With the new cap imposed by Medicare effective January 2006, Medicare beneficiaries will only get $1,740 of therapy services (combined with Physical Therapy and Speech Therapy) and a separate cap for Occupational Therapy.

         How will it affect the Medicare Beneficiaries?

         1.Our senior citizens people will dramatically be affected by this cap due to obviously, many of them suffers from all different physical conditions that needs therapy. After a stroke, surgical replacements, they need to have therapy to be able to go back to their normal lives.

         2.Patients who needs therapy do not normally have the same and only one kind of episode in one calendar year. Usually, they are being treated with additional cases. Medicare will no longer cover the services after the $1,740 cap has been reached. One example, the patient is being treated due to difficulty in walking because of previous stroke then later on had a hip replacement, that is another case but had happened on the same calendar year. This patient will be forced to pay out-of-pocket to get the therapy services that he needs to be able to walk again. But what about other senior citizens who only depends on their social security? This will mean additional cut on their monthly benefits?

         3.The bottom line here is that, the older people who primarily needs important care is obviously the most vulnerable and helpless among the Medicare beneficiaries. These are the people who are vulnerably sick and weak.

         With a lowest average physical therapy charges of $ 160.00 per visit, a patient can only get 10 visits per calendar year (but this is combined with Speech Therapy!). With let? say Physical Therapy Services alone, that would only be twice a week for only 5 weeks! Imagine it when the patient needs combined with Speech Therapy! A stroke patient usually needs both Physical Therapy and Speech Therapy, is it not?

         The above issues are a reality. We hope the congress may lift this policy on therapy cap and realize the impact on this policy to many who needs the essential care and therapy services!

         About the Author: Pinky Mcbanon is a Systems Engineer and a Medical Biller/Coder.

         She shares her medical billing and coding expertise with http://www.medclaimsplus.com and her technical support specialty with http://www.fix-exchange.com.