2008 Update on the Medicare Exceptions Process

Since 1999 when Medicare caps first became effective, providers have had to pay close attention to the claims process. This article summarizes the Medicare Exceptions Process that, for 2007, underwent a number of changes. The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Final Rule of November 27, 2007 made three important changes. These changes addressed certification for patient plan of care, personnel qualifications for therapists, and a review of Part B policies and their application to Part A settings that are projected to go into effect in July of 2008. Particular attention was given to explanations of the manual submission process and the change in definitions of “complexities” and of a “therapist.”