"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

Monday, November 14, 2011

Medicare Uses "Inaccurate and Inconsistent Data" to Audit Providers

The Washington Post reported today that...
"Medicare contractors are paid tens of millions of taxpayer dollars to detect fraudulent Medicare claims are using inaccurate and inconsistent data..."
The Washington Post is reporting on an unreleased report by the Office of the Inspector General (OIG)...
"The U.S. Department of Health and Human Services inspector general’s report — obtained by The Associated Press before its official release — found repeated problems among the fraud contractors over a decade and systemic failures by federal health officials to adequately supervise them."
The Recovery Audit Contractors (RAC) auditors were implemented in 2007 in Florida, California and Texas to solve these problems.
"CMS has repeatedly said the latest system of fraud contractors was designed to fix the problems with earlier contractors and allow the agency to better monitor them."
These RAC auditors are currently auditing physical therapists, physicians and hospitals.
"The same issues were identified 10 years ago by inspector general investigators, and dozens of reports in the past decade also have found problems.
In 2001, acting Inspector General Michael Mangano testified that the Centers for Medicare Medicaid Services (CMS) wasn’t doing a good job of holding contractors accountable."
I hope someone is auditing the auditors.

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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 .

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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.