We get a lot of questions from billers, therapists and front desk people asking if the In Touch EMR™ system tracks the KX modifier and Medicare caps.
The Medicare cap is shared with multiple professionals and the software has no way of knowing if a patient has seen another provider.
Tracking Medicare Caps
Clinicians can track the Medicare cap on a specific patient on the Medicare website. It’s the only accurate way of monitoring when a patient has neared his/her financial cap.
There’s no available EMR system that can track the Medicare cap, despite what vendors say. It’s not that they’re being deliberately misleading. It’s that they simply don’t know.
The In Touch EMR™ Difference
With the In Touch EMR™, Medicare caps are handled differently. Clinicians monitor the caps of their patients to determine when it’s met or exceeded.
At that point, practitioners call In Touch EMR™ and the system is told to amend the KX modifier, which it does from that point going forward.
The KX Modifier
Medicare places an annual cap on the reimbursement amounts that it will pay for each patient’s physical therapy needs. That amount was $1,900 in 2013 for combined services of physical therapy and speech pathology.
Another $1,900 was allotted for occupational therapy.
The KX modifier is used for Part B claims when the cost for services exceeds Medicare’s financial cap, while meeting the exceptions process.
The KX modifier is also used when performing gender specific therapy. Its use notifies Medicare that it may need to examine a claim for editing.
It’s important to note that even with pre-approval, there’s no guarantee that reimbursements will be made.
It’s critical that clinicians understand the limitations and abilities of their EMR.
While no EMR can monitor the Medicare cap on a specific patient, Medicare maintains a running tab on each beneficiary and practitioners can use the site to ascertain the cap of any patient.