Back
Therapy Services Compliance
Perform a prospective or retrospective review of a sample of therapy claims
and supporting documentation to evaluate complete charge capture and
documentary support for claimed services, including "POS" accuracy,
assuring optimum revenue and prevention of overpayment. This review can be a
general review, provider specific, service-specific and/or site specific.
Associate specialties include:
- Physical therapy services
- Occupational therapy services
- Speech therapy services
Physical Therapy
- Evaluation of physician order
and treatment plan regulations, 30 day review and MD visit
requirements and documentary support for such
- Evaluation of compliance with
Medicare's "therapeutic benefit" requirement and documentary
support for such
- Complete charge capture,
accurate coding and documentary support for "incident-to" vs.
"private practice" vs. Institutional "facility fee"
Part A billing and correct Carrier vs. Intermediary billing
- Compliance with Medicare's
site of service requirements, correct billing based on site of service and
beneficiary Part A/Part B benefits availability/exhaustion
- Compliance with Medicare's
outpatient therapy caps and documentary support for such
- Compliance in the complex
coverage areas of wound care, ECP, EMG, gait training, ROJM, ultrasound,
shortwave, microwave, heat treatments, hot packs, paraffin baths,
infrared, and whirlpools.
- Compliance with regulations
governing time-based therapy codes and documentation to support such
- Compliance with Medicare's
"supervision" and "presence" requirements when therapy
services are provided by therapy assistants; documentary support for such
Speech Therapy
Review includes compliance in all the above areas as well as:
- Compliance with Medicare's
regulations governing reimbursable and non-reimbursable swallowing, speech
and language disorders and documentary support for such
- Review compliance in the
complex areas of restorative and maintenance speech therapy services,
initial assessment vs. re-assessment of language, routine speech services
necessary due to illness or injury; documentary support for such
Occupational Therapy
Review includes compliance in all the above PT areas as well as:
- Review focused upon documentary
support for Medicare's reimbursement requirement of "significant
practical improvement in functioning"
- Review compliance with
Medicare's reimbursement of maintenance program design and evaluation vs.
non-reimbursement for actual patient maintenance services; documentary
support for such
- Review compliance in the
complex area of OT coverage in psychiatric diagnoses; prevocational
/vocational testing and training, OTA's and OT
supplies
While a review of accurate and complete Diagnosis
Coding is standard to all reviews, a focused review on diagnosis coding
compliance and revenue optimization is available as an add-on or stand alone
engagement.
Perform a Credentialing Review of
therapy practitioners to determine compliance with Medicare and Third Party
Payer regulations governing minimal education and licensure requirements,
assuring reimbursable claims
Coding: “per diem” and
"backlog" coding services are available by AAPC certified coders
Our Coding Helpline to answer
coding/billing questions on demand is available with a 24 hour response time in
most cases.
“Documentation” and “Charge Capture” Templates
Claim Denial, Suspends and Reduction reviews are available to
identify problem areas and solutions; as well as preparing Re-submissions and Payer Appeals.
A "Shadow Review” service
for Third Party Payer "Medical
Claim Reviews" is available as an add-on or stand alone engagement.
Litigation Support
in Administrative Hearings, Fraud/Abuse Actions and Settlement
Negotiations.
Seminars for clinical staff in
compliance, coding, and documentation of therapy services
Billing Seminars on therapy
services
"Update Seminars" are
available focusing on regulatory change
All seminars are available on videotape
Additional services available