Teleconference: "Prepare for Audit: Will Your Practice Pass the Test?

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Date: 12 October 2010, Tuesday 06:00 PM "Prepare for Audit: Will Your Practice Pass the Test?" The chances of you and your practice getting audited, scrutinized, or investigated is much higher than ever before in the history of our profession. Most practices are doing things that can get them into a lot of trouble, and don't even know it. In this teleconference, you will learn... 1) Changing your documentation and billing practices! 2) Important training and policies that MUST be in place. Don't let your employees get you into trouble! 3) What to do and who to call if you get into trouble. I think this is one of the most important issues in our industry. What you do today will dramatically affect your future. You are potentially going to be audited because Medicare has launched RAC Recover Audit Contractors. What RAC is? Medicare has given private auditors this carte blanche free for all open door to go out and audit Medicare providers. For every dollar you collect back we¶re going to give you this percentage. They¶re going out looking for easy prey and targets. By 2014 there¶s going to be 20 out of 50 that are going to audited or scrutinized. Let¶s see what you can do today so that you can be somewhat safe when you¶re audited. I was asked to be an expert witness in court in Arizona. A PT there was being charged with 57 counts of fraud.

Difficulty reading because bending down causes neck problems Difficulty working at their desk Difficulty golfing Difficulty looking up to put away dishes You want to have something functional For each body part. You have to document a functional impairment. You must write down some functional impairment such as: You¶re though process Basic 5 functional activities Eating Sleeping If they cannot sleep they cannot heal Standing Going to the bathroom Difficulty driving because«. Having arthritis is not a functional impairment. Having paresthesia is not a functional impairment. The first item we¶re going to address is your documentation and billing process. You have to find a functional impairment in the initial evaluation. write down at least 3 things that are functional 3 common impairments associated with each body part Putting down some kind of functional impairment in their documentation .90% of practices out there do not know what is going on.

25% Use percentages You want to start using percentages Any lay person can understand percentages They don¶t understand our healthcare practice They can easily see there¶s a functional improvement each and every visit If you don¶t have a flow sheet in your practice to document who did it. 22%. it¶s based on real life people being prosecuted for these exact same things Now your billing practices The way most of you are billing is going to set you up or target you for overutilization and billing fraud Most of you don¶t even know it What they were trying to do to this PT practice was so unfair We are starting a therapist advocacy group called TAG Everybody just wanting to get money A lot of therapists don¶t know what to do when they are attacked What should you do for billing practices? #1 it has to do with the code 97110 Therapeutic exercise If you have a patient comes in for their 3rd or 4th visit and you are watching them . a comparable sign. a subjective sign PT board have scrutinized my documentation and said we cannot fault you This is not based on theory.How much improvement? 15%.

Or a technician watching them You might give them a verbal or tactile cue Do you deserve to get paid? When you get investigated they¶re going to use this as a reason to take money back unless you do something very important They have just categorized ther ex as a one on one event that requires skilled intervention What you have to write down for that day¶s ther ex is to write down how you actually contributed or was involved with that ther ex If you actually give them a tactile cue You had to touch their lower back. but that¶s what they¶re actually doing Show how you intervened with the skill during that session Does that make sense? It¶s outside the scope of this short teleconference We¶re creating this specific class for billing and documentation 97110 is one of the billing practices that you have to change There is now directly from Feinberg¶s office a CMS on how the 8 minute rule works There¶s still no clarification on when the timer starts or when the timer stops The law doesn¶t define when the tier starts or when the timer stops You¶re most safe by starting the timer when you start the procedure and stop the timer when you actually stop the procedure Secondly . I want you to flatten that or suck in your belly button I want you to write down that you gave them a tactile cue You can¶t actually prove that you actually offered skilled intervention It¶s absolutely ridiculous.

There are certain training and policies that have to be in place Therapist are crawling out of the woodwork saying James I¶m getting scrutinized #1 reason why these practices are getting in trouble How did HealthSouth get into trouble? Does anybody know? The reason why they got into trouble was a disgruntled employee A disgruntled employee is the one who opened the can of worms on HealthSouth Your employees will get you into trouble The court case was started from a PT student intern The PT student intern. do they know anything about how the real world works? A lot of interns think they know better than the owner or PT A PT intern can get you into trouble if they think you¶re not doing something right One of the policies that you must have in place #1 Policy Your employees or PT student interns are not allowed to invite anyone into your facility without specific authorization by you the owner #2 Policy: no staff member or employee is allowed to reveal or share patient information or documentation to anyone without specific authorization from you What this means is this Each employee should sign it If they break any of these policies it¶s immediate grounds for dismissal The PT board. consumer affairs. and Medicare act like they are FBI when they are not They will come to you facility unannounced and will utilize to go to you when you are most vulnerable. when you are not there . RAC.

financial. about the financial operation. insurance companies representatives. they write it down It¶s very unfair You have legal rights to not let them in They have to get specific authorization to come in before they interrogate you staff Have those 3 policies in place #4 Policy: this specifically refers to PT board. you as an employee are not allowed to let them in or see any documentation. and Medicare representatives If they come in. or question you without specific authorization from the owner Make sure you address these with your staff immediately. or about the clinical operations until specific authorization from you.They will flash a badge They will actually walk in and flash their badge and say I¶m senior investigator so and so from consumer affairs division Is it ok to look at your patient charts If the receptionist is not trained ahead of time what is she going to say 99% of the time the receptionist is going to say of course They are intimidated Here¶s another things #3 Policy: No staff members are to answer any questions about the daily operation. the owner They are not to answer any questions regarding the clinical. it can happen to you anytime They¶ve used unscrupulous methods to try and prosecute . consumer affairs. or operational of the facility Their appropriate response was to say you have not right to come in until I get authorization from James Ko They¶re going to use that testimony from that pressurized interview They don¶t record it.

medical boards. like nursing boards. dental boards .They will use your employees to turn against you What do you do and who do you call if you get into trouble First thing If you get into trouble If you get investigated or get served with papers You do not want to answer their questions without legal representation You must do it with our attorney represented The attorney can advise how and what to answer or not They¶re specifically going out to prosecute and indict They¶re trying to rack up as many indictments as they can They really don¶t care if you¶re a common. decent therapist You call IndeFree Therapist Advocacy Group We will tell you exactly what to say and what to do We will get you in contact with an attorney who know what they¶re doing in your state You will not want to fight this fight alone because you will lose You don¶t want anyone to look at your documentation without legal representation The thing you don¶t want to do is get an attorney who doesn¶t have experience with physical therapy They will charge you upwards of 50 to 200.000 dollars if you have to go to court Someone who has experience will be better and cheaper There aren¶t that many that are good for physical therapy Out of all the boards.

not to help you Look at your state practice act If you state allows you to utilize 1 or 2 aides They can render services under supervision and it¶s like coming from you But Medicare wants you to see one patient at a time That¶s something you can prove in court that you did nothing wrong These experts are not experts If you saw them in court see how they handle themselves in court They¶re like religious fanatics They¶re so absurd What they¶re trying to justify in their mind about what they¶re doing .Physical therapy boards are the most aggressive of all the boards The PT board is almost becoming radical Almost religious about it And those of you that thought the PT board is you friend They are far from being your friend Their job is to prosecute you.

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