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tci Part B Insider - 2015 Issue 42

Compliance: OIG: 43 Percent of Physical Therapy Claims Didn't Pass Muster

Recent audit showed that just 57 percent of claims were Medicare-compliant. When it comes to Medicare claims, documentation is everything—and that’s especially true for physical therapists, whose payments hinge on a Medicare-compliant plan of care. Unfortunately, the OIG recently found that nearly half of the PTs that the agency audited did not meet the rules, and could be subject to paybacks. The OIG revealed these findings in its October report, “Boulevard Health Care Program, Inc., Improperly Claimed Medicare Reimbursement for Outpatient Physical Therapy Services.” According to the report, auditors reviewed 100 PT claims from the...

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