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

Another Audit Victim
1/9/2011 4:11:00 PM
I received a call from another MediGraph subscriber that was recently the subject of a Medicare RAC audit.  We at MediGraph have been forwarding warnings regarding the RAC process and standards.  Those that implement our suggestions do well.  The subscriber that called did not pay heed to our warnings and called seeking our advice.  Some issues sited in this user''s audit include:
  1. Baseline measurement outcome questionnaires were not employed. 
  2. The numerous testing modalities within MediGraph were not utilized. 
  3. For locomotion -lower extremity diagnosis, they did not employ the 6 Minute Walk, the 
  4. TUG, the Dynamic Gait Index, or the other gait, balance, and  locomotion tests in MediGraph. 
  5. They did not  employ Time in Time Out recording. 
One of the results of the above violations was the auditors concluded that the skilled care requirements were not satisfied.  When asked, "Why was this patient treated for four weeks" the response offered was the worst response that a therapist can give; "The prescription for therapy was three times per week for four weeks."   A refund to Medicare will be forthcoming  and they have been placed on notice that a follow up exam will be performed.  (I have never heard of a follow up Audit exam before this subscriber''s encounter.)  The therapist called seeking counsel on how to prepare for the next audit.
We at MediGraph are in a unique position.  We have the opportunity to interact with fellow PTs on a daily basis and therefore gain a broader view of what is happening within our profession.   We obtain feedback from our subscribers that helps us to identify trends to  share with all MediGraph users.    The difficult  lesson learned by this PT group that was recently audited occurred because they ignored the messages that we have been sending to our subscribers;  good clinical documentation and treatment is not sufficient to overcome an audit.   Auditors want proof!
Some PTs object to the documentation standards that we suggest.  MediGraph does not establish these standards.  Our goal is to make it easy for you to comply with these standards that are being employed by RAC audits.   A common response is, "I don''t need a 6 minute walk Test or the LEF scale to treat a patient!"  I agree.  You probably do not need these tools to treat a patient.  But if you want to get paid for what you do, start using these tools today. 
Remember, audits are not performed by PTs.   The auditors are usually paper pushers or possibly a nurse that believes she or he understands PT because they have read the Medicare Manual.   Auditors are taught to use objective standards because they do not understand what we do (which is another  reason  why MediGraph employs bar graphs and tables for easy visual recognition).   
The days of only employing patient centric documentation are dwindling.  Unless we supplement patient oriented documentation with  objective outcome based decision making  expect an audit in the future, and do not expect to do well in the audit.   The documentation tools contained in MediGraph provide  you with the advantages you need to prevent an audit and overcome an audit that does occur.  Start using these tools now. 
Tom Kane, PT
MediGraph Software