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

Regards,

Tom Kane, PT
MediGraph Software

RACs to Audit Documentation Prior to Claim Submission
11/22/2011 8:57:00 PM

As of January 1, 2012. Recovery Audit Contractors (RACs) will be abble to examine claims before they are paid.  CMS states that these 'prepayment audits' will be conducted on certain types of claims that historically result in high rates of improper payments.”  Want to know what those claims are?  So do we.  Because these claims have not been  defined, everything is fair game. The program will begin in areas with high populations of fraud- and error-prone providers.  These states include California, Florida, Illinois, Louisiana, Michigan, New York.  The pre-payment reviews will also be conducted in “high claims volume states including Missouri, North Carolina, Ohio,and Pennsylvania.  Pre-payment review threatens PTs because it significantly impacts cash flow.  Sadly, there are no substantive criteria or procedures in place to determine placement on or removal from pre-payment review.  Because RACs  are finically incentivized, and the harsh impacts that pre-payment review can have on providers, we continue to forewarn you of the potential hazards of improper documentation and billing.

As stated many times in this blog, Medicare's goal is to reduce  overpayment, fraud, and abuse.  By CMS' outsourcing to RACs and providing them will the most motivating of incentives (financial gain) the RACs have been successful.  The RAC reimbursement incentive is they receive a percentage of the refund obtained from the medical provider.  As also stated many times in this blog, please employ MediGraph properly to prevent becoming an audit victim.  Documentation of impairments (ROM loss, strength loss, pain, etc.) alone will not satisfy the 'Medically necessary' requirements for CMS and the RACs.  Satisfying medically necessary is where the RACs have been most successful.  You must employ the functional testing components and outcome questionnaires built into MediGraph to overcome the RACs.  For more info, the link to CMS is below.  As always, if I can help, please call.

 

Regards,

Tom Kane, PT

https://www.cms.gov/apps/media/press/factsheet.asp?Counter=4170&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date 

 

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