Medicare assumes that better patient outcomes are the result of process and
measurements. Are measurements important?
Of course they are. Measurements can assist with
determining our patients’ progress. However, there are
other non- clinical reasons that Medicare is seeking standardization.
A major non-clinical reason for Medicare to emphasize measurements and
process is cost control. Failing to satisfy the
changing Medicare demands can have a negative outcome for we therapists.
Many of us are in denial regarding the prospect of a Medicare audit. We at
MediGraph have continued to
warn of the changing environment, standards and practices surrounding Medicare
RAC audits. We have warned that RAC auditors do not get
paid unless they extract a refund from you. The more a RAC
extracts, the more they make. Because these audits are
outsourced, the number of audit contractors (bounty hunters) is increasing the
number of audits that can be performed.
Medicare RACS are looking for specifics, process, and measurements.
Some of the things Medicare wants to know include:
- How you make your clinical
decisions. (Do you take measurements).
-
Can you prove there was a
functional deficit associated with impairment?
-
What tests have you performed that
demonstrate that your impairments resulted in a functional deficit?
-
Did you record your time?
-
One on one CPT codes.
-
PTA supervision requirements.
-
Fifteen minute time codes as the
basis for patient encounters
-
Demonstrating that skilled care
was required (establishing a plan of care, progress measurement).
-
Physician referrals and
re-certifications
-
Time in –time out.
MediGraph
provides all the tools that you need to help satisfy these Medicare/RAC demands.
To prevent and overcome an audit, employ standardized pre-established
measurements (6 Minute Walk, TUG, 9 hole Peg test, etc.) to baseline and
demonstrate functional improvement. ROM and HHD measure
impairments that assist to establish the cause of a functional deficit or a
disablement. MediGraph’s easy to read bar charts and tables
permit the most untrained RAC auditor to understand your patients’ improvement.
These tools are at your disposal. There are no
additional charges when you employ these testing modules. We
as PTs must behave in a preventive-defensive manner. The best
defense against a RAC audit is to have documentation that deters the RAC
contractor. The tools that help to accomplish this task are
at your disposal. Please consider using them.
Regards,
Tom Kane, PT