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.
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).
- requests for medical records,
- chart reviews and
- denials based on medical necessity,
- skilled physical therapy,
- insufficient documentation,
- no documentation,
- etc.
Logging you in...
@PTassociatesofQ · 664 weeks ago
R
Tim_Richardson 60p · 664 weeks ago
Parameters don't change much - maybe 50% Pulsed ultrasound for inflammation vs. 100% continuous wave for a contracture or healed muscle injury - and could be automated so that clicking a button would fulfill the requirement.
Timed Codes should also be automated - perhaps using a handheld device with similar point-and-click technology when a Manual Therapy Code is done or an Ultrasound is finished.
Physical therapist documentation for Medicare compliance is still in the 1980's compared to the advances in medical and communications technology in 2012.
Tim