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Medicare Threshold: Alerts and Reporting

When a therapist is approaching or exceeding the Targeted Medical Review Threshold guidelines for Medicare ($2,230.00), an alert will display in SOAP 2.0. Alerts are available for the PT/SLP and OT thresholds, and the alert displayed is based on the user type of the patient's assigned therapist. 

This alert is currently visible to therapist users (PTs, OTs, SLPs, ATCs, DCs, and RTs.)
Important: The Medicare Threshold report and patient chart alerts in 1.0 will not update with SOAP 2.0 data. Follow the instructions below to manage the threshold for your patients in SOAP 2.0.

Medicare Threshold Alerts in SOAP 2.0 

You’ll receive approaching and exceeded threshold alerts on the patient’s SOAP 2.0 chart. 

  • Once you’ve exceeded the threshold, the alert will prompt you to add the KX modifier. You will not be prevented from creating new notes.
  • You’ll also have a quick view of the Medicare Threshold Used in the Case Summary.

Dismissing Alerts

This alert will be automatically dismissed by adding the KX or GA modifier on the patient's case.

  1. From the patient’s 1.0 chart, click Patient Info.
  2. Click the Edit icon for the Case needing the modifier.
  3.  Choose the appropriate modifier from the Apply Modifier section.
  4. Click Ok and then Save Patient.
  5. The alert will no longer display on the Patient’s 2.0 chart.

How can I track my Medicare patients' progress toward the threshold?

Track your patient’s progress on the patient’s SOAP 2.0 chart as shown above or through the Medicare Threshold Analysis Grid in Analytics. Important: Ensure you have the Analytics Access permission enabled.

Analytics Reporting: Medicare Threshold

  1. Open the Analytics portal by clicking the icon at the top of your WebPT screen.
  2. Click on the Reports section in the left menu.
  3. Navigate to the Visits subsection, and select Medicare Threshold.
  4. The Medicare Threshold analysis grid displays a list of all patients with Medicare insurance by year. This defaults to the current year. 
  5. Sort the Amount Remaining column by clicking on the column header and choose Sort A-Z. This will order patients who are closest to the threshold at the top. 
  6. When you’ve identified the patients who need the KX modifer, you can click on the Patient Name to be navigated to their chart.
  7. To remove patients who already have the KX modifer applied to their case, filter by KX modifer using the steps below.
    1. Click on the KX Modifier column header and select Filter.
    2. In the Filter window, use the (...) button to select Yes. 
    3. Click Add. 
    4. The filter ensures that only patients with the KX appear in the report.
  8. Tip: Quickly remove discharged patients from this list by filtering by Case Status using the steps shown below.
    1. Click on the Case Status column header and select Filter.
    2. In the Filter window, use the (...) button to select Active. 
    3. Click Add. 
    4. The filter ensures that only patients with active cases appear in the report.
  9. Want to save time? Try using the Saved Report functionality to maintain your filters and sorting views. Click here to learn more.
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