form and have them sign it, in order to have documentation that the client is aware of their insurance benefits. 

Please review the applicable sections of the Medicare Physician Fee Schedule Rule Update for 2008, to obtain additional information: http://www.cms.hhs.gov/physicianfeesched/downloads/cms-1385-FC.pdf