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
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