| Bulletproof Medicare Resources |
| 17-page Medicare PT Evaluation (due May 2013) |
| 2009 Developing Outpatient Therapy Payment Alternatives (DOTPA) Annual Report |
| Outpatient Therapy Alternative Payment Study 2 (OTAPS 2) - Therapy Cap Report |
| Group Therapy (97150) Billing Scenarios |
| 8-minute Rule for Timed vs. Untimed Codes |
| Medicare Payment Basics primer from MedPAC |
| 2010 MedPAC Report to the Congress |
| Recovery Audit Contractor (RAC) Demonstration Report (June 2008) |
|
|
|
Recovery Audit Contractor Information (slideshow)
RAC slideshow (pdf) CMS recently posted this quick, informative slideshow on the RAC webpage. Learn the techniques by which Medicare has made provider audits into a 'revenue generating' activity. Learn who is the target in Medicare RAC audits and who is not. |
|
Transmittal 88
Medicare Benefit Policy Manual, Transmittal 88 (pdf) May 7th, 2008. The latest update to the Medicare Manuals for Physical Therapy outpatient Part B. Extends the re-certification period to 90 days. NOTE: Transmittal 88 makes no change to the basic requirements for a fully compliant Physical Therapy chart with Medicare Long Term Goals. That is...
|
|
OIG Compliance Program for Small Group & Physician's Practices
Office of the Inspector General Compliance Program for Small Group Physician's (pdf) The Office of the Inspector General's (OIG) position statement on the ideal Medicare compliance program. The OIG recognizes the burden that a compliance program places on private practice physical therapists and offers this document to break down the steps necessary to achieve full compliance. NOTE: not every step in your compliance plan needs to be completed at once as long as you can show evidence of ongoing efforts towards compliance.
This document suggests that several independant steps, such as education and oversight, will contribute to improved compliance while maintaining high clinical standards. |
|
Group Coding Scenarios
Medicare Group Billing Scenarios (pdf) Learn how to...
|
|
OTAPS 2 Report
The Outpatient Therapy Alternative Payment Study 2 - Utilization Report(pdf) February 1st, 2008. This is some of the first data that emerged after to implementation of the Therapy Caps - where CMS concluded that costs went down but beneficiary access to care was not impaired. Get the report that drives Medicare auditors to look at physical therapy 'outliers'. Are you an outlier? This study details the impact of the Therapy Caps on 'Cost Outliers' and makes recommendations for continuing the Therapy Caps until an alternative payment system is available.
|
|
Developing Outpatient Therapy Payment Alternatives (DOTPA)
Medicare would like to find an alternative to traditional fee-for-service for hard-to-value physical therapy services. Here is their 2009 Annual Report - it describes the direction of their thinking, the recommendations of their Technical Expert Panel and cost data (including tables) that DOTPA uses to support its position - the position that Fee for Service is too costly and Medicare needs to move towards an outcomes based system for rehabilitation. The preponderance of the evidence, as well as low-cost, seems to suggest that Computer Adaptive Testing (CAT) gathering self-report data in the clinic or at home might help patients, clinicians and payers find value in physical therapy. DOTPA was looking for clinics to pilot-test the new method. Sign up and contribute to the alternative! |
|
Reference for the 8-minute Rule
Reference for PT Timed and Untimed Codes
It's always better to have the original source documents - here they are - first transmitted on August 3rd, 2006. These rules have generated much discussion and some confusion - don't worry - now you can go to your staff or your manager and give them the real deal. |
