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

Medicare Increases RAC Records Request Volume
8/24/2011 10:54:00 AM
Effective August 22, 2011, Medicare has given RAC auditors the authority to increase the number of  records they may request for audit.   The rules are defined at:
 
 
One of the areas affected by these changes are the rules governing records requests are now defined in a ''Per Campus'' framework.  A campus is described as one or more facilities with the same Tax Identification Number (TIN) that is located in the same area.  The ''area'' is defined by the first three numbers of your Zip Code.  For example, if you have two offices (A & B)  with the same TIN, and office A is in zip code 12345, but office B is located in zip code 23456,   these two offices (with the same TIN) will be considered two campuses.  Therfore, RACs will have the abilty to double their record requests because the offices are not in the same area.  The limits for the number of records requested are now based on volume instead of the older method which was limited by an arbitray number. 
 
Regards,
Tom Kane, PT
Medicare Anti-Fraud Act Denies Medicare Providers Future Access
8/19/2011 4:10:00 PM
A recent bill introduced to Congress under the name of the "Strengthening Medicare Anti-Fraud Measures Act of 2011 (the "Act"), increases DHHS'' existing powers.  (Reminder;  coding errors can be treated the same as fraud).   Instead of paying a fine (prior restitution for fraud), the bill allows DHHS to exclude owners, officers, and mangers of companies that are convicted of health care fraud from participating in federal healthcare programs.  According to the DOJ (Department of Justice) and HHS, new aggressive initiatives to combat health care fraud also allows for the criminal prosecution of owners and executives.  According to the Act, the exclusion and/or prosecution may proceed even if the owners and executives were not complicit in the fraud, but could have stopped the fraud if they had known that fraud was occurring.   Stated more colloquially, if you did not know that fraud was occurring, but you were in a position to stop the fraud if you did know, you will be prosecuted as though you committed the fraud.  To avoid criminal prosecution (and the legal costs to defend yourself),  you could just surrender your ability to accept Federal insurance, and agree not to work in a facility that accepts federal insurance. (Where could you work?). You may be thinking, "Are we talking about the USA?"  Sadly,  our run amok government considers us criminals even if we did not commit the fraud, but would have prevented the fraud if we did know about it.  (Sounds like ''''Minority Report'''' starring Tom Cruise!).  Therefore, if your billing clerk or agency submits an improper code by mistake (and this code is repeated multiple times), you committed Medicare Fraud.  If your documentation clearly identifies the content and context of your treatment, your documentation may serve as mitigating factors that weigh in your favor.  However, improper documentation could be used against you to substantiate the fraudulent intent (though none existed).  Please understand that having proper documentation is not a guarantee that your error will be dismissed.  But having improper documentation almost guaranties that you will be prey for a government bureaucrat that understands you can be excluded from all Federal healthcare programs or undergo prosecution.   As mentioned previously on this blog, CMS has re-characterized physical therapists in the Moderate risk category for fraud.   Has fraud occurred?  Yes it has.  Are the vast majority of our colleagues honest?  Yes they are.  These overreaching rules and classification of PT in the Moderate fraud risk categories should serve as a warning. Everyone is vulnerable.   
 
Be well,
Tom Kane, PT
MediGraph Software
New Medicare Enrollment Requirements
8/12/2011 5:53:00 PM

The April 1, 2011 post on this blog presented a preview of things to come from Medicare.  That post addressed the prospect of unannounced on site visits from Medicare.  Final rules regarding eligible enrollment of PT have been established by CMS. 

Physical therapists that were enrolled in the Medicare prior to March 25, 2011 must revalidate their enrollment as required by the Affordable Care Act (ACA, commonly referred to as Obamacare). Part of the reason for this new enrollment is the classification of the new risk (fraud) screening criteria.  As was addressed in the aforementioned April 1, 20111 blog post, PT has been assigned to the Moderate risk category for fraud. The risk categories (low, moderate, high) determine the degree of screening that will be performed by MACs (Medicare Administrative Contractors).  As stated in the April posting, the moderate risk classification means that PTs are subject to unannounced on site inspections from Medicare Administrative Contractors.   

Starting from today through March 2013, MACs will be notifying practitioners of the need to re-enroll in Medicare.   CMS has advised providers to begin the revalidation process as soon as they hear from their MACs.  You only have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges. 

Regards,

Tom Kane,  PT

http://ww.cms.hhs.gov/cmsforms/downloads/cms855a.pdf   

http://www.cms.gov/MLNMattersArticles/downloads/SE1126.pdf 

http://ww.cms.hhs.gov/cmsforms/downloads/cms855a.pdf

RACs, MACs, and Demand Letters Rules Changes
8/10/2011 11:48:00 AM
Beginning January 1, 2012, Recovery Audit Contractors (RACs) that identify ''overpayment'' will be submitting their demand letters through Medicare Administrative Contractors (MACs).  MACs will be responsible for administrating  the refund from targeted medical providers, and  CMS will require MACs to establish time frames for the refund of your fees.  To complicate matters and make it more difficult to appeal an audit,  MACs will also manage the appeal process.  The RACs will remain responsible for audit specific communications, including questions regarding a reviver''s rationale for demanding a refund. 
 
The August 4, 2011 Provider Compliance Newsletter released by CMS once again revealed that the main vehicle for RAC refund requests are based upon the medical provider''s failure to prove that treatment was  "Medically Necessary"  There are many examples presented on this blog that provide guidance for PT in this matter.  Please review them, implement them,  and prevent your facility from becoming a RAC victim.   As always Dave Naples (ext. 211) and I are availble to discuss this matter with you.    
 
Regards,                                 
Tom Kane, PT
800-804-6334 ext. 210