Medicare PT-OT Claims: Manual Medical Review

Medicare PT-OT Claims
December 6, 2014
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As we get closer to the end of the year, more of your patient Medicare PT-OT claims are likely to be close to or above the $3,700 annual cap that triggers a mandatory manual medical review of each claim above the cap. (This $3,700 cap covers about 40 visits.)

The mandatory review will require you to provide an extensive amount of documentation. Also, because the review will likely be done by a nurse with little therapy expertise and involve patients who have been seen for 40+ therapy visits during 2014, the likelihood of denial is very high.

Therefore, we recommend a close review of the chart for any patient who is above or likely to go above the $3,700 cap because, for all practical purposes, your likelihood of being paid for visits above this cap is very low.

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