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January 2008 Client Newsletter


The Centers for Medicare & Medicaid Services (CMS) announced the Part B annual deductible for 2008 is $135.00 (up from $131 for 2007). If the patient has no secondary insurance, we strongly recommend collecting the deductible and co-insurance on the day of service. Be sure to ask if the patient has paid all or part of their deductible to any other providers, of course.

The annual co-insurance form that we prepare will be sent as soon as we receive the 2008 fees from Medicare.


The Therapy Cap for 2008 is $1,810. However, the moratorium on the Medicare Cap Exceptions process for independently practicing physical, speech and occupational therapists was extended only to June 30, 2008 by Congress with President Bush expected to sign that bill by December 31st. The cap will be $1,810 after that for the remainder of 2008 unless Congress acts later to extend it.

That Cap applies for Physical Therapy & Speech-language pathology combined and for Occupational Therapy services alone. Thus, a patient will have $1,810 for PT/ST and another $1,810 for OT. When a patient exceeds the $1,810 (total of Allowed Amounts) the patient is responsible for the Allowed Amount in excess of the $1,810. If a Medigap policy is secondary then there will be no coverage. If a supplemental plan is secondary then there may be coverage and that plan should be contacted before treating to determine benefits.

There is a requirement for the provider to give the patient at the first encounter an NEMB (with specific language) that they will be responsible for allowed amounts when they exceed the Cap (subject to their secondary policies) if no valid Exception applies. The Cap is per year for all outpatient rehab services except outpatient hospital.


This is a good time to review your Charge forms for new CPT, ICD-9 and HCPCS codes and to decide whether to add your new NPI # before you re-order. The Charge form is a key part of any insurance audit so ensuring it is current is important. CPB will be glad to review all codes on the form for you and provide any necessary corrections at no cost. Many clients also have their Tax ID#, Medicare # or other numbers on their Charge form but they are not required unless the patient does their own billing.

Medicare Preventive Services Quick Reference

Enclosed this month for our PCP’s is a copy of the Medicare Preventive Services Quick Reference form indicating what is required to bill for the Initial Preventive Physical Examination (IPPE). If you would like these CPT codes added to your charge form, please let Rich know. Medicare’s 2007 Allowed amount is $99.46 for the IPPE and $26.99 for the EKG. The updated 2008 Fee Schedule has not yet been released.

DME Supplier Accreditation Requirement

On December 19, CMS held an Open Door Forum and announced that all DME suppliers must be accredited was September 30, 2009 in order to be paid for products. CMS specifically stated they had no exemptions to announce.

CMS Online Internet Applications

The Centers for Medicare & Medicaid Services (CMS) has announced new online enterprise applications that will allow Medicare fee-for-service providers to access, update, and submit information over the Internet. Details of these provider applications will be announced as they become available. Even though these new internet applications are not yet available, CMS recommends that providers take the time now to set up their online account so they can access these applications as soon as they are available. The first step is for the provider or appropriate staff to register for access through a new CMS security system known as the Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC). This does NOT apply to DMEPOS suppliers at this time. This is the first step in the PECOS On-Line Provider Enrollment process which is expected to begin in about 60 days. Please let Rich know when you have done this.

A recent MLN Matters article, the first in a new series on IACS-PC, addresses key questions and answers about the registration process and can be found at on the CMS website.

What is particularly important is that a provider can designate an authorized representative to access the system on their behalf. This will allow physicians and other providers to designate the billing company as a designated representative. As the designated representative, the billing company will be able to complete the on-line enrollment, as well as update information as necessary.

A key point is when someone should register as an “individual” versus an “organization”. If the provider registers as an “individual” ONLY he or she is authorized to enter or change information. If the provider wishes to allow someone else access (an employee, billing company, etc.), then he/she must register as an “organization” - even if it is a solo practicing physician.

CPB will be glad to do this on your behalf at no cost – just fax a request to Rich.
2008 Client Newsletter Archive