Medicare Threshold (Analytics Report)
This article discusses the Medicare Threshold report in Analytics, it includes SOAP 1.0 and 2.0 data. For the Medicare Threshold report in the EMR, click here.
Even though the Medicare Cap has officially been repealed as of February 9, 2018, PTs, SLPs, and OTs are still expected to apply the KX modifier to claims over the following threshold amounts for 2023:
- $2,230 for PT and SLP services combined, and
- $2,230 for OT services
This information pulls the charges from the patient’s finalized, billable notes, and matches those to your Medicare Fee Schedule to calculate the charge amounts. This means you must have accurately completed your Medicare Fee Schedule in the EMR.
Location
You can locate this report in the Visits section of Reports in Analytics. If you do not see the report listed in this section, ensure that you have the correct Analytics Access permission.
Run and Customize the Report
- Choose which clinics appear in the report using the View Clinics by: drop-down menu and corresponding (…) button.
- Select which year you’d like to view threshold information for from the Year drop-down. Note: Currently the report contains only the current year's Medicare Threshold data.
- Add custom Filters to create specific segments of data using any of the column values in the report.
- Select Add Chart to visualize the data. Charts can be saved and displayed in your Custom Dashboards.
- Use the Column Headers to Sort, Filter, Group, Aggregate, or Format the report output.
- Once you've manipulated the report to your liking, you can save the customizations to your Saved Reports to run again later or share it with others in your organization.
Column Field Descriptions
| Field Name | Definition | Source |
| Clinic Name | The clinic location where the patient's note was finalized. | Patient Notes |
| Patient Name | The patient's name, as entered in the Patient Info section of the patient chart. | First Name and Last Name fields in the Patient Info section |
| Last Date of Service | The date of service listed on the patient's most recent finalized note. | Date of Service field in the finalized SOAP Note |
| Previous Amount Used | The previous amount used according to information in the patient's case. | Prior to Existing OT and PT/SLP Treatment field in the Add/Edit Insurance window |
| Amount Used | The dollar amount that has already been charged to Medicare for the given calendar year, accounting for multiple procedure payment reductions for the therapist type. | Calculated value based on the documented (billed) units from the patient's finalized notes and their related charges as set in the Medicare Fee Schedule |
| Total Amount Used | The sum of the Previous Amount Used and Amount Used Fields. | Calculated value |
| Amount Remaining | The soft threshold amount minus the patient's amount used to date, calculated based on therapist type (PT/SLP or OT). | Calculated Value |
| Case Name | The title of the patient's case. This will be the most recent active case. If there are no active cases, it will be the most recent case. | Case Title field in the Add/Edit Case window |
| Case Status | Status of the patient's case displayed in the report (e.g. Active, Discharged) | Patient Case |
| KX Modifier | This indicates whether or not the KX modifier has been applied to the patient's case. Note: If the Apply Modifier button is not selected for the KX Modifier in the patient's case, this field will populate "No". | Apply Modifier radio buttons in the Add/Edit Case window |
| Therapist Type | Medicare calculates soft threshold amounts for PT and SLP combined and OT alone. This field contains options for each (e.g., PT/SLP or OT). | User Type drop-down in the Add/Edit User page |
| Case Therapist | The assigned therapist for the patient's case. | Assigned Therapist field in the Add/Edit Case window |