About 2010 Medicare Limits

 

Most of our facilities participate with Medicare, and we recommend you check with the facility before scheduling your appointment. Below is information pertaining to the annual Medicare cap for physical and occupational therapy. Please be advised that the cap does not apply to any Kessler facility within 35 miles of our West Orange facility. The cap does apply to the following sites: Brielle, Howell, Lakewood, Ocean, Tinton Falls, Ocean Township, Toms River, Brick, Flemington, Freehold (3499 rt. 9), Neptune, & Jackson.

 

The following sites do not participate with Medicare: Fair Lawn (15-01 Broadway), Eatontown, Mendham & Phillipsburg.

 

“For 2010, the annual limit on the allowed amount of outpatient physical therapy and speech-language pathology combined is $1860; the limit for occupational therapy is $1860. Limits apply to outpatient part B therapy services from all settings except outpatient hospital and hospital emergency room”… this was taken from CMS Pub 100-04, transmittal 1414 dated 1/17/08.

 

One of the many requirements for an off-campus facility to be considered a provider based entity is the location test which states “the facility…is located with a 35 mile radius of the campus of the hospital…that is the main provider.”…taken from 42 CFR section 413.65(e)(3).

Kessler Rehabilitation Center is contracted with a broad range of insurance carriers. We are a network provider for a number of HMO, PPO and POS plans. The amount of which these managed care plans pay for our services is dependent on the coverage of the individual patient's health insurance policy.

Our Managed Care Department verifies insurance coverage information for all our patients. This eliminates the stress from the patient having to obtain coverage.

 

Once the coverage information is obtained, it is explained to our patients in detail. Each patient is educated as to how much of their treatment will be covered by their insurance carrier.

Kessler Rehabilitation Center is dedicated to the proper management of the workers’ compensation patient. We see attention to detail, superior communication, aggressive treatment strategies and continuous follow up as the backbone to our program. We are committed to providing a quality service to all of our customers - the patient, the adjuster, the case manager, the employer and the physician.

 

Functional Capacity Evaluations (FCEs): A comprehensive, objective assessment of a person's safe physical capabilities. This assessment helps determine one's ability to perform work related tasks and/or gives specific limitations as to the patient's current capabilities. This is an excellent tool to determine return to work status, maximum medical intervention and validity, or to help with case closure.

 

Pre-Placement Screenings: Utilizing the job description for a specific job title, we develop a 20-minute screening that emphasizes the physical demand requirements for a given job. This assessment affords the employer the ability to determine if the potential employee is physically capable of performing the essential job requirements.

 

Ergonomic & Vehicle Assessments: An ergonomic assessment consists of watching an individual in their work environment, and making injury-preventing recommendations. By observing the client in his/her specific space, we can determine if it is an efficient, safe environment or whether there are risks for injuries. The results of the assessment can lead to recommendations for changes either to the physical work space, or to the way the individual does his/her work through proper body mechanics education. In addition, we offer vehicle assessments for companies with sales forces or other workers who require significant time in vehicles. Kessler and its national partners assist fleet managers and medical personnel in making appropriate vehicle choices and educating workers on the use of vehicle options as well as best practices on positioning and movement patterns.

We understand the complicated needs of our patients involved in motor vehicle accidents. Our high standards of professional awareness of the ever-changing New Jersey regulations are what makes Kessler unique. This ensures minimal out-of-pocket expenses for our patients, based on your elected P.I.P. (personal injury protection) coverage. Kessler participates with all NJ auto insurance plans, and most secondary insurances when applicable.