Hey, To make the point about limited skill documented in notes a little clearer along with the financial implications see below (copied for another list serve post). Jimmie Date: Tue, 12 Apr 2005 14:57:35 EDT From: [EMAIL PROTECTED] Subject: From the OIG
Dear PTManager Listserv: I copied the below from an OIG email I received today. It made me think. ------------------------------------------------------------------------ Results of the Medical Reviews Performed on Selected Medicare Claims for Physical and Occupational Therapy Services Provided During Calendar Year 2002 in the State of Texas (A-06-03-00085) http://www.oig.hhs.gov/oas/reports/region6/60300085.pdf This report provides the results of our review of a non-statistical sample of 100 physical and occupational therapy claims submitted for payment by 10 therapists in Texas during calendar year 2002. Our audit objective was to determine if the therapy services billed on these claims met Medicare reimbursement requirements. Medical reviewers from TriCenturion, a Program Safeguard Contractor for the Centers for Medicare and Medicaid Services, determined that 2,709, over 99 percent, of the 2,734 services contained in the 100 sampled claims did not meet one or more of Medicare's reimbursement requirements because the therapists did not maintain adequate documentation, the therapists did not meet the plan of care requirements or someone other than the billing therapists performed the services. Based on the results of the medical review, the therapists received $57,253 for services that should not have been billed to Medicare. We recommended that TrailBlazer Health Enterprises, ! LLC (TrailBlazer), a Medicare Part B carrier, recover these improper payments. TrailBlazer agreed with our findings and recommendations. _______________ Jimmie Arceneaux, LOTR Metro Preferred Home Care 3501 N. Causeway Blvd., Ste 200 Metairie, LA 70002 504-838-7080 Fax 504-833-9309 *** NOTICE--The attached communication contains privileged and confidential information. If you are not the intended recipient, DO NOT read, copy, or disseminate this communication. Non-intended recipients are hereby placed on notice that any unauthorized disclosure, duplication, distribution, or taking of any action in reliance on the contents of these materials is expressly prohibited. If you have received this communication in error, please delete this information in its entirety and contact the Amedisys Privacy Hotline at 1-866-518-6684. Also, please immediately notify the sender via e-mail that you have received this communication in error. *** -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
