It’s important to note that Stride automatically adds to a patient’s Medicare Threshold amount each time a note is signed off IF your practice has an Accumulator Tracker amount set up AND pverify has been ran at least one time, in order to provide initial data on progress towards the cap upon initiation of care within your practice.
Utilizing the Accumulator Tracker within Stride offers the greatest level of proactive managment for your Medicare Cap amount. Your Clinician will be flagged automtically to apply the KX modifier when locking a note when they are within $400.00 of the Medicare cap. Once this is done one time, it will be auto applied for all notes that follow.
Accumulator Tracker should be set up for your practice under Settings > General.
Additionally, you can use the Deductible Accumulator within the specific Payer Setting for medicare (and all other payors) to ensure the amount added each visit is consistent with the average reimbursement rate per visit for your practice, for that specific payer.
For more information about the Accumulator Tracker feature, please refer to the following articles:
Set spending accumulator deduction amounts
Medicare Cap Report: Overview
This report can be found under Reporting > Cases > Medicare Cap
The Medicare Cap Report is a valuable resource for reviewing a Medicare Part B patient’s threshold amount. This becomes especially important as the end of the year approaches, when more patients begin to exceed that threshold and require the KX modifier to be applied to their claims. Columns within the report are defined as:
- Patient: Patient Name
- Payer Name: Payer associated with Medicare Part B payer type
- Last Visit Date: Date of the patient's most recent appointment
- Next Visit Date: Date of the patient's next upcoming appointment
- Patient Status: Active, Discharged or New
- 2025 PT/SLP Spend: Medicare Threshold Amount
- 2025 Visits: Number of visits seen in 2025
- Last Update Date: Date that the insurance was last verified
-
2025 Status: Below, Approaching, or Over
- Below: < $2,010.00
- Approaching: Between $2,010 - $2,400,00
- Over: >$2,410.00
Best Practices: Medicare Cap Management
To ensure that the KX modifier is being applied to claims and prevent denials for the absence of the KX modifier, it is best practice to review this report often.
For most efficient use of this report, please follow the below steps:
1. Filter by 2025 Status = Below:
2. Click the hyperlinked Payer Name to open the patient’s insurance details window.
3. From this location, click Verify again and/or manually input any information received through other verification methods.
Running this often ensures that the ACTUAL amount applied to the cap is known by Stride and your practice, vs. the estimation that is achieved through use of the Accumulator Trackers.
4. Repeat this process for each patient on the list until all have been reviewed.