The best way to ensure that the Medicare Cap threshold is being addressed is to utilize our Accumulator Tracking feature. This feature will make Automatic deductions from insurance fields. The remaining amounts for a patient’s deductible, out-of-pocket maximum, insurance visit limits, and case max visits will decrease as the patient continues care. Additionally, for traditional Medicare patients the KX modifier accumulator will increase. For more information on how the Accumulation Trackers work, and how to set them up for your practice: Accumulation Trackers Article
Additionally, Stride also offers a Medicare Cap report. When combined with accumulation trackers, this report will give you the tools you need to see when a patient is approaching their KX threshold:
https://app.stridethera.com/reporting/cases/medicare-cap
With these features set, once Medicare patients are within $400 of their Medicare threshold, clinicians will begin to see messages like below, and if the checkbox is checked, the KX modifier will automatically apply to each CPT code when using the "Auto Calculate" button.
Once the threshold is surpassed, you will receive a message that must be affirmed before locking the note. Again, the KX modifier will be auto-applied to each CPT code as long as the 'Auto Calculate' button is utilized.
Please note that each time a note is signed, the KX amount used will go up based off the preset 'Accumulator Trackers' that can be set in the Payer settings, or as a global setting for the entire practice as shown in the image below:
For example, if the patient comes in initially with a KX amount of $1,800 and they were seen 2 times with the note signed off, then on that 3rd visit, based off of the accumulation trackers pictured above, the clinician should start receiving the KX warning that they are approaching the threshold.