◆ Clarification and update: The outpatient therapy cap applies to critical access hospitals. It does not apply to other hospitals, as RMC explained in the 1/22/18 issue. As the story reported, CMS is holding claims affected by the therapy cap and the expiration of the exceptions process for a short time to “limit the impact on Medicare beneficiaries” while Congress sorts things out. CMS later added that “only therapy claims containing the KX modifier are being held; claims submitted with the KX modifier indicate that the cap has been met but the service meets the exception criteria for payment consideration.” But on a Jan. 25 call with providers, Noridian, the Medicare administrative contractor, said the cap right now extends to all hospitals, says Nancy Beckley, president of Nancy Beckley & Associates. So the picture remains murky. “Members of the therapy cap coalition, including APTA and NARA, have been working hard on the legislative front to resolve the therapy cap legislation, as well as on the regulatory side, continually asking CMS to provide clear guidance to providers and beneficiaries,” Beckley says. “At this point information is contradictory, and we are in that time period where the lack of clear guidance to providers, consistent with the law, will begin to affect beneficiary access to medically necessary outpatient physical, occupational and speech therapy.” Contact Beckley at nancy@nancybeckley.com. Visit https://tinyurl.com/yafh7sl5.