Both houses of Congress today approved an agreement struck yesterday by a conference committee to extend the payroll-tax cut to the end of 2012 and eliminate a steep cut in physician fees in the Medicare program. The final bill also provides for the therapy caps exceptions process to be in place until the end of the year.

As reported in Provider on Thursday, the deal also reduces skilled nursing facility (SNF) reimbursement for bad debt for dual-eligible beneficiaries over three years until it reaches 65 percent coverage, in 2015. For those people who are not duals, reimbursement will drop from 70 percent to 65 percent this year.

The bill, which is expected to be signed by President Obama shortly, extended the therapy caps exceptions process through Dec. 31, 2012, but not without modifications. Those changes will require that the physician reviewing the therapy cap plan of care be detailed on the claim, reject all claims above the spending cap that do not include the proper billing modifier, and provide for a manual review of all claims for high-cost beneficiaries to ensure that only medically necessary services are being provided.

The spending caps of $1,880 in 2012 are extended to the hospital outpatient department setting to prevent a shift in site of service to higher-cost settings once enforcement of the current exceptions process begins.

To help pay for the tax cut extension and “doc fix,” SNFs saw changes to bad debt payments. Federal reimbursement for bad debt for dual eligibles, currently at 100 percent for SNFs, will be 88 percent in fiscal year (FY) 2013, 76 percent in FY 2014, and 65 percent in FY 2015.

This year, as mentioned above, will see non-duals dropped from 70 percent to 65 percent.