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RACs

RAC Therapy Reviews Underway: 2014 Therapy Claims

RAC Therapy Reviews Underway: 2014 Therapy Claims

RAC therapy reviews are underway as CMS paved the way for manual medical review of therapy claims over the $3700 threshold by the Recovery Auditors (RACs). Effective January 16th CMS provided a contract addendum to the current (outgoing) RACs in all 4 regions to begin a review of therapy claims over $3700 submitted between March […]

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February 26, 2015 3 Comments
$3700 Therapy Threshold RAC Reviews

$3700 Therapy Threshold RAC Reviews

$3700 therapy threshold RAC reviews have resumed even though the larger RAC program has been “paused”.  Therapy over the $3700 per beneficiary thresholds ($3700 for PT & SLP combined, another $3700 for OT) is mandatorily reviewed for medical necessity.  CMS has assigned the review task to the RACs.  According to information provided by CMS to the […]

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December 4, 2014 1 Comment
RAC Restart Facts…(Not Rumors)..So Far

RAC Restart Facts…(Not Rumors)..So Far

The therapy community is abuzz with all the rumors and misinformation on the RAC restart facts. So far there are a few things that we do know.  We know that CMS wrote letters to members of Congress on Friday August 1st announcing their intention to have a limited restart to the “paused” RAC program. We also know […]

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August 12, 2014 2 Comments
CMS to Restart Some RAC Reviews

CMS to Restart Some RAC Reviews

CMS announced today that it is initiating contract modification with the current Recovery Auditors in Regions A, B, C and D to restart reviews of a limited number of issues.  While CMS had previously announced that new Recovery Auditor (RAC) contracts would be announced for Regions 1-5 no later than August 15th their announcement today […]

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August 4, 2014 3 Comments

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Compliance

2016 PQRS Measures for Occupational Therapy

2016 PQRS Measures for Occupational Therapy

There is no change in 2016 PQRS measures reporting for occupational therapy for claims based reporting.  As the new year begins occupational therapists, much like physical therapists, may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting […]

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January 3, 2016 0 Comments
2016 PQRS Measures for Physical Therapy

2016 PQRS Measures for Physical Therapy

Time to get started to with 2016 PQRS measures for physical therapy!  As the new year begins physical therapists may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting was unsuccessful and therefore a 2% […]

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January 1, 2016 1 Comment
Medicare Therapy Cap in 2016

Medicare Therapy Cap in 2016

The Medicare therapy cap in 2016 is set at $1960.  The therapy cap for physical and speech-language pathology combined is set at $1960 and there is a separate $1960 therapy cap for occupational therapy.   This represents an increase of $20 per cap over the 2015 amount of $1940.  The increment is based upon a medical […]

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November 25, 2015 2 Comments
OIG 2016 Work Plan and Physical Therapists in Private Practice

OIG 2016 Work Plan and Physical Therapists in Private Practice

The 2016 OIG Work Plan once again includes a review of physical therapists in private practice and is captioned as “Physical therapists—high use of outpatient physical therapy services”.  Per the OIG Work Plan and physical therapists in private practice: We will review outpatient physical therapy services provided by independent therapists to determine whether they were […]

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November 14, 2015 1 Comment