COMPLIANCE: Therapists--Forget Your John Hancock and You Could Be Out Thousands

Why This Topic Matters

Therapy claims can fail even when the procedure code is correct if documentation, supervision, plan-of-care, payer selection, or site-of-service requirements are not met. Understanding the audit findings helps providers reduce payment risk and spot compliance gaps before claims are submitted.

Article Sections

1. OIG audit findings and repayment outcome

   Summarizes the audit results and the overall payment impact on the reviewed claims. It frames the compliance issues addressed in the rest of the article.

2. Documentation and timed therapy service reporting

   Covers documentation requirements for therapy records and the need to support time-based reporting. The section discusses how billing records and service minutes relate to claim support.

3. Service provider, supervision, and billing accuracy

   Describes problems involving who actually furnished or supervised the service compared with who was billed on the claim. It addresses claim accuracy and attribution concerns.

4. Medical necessity and reasonable-service requirements

   Reviews the topic of whether therapy services met Medicare’s necessity and reasonableness standards. It also discusses the role of payer-specific criteria and beneficiary notices in coverage planning.

5. Plan of care and physician signature requirements

   Explains the need for an active, current plan of care and related signature and dating expectations. The section focuses on maintaining plan-of-care compliance over time.

6. Correct payer selection for accident-related injuries

   Addresses situations where another insurer may be responsible for payment instead of Medicare. The section discusses claim routing in accident-related cases.

7. Cardiac rehabilitation billing requirements

   Covers general Medicare requirements for cardiac rehabilitation services and the setting limitations referenced in the article. It highlights the importance of meeting site-of-service conditions before billing.