SafeGuard Services LLC, (SGS) the Medicare program safeguard contractor charged with developing comparative billing reports (CBR) held an informational session this afternoon for physical therapists in private practice who received the report. This is the second CBR on physical therapists in private practice, and the 8th in a services released by SGS . The purpose of the call, which was aided by a PowerPoint presentation handout was to assist therapists in interpreting the report.
According to SGS the purpose of the Comparative Billing Report (CBR) is
to help prevent improper payments by educating physical therapy providers using billing data for selected therapy services billed to Medicare. The CBR provide comparative billing data on how individuals health care providers compare to their peers by looking at utilization patterns for billed services.
According to the CBR, this was prompted in part by the Office of the Inspector General (OIG) December 2010 report on Questionable Billing for Medicare Outpatient Therapy Services:
The OIG has indicated that outpatient therapy expenditures have increased by 133% over the past 10 years which represents an increase of $2.8 billion. The OIG report also indicated that the KX modifier was over-utilized and exceeded annual therapy caps at levels much higher than the national average.
The analysis for the second PT CBR encompassed all final Medicare Part B paid claims retrieved from the Integrated Data Repository on 6/24/2011 with service dates from 1/1/2010 through 12/31/2010, with “office” as the place of service. The highest billed codes that were analyzed: 97110, 97140, 97112, G0283 and 97530.
Hospital outpatient therapy departments, rehab agencies, CORFs and SNF Part B providers did not receive reports as institutional providers. The CBR reports were individual in nature and released to the billing physical therapist. The data collected during the SGS analysis of physical therapy billing with the KX modifier in the 2010 and 2011 reports will not be aggregated or released as a report, only individual providers will receive a report on their billing activity.
It should not go without stating that Safeguard Services is a Medicare Program Safeguard Contractor, and is also the Zone Program Integrity Contractor (ZPIC) for the State of Florida. Who’s to know how that collective information might be utilized in the future?