tci Part B Insider - 2016 Issue 17

Physical Therapy: OIG Cautions PT Practices to Align Policies and Procedures

Incomplete claims documentation and confusion can lead to big financial losses. Understanding what is “medically reasonable and necessary” under the terms defined by Medicare Part B’s Outpatient Physical Therapy Services mandate is both daunting and confusing. Sometimes the gray area of what and how to code these claims can get your practice in hot water. Background: The OIG published a report last month about a Vero Beach, Fla. physical therapy practice that inappropriately collected $52,000 in Medicare reimbursement in 2012 and 2013 from incorrectly billed claims. Of the 100 beneficiary claims audited, 86 were accepted; however...

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