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Archive for June, 2013

OIG: Spectrum Rehab Overbills Medicare Program $3.1 Million

June 26, 2013 1 Comment
OIG: Spectrum Rehab Overbills Medicare Program $3.1 Million

According to a report issued by the Office of the Inspector General Spectrum Rehab LLC of New Jersey claimed Medicare reimbursement for outpatient physical and occupational therapy services that did not comply with certain Medicare requirements. The OIG random sample incuded 100 claims from a 2 year timeframe.  According to the OIG report, Spectrum improperly claimed Medicare reimbursement for […]

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Manual Medical Review – The RAC Maze for Outpatient Therapy Claims over $3700 Thresholds

June 25, 2013 2 Comments
Manual Medical Review – The RAC Maze for Outpatient Therapy Claims over $3700 Thresholds

Rehab providers are now receiving ADR (Additional Documentation Requests) from their Medicare MACs for therapy over the $3700 thresholds. ($3700 for physical therapy and speech language pathology; and $3700 for occupational therapy).  The ADR letters provide instructions on how to submit requested documention to the appropriate Recovery Auditor (RAC).  It is a good idea to […]

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Mandatory Functional Limitation Reporting: Report or Reject on July 1, 2013

June 24, 2013 0 Comments
Mandatory Functional Limitation Reporting: Report or Reject on July 1, 2013

The final week of “practice” functional limitation reporting is beginning.  For providers who have been reporting with no problems, you are relieved to know that you can just continue with patients after July 1st in the normal progress reporting periods.  For providers that used the practice period from January 1st through the end of this […]

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Functional Limitation Reporting FAQ Posted by CMS – Part B Therapy Providers Important Update

June 20, 2013 2 Comments
Functional Limitation Reporting FAQ Posted by CMS – Part B Therapy Providers Important Update

A much awaited Frequently Asked Questions – FAQ – document on Functional Limitation Reporting (FLR) was posted by CMS to provide clarifications to provider questions brought up during the 6 month testing phase which began on January 1, 2013.  Providers that have already been reporting on patient functional limitations, via G codes and impairment modifiers, […]

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Manual Medical Review of Therapy Underway by the Recoverys Auditors (RACs)

June 19, 2013 0 Comments
Manual Medical Review of Therapy Underway by the Recoverys Auditors (RACs)

RAC ‘n Rehab© Series  Providers are receiving the first round of manual medical review results letters from the Recovery Auditors (RACs), and for some the results are a sobbering reality that their Medicare documentation may not be compliant.  For most therapy providers, the manual medical review of therapy claims over the $3700 thresholds is likely […]

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Functional Limitation Reporting – July 1st Start Modification Update: Again!

June 18, 2013 1 Comment
Functional Limitation Reporting – July 1st Start Modification Update: Again!

CMS has clarified in an email to APTA that beginning July 1, 2013 “…therapy providers who have submitted functional limitation data (G-codes) on Medicare Part B patients prior to July 1 will not need to restart functional limitation reporting on the first date of service on or after July 1.”  For these patients only providers are […]

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Functional Limitation Reporting – Time to Start – or Restart – July 1, 2013

June 12, 2013 2 Comments
Functional Limitation Reporting – Time to Start – or Restart – July 1, 2013

The January 1 – June 30, 2013 testing phase for functional limitation reporting is about to come to a close.  Just when the therapy community was poised to transition in to the mandatory phase of functional limitation reporting (FLR) on Monday July 1st, CMS made a few statements in the Physician’s Open Door Forum (ODF) […]

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