The end of 2006 brought some relief to PTs who treat a high number of Medicare patients: President Bush signed into law a bill that included an extension of the Medicare Therapy Cap exceptions process. While this is great news for PTs and Medicare patients, it is merely a quick fix to a much larger problem.

The legislation, passed in December 2006, extends the therapy cap exceptions process through 2007 and replaces the scheduled 5% reduction in the 2007 conversion factor with a freeze at 2006 levels. Medicare beneficiaries are still limited to one combined $1,740 cap (annual, per beneficiary) for physical therapy and speech-language pathology, and a separate $1,740 cap (annual, per beneficiary) for occupational therapy. If a referring physician can demonstrate to his or her Medicare carrier that a beneficiary's continued therapy regimen is medically necessary, the Centers for Medicare & Medicaid Services (CMS) will grant an exception that enables the government to pay for services above the $1,740 caps. Within the first 3 months of 2006, CMS announced that it already had processed roughly 4,000 automatic exceptions and a few hundred manual exceptions.¹

The insufficient amount of reimbursement leads PTs to adopt new practice protocols to maximize treatment and minimize the payment required by Medicare patients. In health care, however, there is no room for therapy providers to make exceptions to the standard rules of patient care; there are no shortcuts to take when the goal is to return patients to optimal mobility. With no other option, PTs are forced to work under the restrictions of the therapy cap for another year. All treatment plans will continue to have to be modified to not only what the patient needs, but also to how applied treatments will affect the facility's bottom line. With these payment limits that are set in place by the CMS, PTs must find a way to maximize reimbursements without curbing patient care. It will be imperative to make sure that your facility's expenditures are cost-efficient.

To help you find and implement the latest products and technology to run your facility and treat your patients more profitably, Physical Therapy Products is honing in on product-focused content in 2007. We've redesigned our logo to fit our new commitment—to deliver the most product-related features covering treatment developments and trends in the marketplace. Our goal is to help you make wise purchasing decisions.

You have to play by CMS' rules in order to get reimbursed. However, you can create your own business-practice rules to help you sustain profitability.

Reference

1. Clearing up the confusion over medicare therapy caps. American College of Foot and Ankle Surgeons. Available at: www.acfas.org/practicemang/medicare-medicaid/caps.htm. Accessed December 20, 2006.