"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

Thursday, December 10, 2009

RACs Get Complex

Up until now, Recovery Audit Contractors (RACs) have only been approved to issue demand letters for multiple, untimed codes:
  • evaluation (97001)
  • re-eval (97002)
  • e-stim (G0283)
  • traction (97012)
  • etc
...per day per patient.

The RACs would review your billing profile using computerized, 'data drilling robots' that spot these un-listed Common Procedural Terminology (CPT) code edits and send you a demand letter.

The demand letter would arrive, automatically generated, with days, patients and dollar amounts listed.

Since multiple untimed codes are 'technical denials' there is no appeal.

Now, RACs are approved for complex review - that means they can request and review copies of your charts. They will attempt to find issues that would give basis for a medical necessity denial.

You can appeal medical necessity denials - and you should.

There is evidence that RACs inappropriately interpret published Medicare guidelines in making their denials.

For my state, Florida, Connolly Healthcare is the CMS-approved RAC. Connolly also administers the RAC program for Alabama, Colorado, Florida, Georgia, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas.

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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"

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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.