Re: OIG Report

[Guest guest]

Hi Vicki,

I seem to recall running the company mentioned through a search engine when

this was first posted. I seem to recall there were limited responses but

one of

them made me wonder if there was a heavy Anodyne type treatment focus.

Dee

Dee Daley, PT

WorkWell Systems

Southern Pines, NC

[Guest guest]

Good points Vicki. We once had a Focus Review Audit from our FI, Blue Cross of

California where three people reviewing the files sat in front of us and one by

one said,

1) This patient was not making progress after six visits and should have been

discharged.

2) This patient was making good progress after six visits and should have been

discharged.

3) This patient was in maintenance after six visits and should have been

discharged.

I asked the panel, " so we should never see anyone longer than six visits " ? They

looked up from their piles of charts with a clueless look and asked, " where do

you get that idea " . Our attorney sat in on the meeting and we won our appeal.

From that point on, all chart notes were treated as a re-eval. All the best.

Doug

Doug Sparks

Advanced Physical Therapy Concepts / APTC

www.aptc.biz<http://www.aptc.biz/>

doug@...

Re: OIG Report

Hi all

What I find very troubling in the report is that none of the claims was

substantiated. The largest portion of claims reportedly did not support being

Medically reasonable and necessary. Maybe I'm an optimist, but I would hope

that a portion of the claims would be found to be reasonable for coverage.

I'm

also concerned about the reviews being too black and white and that the

human component of treatment is thrown into the garbage. The Medicare

population

is certainly not cut and dry and there are many times when their pace of

recovery is slower than I believe Medicare likes to cover, or " significant

recovery " is relative. I did not see a way of digging deeper into the claims

reviewed to see what they were basing decisions on, but I would bet we would

all

see some of our past clients and circumstances mirrored there. I think we

need to be very careful about condemning the therapists and figure out a way

to find out a little more about the process and the reviewers. There are two

sides to every story.

I wish everyone a great day

Vicki

Vicki Tilley PT,GCS

President

ElderFit In Home Rehab, North Carolina

(919) 644-6646

vicki@...

www.elderfitpt.com<http://www.elderfitpt.com/>

In a message dated 7/24/2006 9:36:04 P.M. Eastern Standard Time,

DPT@... writes:

Rick,

I'd say a nearly $10million payback makes this a must read. Take note that

the significant errors found resulting in recovery was for failure of

documentation, including evidence the patient had visited their physician q30

days

and the demonstration of medical necessity.

, PT

Therapeutics

[Guest guest]

OIG Report

IG today posts three reports to the website. As

always, selecting the link immediately following the

report title will take you directly to the full

document.

Physical Therapy Billed by Physicians

(OEI-09-02-00200)

http://www.oig.hhs.gov/oei/reports/oei-09-02-00200.pdf

OIG found that approximately 91 percent of physical

therapy billed by physicians in the first 6 months of

2002 did not meet program requirements. These

inappropriately paid services cost the program and its

beneficiaries approximately $136 million. Because of

inadequate documentation, reviewers had difficulty

assessing the quality of the therapy services. In

addition, we identified aberrances in physicians'

billing patterns and unusually high volumes of claims

that suggest physical therapy is vulnerable to abuse.

Finally, physical therapy billed " incident to "

physicians' professional services and rendered by

unskilled and/or unlicensed personnel represent a

vulnerability that could be placing beneficiaries at

risk of receiving services that do not meet

professionally recognized standards of care. To

address these issues, we recommend CMS should consider

revisions, clarifications, and further study of the

" incident to " rule to ensure that Medicare

beneficiaries are recei!

ving skilled services from appropriately trained and

licensed staff and that the services meet

professionally recognized standards of care.

Rick Gawenda, PT

Director PM & R

Detroit Receiving Hospital

www.gawendaseminars.com

HPA Government Affairs & Practice Committee

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