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

Tools used by RACs to Audit Records
7/7/2011 12:22:00 PM
Understanding the resources available to Medicare Random Audit Contractors (RACs) allows physical therapists to initiate measures that will assist with preventing audits and respond properly when an audit occurs.  The number of acronyms for the tools available to RACs is large and growing.  The current list includes:    
  • Raw data - RAC databases, routine CMS RAC Data Warehouse downloads, industry trends;
  • Outcome reports - CERTs(1), OIG(2), PEPPER(3), GAO(4), QIOs(5);
  • Industry experience and information - AAHAM, AHA, AMA, AAASC, JCAHO, JCAHACO;
  • Policy/rules and regulations(7) - LCDs, NCDs, CRs(8), IOMs, MLN; and
  • CMS programs - ZPICS(9), DOJ(10), vulnerabilities reports(11), carriers, FIs, MACs.
What does all this mean?  It means that RACs have become an unbridled extension of government bureaucracy that has one goal; obtaining a refund from medical providers.   These tools give RACs the ability to design criteria that can change on an ongoing basis.  For physical therapists there is good news and bad news in relation to this process. 
The good news for physical therapy is that on a comparison basis, PT will face fewer variations in the criteria used by RACs when compared to other disciplines (multi-discipline medical practices, out patient surgical units, private outpatient surgical suites) that will be forced to anticipate audits on numerous intervention levels.  The bad news is that auditing PT records is easier for a RAC because they can focus on the blatant omissions that currently occupy many therapists'''' documentation. 
Many of the MediGraph subscribers that I speak with do not utilize the RAC prevention tools in the software. The vast majority of therapists searching for documentation software are not currently using the proper documentation measures.   Most PTs continue to emphasize and document the impairment model instead of integrating the impairment model into the disablement model.  Many therapist fail to measure impairments.  Those that do measure impairments fail to demonstrate/measure that the impairment results in a functional disability (gait or balance problems, self care disability, etc.).   Many therapist do not use the published outcome questionnaires (72 of these instruments are in MediGraph).  All of these RAC prevention tools are at your disposal at no cost. With proper billing they are your defense against  a RAC refund. 
If you have any questions regarding how to implement these tools, please contact Dave Naples at extension 211, or Tom Kane at extension 210.  As always, the education and customer support are included as part of your subscription  at no cost.
Be well,
Tom Kane, PT
MediGraph Software