Let's Help Each Other

Physical therapy is changing rapidly. As a PT with more than thirty years of experience, the changes observed in the last ten years triple those of the first twenty years. The pace of change is not slowing down. The Medigraph Blog will serve as a forum that will enable us to exchange ideas and assist each other. This blog will be used to share billing, documentation, and any other ideas to improve any aspects of our profession. If we share what we have learned, we can develop a resource that enables our collective understanding to advance our careers.

As profit margins grow smaller and expenses grow larger, we need to assist each other to survive and prosper. If we share our experiences we can help each other to grow professionally, administratively, and financially. Our professional lives, our livelihood, and our personal lives are intertwined. Our resources individually are limited. Together we can accomplish more than we can individually. Let's help each other


Tom Kane, PT
MediGraph Software

Medicare Audits: Prevention is Better Than Cure
7/27/2010 4:08:00 PM
Ben Franklin stated, “An ounce of prevention is better than a pound of cure.” This universal principle applies to everything from diet to automobile maintenance.  Medicare audits are no exception to this rule. With forethought (prevention), the new Medicare RAC audit system can work for you instead of against you.

The new RAC (random audit contracting) auditing methods have totally changed Medicare audit methodology. The prior auditing system permitted the auditor to be paid to review records regardless of the outcome. For example, if your documentation was acceptable, and there was no demand for refunds of previous payments, the auditor got paid. In the new RAC system auditors only get paid if they obtain a refund from you. Those that have endured the RAC audit have described the experience with colorful adjectives and adverbs. However,  as with most crises, opportunity may lie therein.

We PTs are patient driven. Our instincts are to provide documentation that is employed to  advance the goal of patient recovery.  Unfortuntely a "patient only" approach to documentation will not satisfy a RAC.  Preventing RAC audits  must also become  one of our documentation goals or we may shoot ourselves in the foot. Medical documentation is the primary leverage employed by auditors to reduce fees for services. Documentation must now satisfy our clinical needs while simultaneous serving as a document that facilitates reimbursement by preventing a RAC audit. If we do not act proactively  reimbursement for services rendered can be denied, or we can be forced to surrender a refund of prior reimbursements.  

 Auditors are paper pushers with limited knowledge of physical therapy. To the hired-gun RAQ auditor patient strength improvement is meaningless unless we can demonstrate increased functional ability.  A functional increase must be displayed in an easy to understand format that does not require PT knowledge.  This approach to documentation prevents an audit. When documentation is more function oriented, and standardized test are employed to reveal functional improvement, the RAC auditor''''s thinking changes to, “These records are not worth reviewing.  If I audit this facility and do not obtain  a refund, I won’t be paid.” As sad as this state of affairs may be, it is reality.  Recent RAC audits of PT facilities in the NJ, NY, PA garnished $9 billion dollars in refunds.  Despite our best clinical intentions, we must learn to produce documentation that prevents our being mugged by RAC reality. Many of us are unwilling to discuss this topic openly fearing that such a discussion is unprofessional  Nothing could be further from the truth than such shallow of a perspective.  Future blog postings will continue to offer more insight into this area.

Be well,
Tom Kane, PT
MediGraph Software