MEDICARE OUTPATIENT THERAPY SERVICES: SELECTED ANALYSES AND RECOMMENDATIONS

MEDICARE OUTPATIENT THERAPY SERVICES: SELECTED ANALYSES AND RECOMMENDATIONS

Library of Congress Cataloging-in-Publication Data

CONTENTS

PREFACE

Chapter 1: IMPROVING MEDICARE’S PAYMENT SYSTEM FOR OUTPATIENT THERAPY SERVICES

CHAPTER SUMMARY

INTRODUCTION

MEDICARE PAYMENT POLICY FOR OUTPATIENT THERAPY SERVICES

MEDICARE SPENDING ON OUTPATIENT THERAPY SERVICES

RECOMMENDATIONS

REFERENCES

Chapter 2: MEDICARE OUTPATIENT THERAPY: IMPLEMENTATION OF THE 2012 MANUAL MEDICAL REVIEW PROCESS

WHY GAO DID THIS STUDY

WHAT GAO FOUND

ABBREVIATIONS

BACKGROUND

CMS IMPLEMENTED TWO TYPES OF MMRS, BUT THE PROCESS LACKED TIMELY GUIDANCE AND FULLY AUTOMATED SYSTEMS

CMS ESTIMATES THAT PREAPPROVAL REQUESTS AND CLAIMS FOR OVER 115,000 BENEFICIARIES WERE SUBJECT TO MMRS, BUT THE FINAL OUTCOMES OF THESE REVIEWS REMAIN UNCERTAIN

AGENCY COMMENTS

Chapter 3: QUESTIONABLE BILLING FOR MEDICARE OUTPATIENT THERAPY SERVICES

EXECUTIVE SUMMARY

INTRODUCTION

FINDINGS

RECOMMENDATIONS

APPENDIX-A.

APPENDIX-B

Chapter 4: OUTPATIENT THERAPY SERVICES PAYMENT SYSTEM

DEFINING THE SERVICES MEDICARE PAYS FOR

SETTING THE PAYMENT RATES

UPDATING PAYMENTS

OUTPATIENT THERAPY CAPS

MANUAL MEDICAL REVIEW PROCESS

INDEX