Medicare Threshold (Analytics Report)

This article discusses the Medicare Threshold report in  Analytics. For the Medicare Cap 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Even though the Medicare Cap has officially been repealed as of February 9, 2018, PTs, SLPs, and OTs are still expected to apply the KX modifier to any claims over $2,080. The Medicare Cap report is an  Analysis Grid that helps you manage your Medicare patient’s progress towards that dollar amount, and know when to begin applying the KX modifier. 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.

Run and Customize the Report

  1. Choose which clinics appear in the report using the View Clinics by: drop-down menu and corresponding (…) button.
  2. Select which year you’d like to view cap information for from the Year drop-down.
  3. Add custom Filters to create specific segments of data using any of the column values in the report.
  4. Select Add Chart to visualize the data. Charts can be saved and displayed in your Custom Dashboards.
  5. Use the Column Headers to Sort, Filter, Group, Aggregate, or Format the report output.
  6. 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.

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.

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 billed units from the patient's finalized notes and their related charges as set in the Medicare Fee Schedule
Amount Remaining The soft cap 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. Case Title field in the Add/Edit Case window
KX Modifier This indicates whether or not the KX modifier has been applied to the patient's case. Apply Modifier radio buttons in the Add/Edit Case window
Therapist Type Medicare calculates soft cap 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