Upcoming Webinars

Site Updates

Disclaimer

The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Menu
Log in


Log in

Modifications Within Common Working File (CWF) to Adjustment Claims Exceeding Annual Therapy Threshold

10 Aug 2018 12:10 PM | Zachary Edgar (Administrator)

Effective Date: 1/7/2019

The purpose of this Change Request (CR) is for CWF to modify the process to set CWF edits correctly on adjustment claims when the therapy threshold is exceeded.

Background: Currently, when CWF receives an adjustment to a therapy (physical-PT, speech-SP, or occupational-OT) claim which had been paid prior to the therapy cap being reached, CWF searches to see if the beneficiary exceeded the threshold. If the beneficiary exceeds the threshold then CWF subjects the adjustment claim(s) to the normal therapy threshold processing, and if no 'KX' modifier is present, rejects the adjustment claim(s) and generates an edit which ultimately results in the original claim being treated as an overpayment.

The CMS request CWF to review CR 8938 and ensure that the system is in compliance with the therapy adjustment requirements and modify/revise the software if when necessary.

The contractor shall ensure that the adjustments to therapy claims for PT/SP and/or OT service(s) are excluded from therapy edits and threshold limits

Reference

Transmittal # R2111OTN


About Us

Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

Learn More 

Join Us

Join today as either a monthly or a yearly member and enjoy full access to the site and a significant discount to our live and recorded webinars.  Members also have access to compliance and billing support.

Join Today 

Find Us


Powered by Wild Apricot Membership Software