Medicare recognizes that PT documentation errors are not fraud

05.25.00  Merlyn Rosell   Label: , , ,
In a somewhat refreshing tone the Government Accounting Office issued a report that showed the US government made $18.6 billion in erroneous payments to Medicaid providers in 2008 but admitted that most of these payments are due to 'procedural glitches' and not fraud.

Deborah Taylor, acting director and chief financial officer of the Centers for Medicare & Medicaid Services at HHS told a panel of the Senate Homeland Security and Governmental Affairs Committee on April 22...
"Most of the improper payments... are generally not due to willful fraud... Rather, most of these errors are the result of documentation and processing mistakes.
Some physical therapists may not understand the money flow involved when Medicare pays a claim for PT services, in any setting...
"The law requires Medicare to pay claims within 14 days of receiving them,"
...explained Peter Ashkenaz, deputy director of media affairs for the Centers for Medicare and Medicaid Services to CNSnews.com.
"Given so little time to verify the services of the doctor or hospital performed before paying for them, Medicare often makes the payments first.

After the fact, they look for possible problems."
90% of the improper payments are due to 'inadequate documentation'. Of the $72 billion in estimated improper payments in 2008, Medicare and Medicaid Services accounted for 50% of the total.

Get the full report here (pdf).

What can physical therapists do to help?

Recognize that Medicare and the federal government are in a pinch: they need to provide mandated benefits and needed services to American citizens and others who qualify but they don't want to get ripped off.

Physical therapists and physicians are in the audit cross hairs not because PTs and MDs are fraudulent or dishonest but because costs are climbing uncontrollably.

How can you protect yourself?

Some of the tips I use in my own Medicare compliance plan (may be different for you) include the following:

  • Get a baseline measurement

    1. Self-report measures such as the OPTIMAL scale (self-report measures may be more reliable than performance measures and other, so-called, 'objective' tests.)

    2. Performance measures - such as the Functional Reach Test to gain predictive information on falls.

    3. Impairment measures - 'old school' measures like Straight Leg Raise and ankle dorsiflexion ROM, that still have predictive value.

    4. Classification measures - powerful, predictive tools that summarize and assign patients to special treatment groups.

  • Use a disablement model - physical therapists should avoid treatment decisions based on pathology. Instead, base your decisions on the ICF model to help you help your patients more.

  • Use a compliance template - the Office of the Inspector General (OIG) has shown small practices how to incrementally implement a compliance template with breaking your bank.

There are more points to mention - many of which I discuss in my Bulletproof PT Tutorial you can get for free by signing up below with your first name and e-mail.
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Medicare recognizes that PT documentation errors are not fraud
Medicare recognizes that PT documentation errors are not fraud
Reviewed by Merlyn Rosell
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