Medicare Warnings for Therapists

Although there is no longer a yearly cap on therapy services, when allowed charges to Medicare exceed an arbitrary, annual amount CMS requires the application of a KX modifier to show that the therapist stipulates further treatment is medically necessary.

Clinicient automatically tracks the Medicare Therapy Threshold and warns you when patients are about to meet or exceed the cap. The examples below show what you can expect to see when these warnings occur as well as the Sign Chart Notes window.

The name of the case for a selected patient appears above the topic tree for a selected patient. Details about the case appear when hovering over the case name. If there are any serious issues about the patient's case, including issues with the Medicare Therapy Threshold or Plan of Care, the therapist will be alerted because the background color of the case will turn red.

The following are examples of the case name appearance and warnings when the patient is reaching the primary Medicare Therapy Threshold, or the level at which Medicare requires a manual Medical review of the documentation.

No Medicare Warning

The name of the patient's case appears with a blue background if there are no warnings about the Medicare Therapy Threshold, Medicare Plan of Care, or need for a Progress Report.

Medicare Therapy Threshold Threshold Warning

When the patient has reached the threshold set to warn users about the Medicare Therapy Threshold, the therapist will see a warning in charting.

Primary Medicare Therapy Threshold Exceeded

After the primary cap has been exceeded, the warning will look like this.

Manual Medical Review Threshold Warning

When the Medicare allowable charges have reached the threshold for warnings, the therapist will see a warning that looks like this.

Manual Medical Review Exceeded

After the manual medical review level has been exceeded, the warning will look like this.

Sign Chart Notes Window

Click the Sign icon to display the Sign Chart Notes window. A check box in the Actions area of the Sign Chart Note allows you to add the KX modifier to indicate the services performed are medically necessary. If you do not select the check box, a warning prompt displays to remind you the patient is about to exceed the annual cap. Click Yes to indicate services are still medically necessary or No to indicate the services are no longer medically necessary.

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