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

New RAC "Semi-automated" Reviews
4/7/2011 5:51:00 PM

Recovery Audit Contractors  (RACs) now employ automated claims reviews and complex claims reviews with the goal of obtaining a refund of fees that physical therapists have received for services rendered.  A new form of audit has been introduced to assist the RAC bounty hunter goal of obtaining a refund from providers (they are reimbursed when they obtain a refund).  The new method is known as overpayment identification: “Semi-automated” claims review.

A Semi-automated review is slightly different than the automated and complex methods of overpayment identification used in the RAC method.  It is essentially a hybrid of the automated and complex reviews.  The changes divide this new review process into two parts. 

  1. The first part of the two-part review process involves an automated review of claims data to identify billings that are associated with a high suspicion of improper payment.  The automated  RAC review occurs when a determination is made at the computerized system level without a person.   Software reviews are often referred to as “Data mining,” where the software to process large numbers of claims combs the data.  It is essentially unchanged from prior RAC reviews.  The minor difference from the regular automated RAC is claims that are identified as only containing possible errors, rather than assumed errors, are identified.
  2. The second part has a notification letter sent to the therapist explaining the potential billing error.  The PT is given 45 days to submit documentation to support the original billing(45 days is also given to providers to submit documentation for a claim that has been selected for complex review).

“Semi-automated” reviews will lead to additional burdens for physical therapists.   It is no secret that automated reviews can result into a complex review. The semi-automated review has established the process that emphasizes the risks of automated review, making it easier for the RACs to request records for review! .  The RACs can now scan unknown numbers of records for issues,  ‘mining’ for unlimited vulnerabilities.

I know the overwhelming majority of therapist are unaware of or ignoring the impact of the documentation tsunami that approaches.  I know because I speak with MediGraph subscribers regularly.   I also speak with therapists that are interested in becoming MediGraph subscribers, and most of them are clueless.  Increasingly, new callers are aware of what approaches, which is their reason for seeking electronic documentation.  

For subscribers, I understand that my good intentions are becoming a bore.  I realize that I am the bearer of bad news that many would prefer to ignore, pretending that that are immune.  If you are already a subscriber, it should be apparent that there are no ulterior motives to my posts that implore you to use MediGraph to its complete ability.  MediGraph does not gain any income when you use the tools that we have provided.  Please document need, proof, meaningful intervention, and use objective tools in MediGraph to accomplish these tasks.  All these tools required to satisfy the Medicare bounty hunters and bean counters are at your disposal.  Start using these tools today.  The RACs are using their software to the fullest capacity to snag you.  Use MediGraph to beat them at their own game.

Tom Kane, PT
MediGraph Software