tci Medicare Compliance & Reimbursement - 2008 Issue 3
Compliance: Forgetting Signature Can Cost You Thousands
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Article Overview
This article explains a Medicare compliance audit involving physical therapy services and reviews the broad documentation and billing requirements that can determine whether therapy claims are payable. It is most relevant for therapy providers, coders, billers, compliance staff, and practice managers who work with Medicare outpatient rehabilitation claims and want to understand the categories of issues highlighted by the audit.
Why This Topic Matters
Therapy claims can be denied or recouped when documentation, supervision, plan-of-care, or payer-routing requirements are not met, even when services were otherwise rendered and billed. The article is useful for identifying common compliance risk areas that can lead to major repayment exposure.
What You Will Learn
- How a Medicare therapy audit can identify compliance risk areas
- Why documentation and signature requirements matter for therapy claims
- How medical necessity and plan-of-care issues can affect reimbursement
- Why correct payer selection and site-of-service rules are important in therapy billing
Who Should Read This
- Physical therapists
- Medical coders
- Medical billers
- Compliance officers
- Practice managers
- Outpatient rehabilitation staff
Codes Discussed
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