There are a lot of myths and misunderstanding about therapy caps and the KX Modifier. To complicate matters, many EMR vendors claim their software can keep track of a patient’s therapy cap in real time. The reality is that no EMR system can provide information on things that take place outside of the system and it’s almost impossible to keep track of therapy caps in real-time.

The Uncertainty of Cap Information

The therapy cap on services is currently $1,900. Clinicians have no way of knowing if the client is seeing a physician or other healthcare professional that offers physical and occupational therapy. They may be receiving services at a skilled nursing facility, outpatient services at a hospital or at home from a privately practicing therapist.

The most accurate means of determining a patient’s cap is by visiting the Medicare website. The information will be a few weeks out of date, but will give a ballpark figure of how much of the funds have been used. Speaking to someone at the Centers for Medicare and Medicaid Services would be more advantageous.

Activating The KX Modifier

At the very minimum, the practice’s EMR should offer the ability to turn the KX Modifier on or off, and it should turn it on automatically after a patient’s cap has been reached to ensure the practice gets paid and clients receive the services they need. Once the cap limit has been reached, claims that don’t include the KX Modifier will be denied. In Touch EMR™ turns the modifier on automatically and works with information obtained from Medicare.

In Touch EMR™ is fast, easy and integrated to make tracking Medicare caps as easy as possible. Functionalities that include the ability to automatically turn the KX Modifier on ensures practices are paid and continuity of services for clients. The In Touch EMR™ maintains comprehensive documentation to demonstrate that services are medically necessary and works with information from Centers for Medicare and Medicaid Services to help therapists track Medicare caps.