- Outpatient Occupational and Physical Therapy Services Billing Guide
- Introduction to Outpatient OT and PT Services
- Outpatient Occupational and Physical Therapy Coverage
- Caregiver Training Services
- KX Modifier Threshold
- 2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring
- Annual Update to the Therapy Code List
- Targeted Medical Review
- Functional Reporting - Using the G Codes
- What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy
- Maintenance Programs
- Multiple Procedure Payment Reduction
- The National Correct Coding Initiative
- Comprehensive Error Rate Testing Program
- Recovery Auditor
- Common Billing Errors and Remittance Message
- Medical Review Therapy Documentation Checklist for Additional Development Request Letters
- Common Questions and Answers
- Related Content
- Related Articles
Recovery Auditor
The mission of the Recovery Audit Program is to detect and correct past improper payments made on health care claims for services provided to Medicare beneficiaries. The goal is to help CMS and the MACs implement actions that will prevent future improper payments.
The Bipartisan Budget Act of 2018, section 50202 retained the targeted MR process, however at a lower threshold amount of $3,000.
MACRA established that not all claims exceeding the KX modifier thresholds will be subject to a MMR as they were before, this also remains in place.
For a general overview of the medical review process, go to CMS’ Medical Review and Education website. For more information on the MMR of therapy claims above the $3,000 thresholds, visit the CMS Medical Review and Education Therapy Services web page.
Reviewed 11/2/2023