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Region

Region A

Issue Title

Postpayment Review - Manual Medical Review of Outpatient Therapy Claims Above the $3,700 Threshold

Number

A000452013

Description

In accordance with The American Taxpayer Relief Act of 2012 (ATRA) signed into law by President Obama on January 2, 2013, reviews will be conducted on outpatient therapy claims in certain settings reaching the $3,700 threshold for PT and SLP services combined and/or $3,700 for OT services. When one or more lines of a claim have reached a therapy threshold, all lines of therapy services on that claim are subject to review. PLEASE NOTE: DISREGARD THE FOLLOWING STATEMENT IN THE “DATES OF SERVICE” BELOW.

States

CT, DC, DE, MA, MD, ME, NH, NJ, RI, VT

Provider Type

Skilled Nursing Facility (Part B Only)

Date of Service

Claims having a "claim paid date" which is more than 3 years prior to the ADR date will be excluded.

References

Date Posted

4/22/2013

Date Revised

5/28/2013

More Information

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Attachments

Created at 6/4/2013 2:47 PM by Aaron Gough
Last modified at 6/5/2013 10:36 AM by Aaron Gough