"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Tuesday, December 1, 2009

The RAC Demand Letter No Physical Therapist EVER wants to get

Save yourself some time and money.

Take this sample RAC demand letter to your physical therapist in private practice (PTPP) office manager and let them know this is TOP PRIORITY - if you get a demand for return of overpayment you have 15 days to respond.

RAC Demand letter

That's 15 days from the date in the upper left hand corner of the demand letter - not the date you find the letter in your mailbox. Here is the 4-page .pdf for download.

Why the rush?

According to Belinda Holmes, CPC/CCP of Kerkering/Barberio, an accounting and medical audit firm in Sarasota Florida, many demand letters wind up in the back office, on a 'to do' pile for several days before any action is taken.

Often, the person opening the mail is not even aware of the seriousness and potential financial liability of an automated RAC audit to a PTPP.

Offsets start on Day 41

Offsets are a 'bubble' in your Medicare cash flow pipeline. Offsets take money you would ordinarily collect in your bi-weekly Medicare check. The offset will continue until the entire amount of the overpayment is satisfied.

The demand letter has instructions for appeal - you should appeal since there is evidence that Medicare Recovery Audit Contractors are inappropriately interpreting Medicare guidelines.

Connolly Healthcare is the Florida RAC. They are only auditing automatic edits of PT un-timed codes in 2009,like...
  • 97001 (PT evaluation),
  • 97002 (PT re-evaluation),
  • 971012 (Traction),
  • etc (get the full list here).
In 2010 (almost here!), RACs may begin complex medical reviews of providers like PTPPs which means...
  • requests for medical records,
  • chart reviews and
  • denials based on medical necessity,
  • skilled physical therapy,
  • insufficient documentation,
  • no documentation,
  • etc.
As I've said, the RACs currently only perform automatic edits on PT un-timed codes.

Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.