PT Private Practice Site Visits Required by Medicare

Under the Affordable Care Act (ACA) physical therapists in private practice were elevated from a “low” risk in the enrollment category to a “moderate” risk. Physical Therapist in private practice were enrolled prior to 3/25/2011 are now required to revalidate their information. As part of the revalidation process a site visit will be performed to . . . → Read More: PT Private Practice Site Visits Required by Medicare

CMS Announces New Program Integrity Initiatives: More Recoupment Efforts Will be Forthcoming

CMS announced today that effective January 1, 2012 they will conduct demonstration projects designed to strengthen Medicare by aiming at eliminating fraud, waste, and abuse. Three programs were announced:

Recovery Audit Prepayment Review: The Recovery Audit Prepayment Review demonstration will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure . . . → Read More: CMS Announces New Program Integrity Initiatives: More Recoupment Efforts Will be Forthcoming

CMS Posts Listing of Providers Receiving Revalidation Notices

CMS has posted a listing of providers and suppliers who have received enrollment revalidation requests under the Affordable Care Act initiative requiring all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. Under Section 6401 (a) of the ACA those providers who enrolled prior to March 25, 2011 are required . . . → Read More: CMS Posts Listing of Providers Receiving Revalidation Notices

Senate Finance Report: Gaming of Medicare by For-Profit Home Health Companies

The Senate Committe on Finance release a report today showing that home health companies intentionally increased frequency of home health therapy visits to manipulate Medicare reimbursement rates. Senate Finance Committee Chairman Max Baucus (D-Mont.) and senior Finance Committee Member Chuck Grassley (R-Iowa) released this report showing tactics used by major for-profit home health companies to . . . → Read More: Senate Finance Report: Gaming of Medicare by For-Profit Home Health Companies

CMS New Electronic Submission of Medical Records: esMD

On a recent MonitorMonday podcast sponsored by RACMonitor.com, Melanie Combs-Dyer, Deputy Director of the Compliance Group, CMS Office of Financial Management provided listeners with how the roll out of esMD will take place. Providers will now be able to submit medical records that have been requested by various contractor electonically, rather than via fax, mail . . . → Read More: CMS New Electronic Submission of Medical Records: esMD

Compliance Update for Rehab Podcast Now Available

The third podcast in an annual series with Rehab Management has been posted. Compliance Update for Rehab Clinics and Practitioners. This year the podcast contains important update information as a result of the Patient Protection and Affordable Act as well as the impact of other regulatory initiatives to combat fraud and abuse in the Medicare . . . → Read More: Compliance Update for Rehab Podcast Now Available