Guest guest Posted September 18, 2009 Report Share Posted September 18, 2009 Can anyone give me some information on the If,when, how the RAC auditing process will affect the free standing OP clinics? Thanks Rick Lee rick.bentonpt@... Benton Physical Therapy Benton, AR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2009 Report Share Posted September 20, 2009 Rick, The way automated reviews work is you will get a letter saying that certain days of service have been audited and that more than one 'untimed code' per patient per date of service has been detected. An untimed code is a 'supervised modality' like traction, parafin, electric stim, ultraviolet, infrared, etc. You are not expected to charge for more than one spinal traction per day, for example, to a patient. You cannot appeal these audits because they are 'technical denials' - based on code edits rather than interpretation of your charts and notes. RAC's ONLY applied automated audits to physical therapy outpatient clinics during the demonstration audits in Florida in 2005-2007. Complex reviews are not just complex, they are costly - RAC auditors come in a read a sample of your charts. RACs get paid based on their recovery and PT services are small dollar claims. During the demonstration audits the RACs recovered just $19 million from physicians OVERALL - from a total of just under $1,000 million (a billion). PT was just a small part of the physician recovery dollars. Furthermore, complex reviews of PT services focus on 'skilled care', 'medical necessity, and 'progress' - which usually require 'expert' interpretation by a paid auditor and which are subject to appeal by you. When you appeal a MAC audit, nationwide, you will win 67% of the time. Under the RAC system the RAC returns 100% of its fee if you prevail on appeal. I could be wrong but I suspect that the permanent RACs will behave much like the demonstration RACs. Tim , PT www.PhysicalTherapyDiagnosis.com TimRichPT@... > > > Rick > If you bill fee-for-service you will be subject to review by a RAC. As a result of what was learned in the RAC demonstration project new guidelines and rules have been set going forward. Three goals are:• Minimize Provider Burden > • Ensure Accuracy > • Maximize Transparency > Some positive changes are:RACs > will not be able to review claims paid prior to October 1, 2007 (during the demonstration project some were reviewed up to 5 years back) > Issues reviewed by the RAC will be approved by CMS prior > to widespread review > Approved issues will be posted to a RAC website before > widespread review > The one approved issue that is likely to have a direct impact on you is:žExcessive Units-Untimed Codes > > Check out the RAC link below. It gives the latest RAC info and will lead you to the RAC for your area. > > www.cms.hhs.gov/rac > > Ron WallAxiom Healthcare GroupOntario, CA > To: PTManager > From: rick.bentonpt@... > Date: Fri, 18 Sep 2009 11:39:14 -0500 > Subject: RAC > > > > > > > > > > > > > > > > > > > > > > Can anyone give me some information on the If,when, how the RAC auditing > > process will affect the free standing OP clinics? > > > > Thanks > > > > Rick Lee > > > > rick.bentonpt@... > > > > Benton Physical Therapy > > > > Benton, AR > > > > Quote Link to comment Share on other sites More sharing options...
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