tci Medicare Compliance & Reimbursement - 2016 Issue 23

Compliance: Get the Facts on Federal Health Programs' Exclusions

Take a look at the different types of exclusions and what they entail. Consider this scenario: You see a patient for the first time and realize that he needs physical therapy for his hip. So, you refer him to the adjacent physical therapy group that just happens to be attached to your orthopaedic practice. After six weeks of therapy, he’s recovered. He still feels stiff, but you know that he really doesn’t need any more medical assistance. However, Medicare doesn’t know that, so—just this once—you decide to fudge your documentation and send him back...

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