Therapy Cap Process
Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the therapy caps exceptions process through December 31, 2017, and modified the requirement for manual medical review for outpatient home health therapy claims (type of bill 34X) over the $3,700 therapy threshold. MACRA eliminated the requirement for manual medical review of all claims exceeding the thresholds and instead allows a targeted review process. The Centers for Medicare & Medicaid Services has tasked Strategic Health Solutions as the Supplemental Medical Review Contractor (SMRC) with performing this medical review on a post-payment basis. For additional information, refer to the additional resources provided below.
Additional Resources
Updated: 11.13.17