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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 […]

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 […]

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 […]

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 […]

August 4, 2014 3 Comments

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Compliance

Becoming A Therapy Compliance Officer

Becoming A Therapy Compliance Officer

Are you thinking of becoming a therapy compliance officer?  I often get inquiries by phone, through this website and via email from clinicians asking about becoming a compliance officer.  Some inquiries are from clinicians that are excited about compliance, some are from clinicians that are burned out and looking for a new career opportunity, others […]

September 2, 2015 0 Comments
Aquatic Therapy Compliance

Aquatic Therapy Compliance

Does your facility offer aquatic therapy?  If so do you have aquatic therapy compliance addressed to ensure compliance with Medicare requirements for your type of Medicare enrollment?  Aquatic therapy may be offered at your facility, next door at the health club or a community pool such as the local YMCA.  Look to your Medicare Administrative […]

September 1, 2015 1 Comment
Wheelchair Assessment

Wheelchair Assessment

Are you being asked to provide a wheelchair assessment?  Physicians referring a patient for a wheelchair are required by Medicare, Medicaid other payers to follow guidelines for submitting a prescription and letter of medical necessity. Physicians seek the expertise of physical and occupational therapists in completing the necessary paperwork they must submit in support of the wheelchair request. Therapy […]

August 31, 2015 1 Comment
Compliance Plan Seven Elements

Compliance Plan Seven Elements

 A compliance plan should address seven elements that are based upon the Federal Sentencing Guidelines.  TheOffice of Inspector General has developed numerous compliance guidances over the past 17 years.  For outpatient therapy practices the OIG’s Compliance Program Guidance for Individual and Small Group Physician Practices (published in the Federal Register: Vol. 65, No. 194 / Thursday, […]

August 30, 2015 1 Comment