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Author Archive: Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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Rehab Documentation Reviews and RACs: Who Ate My Fax?

July 18, 2013 3 Comments
Rehab Documentation Reviews and RACs: Who Ate My Fax?

Have your faxes not been getting through to the Recovery Auditors (RACs)?  You are in good company, and by the end of this post you’ll have a surefire way to securely get your records to the RAC.  RAC manual medical review of therapy claims over the $3700 thresholds are underway and providers are getting a […]

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Documentation According to the OIG

July 16, 2013 0 Comments
Documentation According to the OIG

Has your therapy documentation been reviewed this year?  If you are participating in Medicare and your patient will exceed the $3700 threshold (PT and SLP combined, and a separate for OT) your documentation will be reviewed under the manual medical review program that is administrated by the Recovery Auditors (RACs).   The Office of the Inspector General […]

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Jimmo v. Sebelius Settlement: – Will There Be More Opportunity for Continued Therapy?

July 12, 2013 0 Comments
Jimmo v. Sebelius Settlement: – Will There Be More Opportunity for Continued Therapy?

Therapists are beginning to question how the Jimmo vs. Sebelius (HHS/CMS) lawsuit might affect their therapy practice.  Therapists are thinking of those patients who make very small, and steady improvement, or patients who have chronic conditions that need therapy frequently in order to maintain independence. Or contemplating their patients residing in independent living apartment apartments whose ability to remain there (rather […]

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Checking the OIG Excluded Individuals and Entities List – A Compliance Monitoring Mandate

July 11, 2013 0 Comments
Checking the OIG Excluded Individuals and Entities List – A Compliance Monitoring Mandate

The Office of Inspector General (OIG) released a new video to its array of social media educational offerings today on How to Use OIG’s Online Exclusions Database.  This new YouTube video supplements previous OIG training videos on exclusions and the use of the exclusions database.  If you are not using the Exclusions database, it is […]

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OIG Adds Online Self-Disclosure Option

July 8, 2013 0 Comments
OIG Adds Online Self-Disclosure Option

The Office of the Inspector General (OIG)launched an online submission process for Provider Self-Disclosure Protocol. This now offers another submission method for providers who are  voluntarily disclosing self-discovered evidence of potential fraud to OIG. Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.  According […]

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Expedited Review When Therapy Services are Discontinued

July 5, 2013 1 Comment
Expedited Review When Therapy Services are Discontinued

Faced with $1900 therapy caps, and $3700 manual medical review by Recovery Auditors (RACs) therapy providers are cautious about providing therapy services that may not be deemed medically necessary by Medicare contractors.  In light of the change in liability for therapy over the $1900 cap in 2013, therapy providers have a choice of obtaining a […]

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On the Clock: Making Therapy Minutes Count

July 2, 2013 0 Comments
On the Clock:  Making Therapy Minutes Count

It seems that everyone in outpatient therapy knows about the “8-minute” rule with Medicare, right?  Well apparantly not so when you hear of recent provider denials by the Recovery Auditor (RACs) reviews of therapy over the $3700 threshold, or the just released OIG report on Spectrum Rehabilitation LLC.   I will have to chime in also – […]

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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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