Documentation and Payment Issues in Outpatient Physical Therapy: Assuring Compliance & Avoiding Fraud & Abuse

Stephen Levine, PT, DPT, MSHA

• Be able to explain why physical therapy is a Prime Target for audit and investigation activities and the implication for physical therapy providers

• Learn the current issues in the Federal Legislative and Regulatory arena and their impact on rehabilitation in 2008 and beyond

• Learn the concepts of Fraud and Abuse as well as the risk areas for fraudulent or abusive behavior specific to rehabilitation

• Learn the definition of Medical Necessity used by many private payers and apply the definition to your practice environment

• Understand the requirements of skilled care under Medicare and ensure you have the information to ensure compliance with these requirements

• Become aware of initial activity in the Pay For Performance and Value Based Purchasing areas

• Understand the Therapy Cap and Exceptions Process as clarified for 2008

• Learn the updated Medicare Documentation Requirements and the importance of adherence to these requirements to justify payment

• Learn the CPT Coding process and Resource Based Fee Schedule methodology and their implication to physical therapist practice

• Learn the basics of financial accounting (balance sheets, incomes statements, fixed and variable costs)

• Learn how to calculate your cost per visit and the factors necessary in determining if you should sign a payer contract

• Learn how to appropriately use the Advanced Beneficiary Notice to legally collect cash from a Medicare patient

• Be able to describe the CPT codes most frequently used in describing Physical Therapist Practice (intent and application)

• Identify areas of risk in coding from a compliance perspective and learn documentation tips important in support of the use of codes to describe clinical practice (all settings)

• Be able to appropriately use ICD-9 codes and billing modifiers to facilitate the reimbursement process and allow for efficient billing and effective payment of outpatient therapy claims

• Become aware of documentation issues from an auditor’s perspective and learn how to ensure documentation content helps to minimize the risk of positive audit findings

• Learn the concepts of Functional Outcomes Reporting in documentation

• Learn about Audit Review Flags that can be identified on your claims and documentation which may lead to further audit or investigation

• Learn how to minimize the risk and impact of a physical therapy audit

Program Content:

Day 1:

• Understanding why Physical Therapy is a Prime Target for Investigation and Audit activities

• Overview of Federal Legislative and Regulatory Activity and its Impact on rehab in 2008

• Review of Fraud and Abuse Concepts

• Definitions of Medical Necessity in Private Pay

• Review of Skilled Care Requirements under Medicare

• On the Horizon: Provider payment based on Performance Measures

• Therapy Cap Update: 2008

• Review of Updated Medicare Documentation Requirements

Day 2:

• Overview of CPT Coding process and a Resource Based Fee Schedule methodology

• Basics in Financial Accounting for Physical Therapists: What Every PT Needs to Know

• Calculating your Cost per Visit and Determining whether to sign an insurance contract

• Medicare’s Beneficiary Notices (ABN): How to Legally Collect Cash from a Medicare Patient

• Instruction in CPT coding for Physical Therapy Practice

• Overview of the application of ICD-9 codes and modifiers and their use for Physical Therapy claims

• Documentation Issues: An Audit Perspective and Functional Outcomes Reporting

• Audit Review Flags: What items on claim forms or documentation could trigger an audit

• Documenting Functional Outcomes: An Alternative Approach

• How to Minimizing the Risk and Impact of an Audit

Seminar Sponsor: Team Care Manual & Physical Therapy Center

For information and or registration, contact: Tanya Frazier, Team Care

tanya.teamcare@ncrrbiz.com  919 603 5400, fax 919 603 5404.

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Seminar Sponsorship available,
Contact RCRI for information