|Does This Scenario Sound Familiar?
- You are a physical therapist in an outpatient setting (outpatient hospital, outpatient Skilled Nursing Facility, home setting, private practice, etc.)
- You spend as much time as you can trying to keep current in all issues related to running the business side of your practice setting while providing high quality clinical care to your patients
- You work with excellent employees who provide great clinical care, and an administrative staff who are equally dedicated to the success of your practice
- Although you love practicing in the outpatient setting, you are overwhelmed by all of the rules and regulations around coding, billing, documentation, and compliance, which take time away from treating patients
- You seem to be working harder for less. Cash flow and revenue generation are always concerns
- You know that even though you have the best intentions, you may have some problems with understanding the CPT coding system, and you know that despite your best efforts, your clinic’s documentation is not what it should be
- You may not always be coding accurately, and you think that you may do better with reimbursement if you understand how to code and bill correctly and if your fee schedule is accurate
- You recognize that Medicare regulations are constantly changing, and also realize the significance of the Medicare influence on the private payer - yet the maze of federal technical and statutory rules are frustrating
- You often get different answers to your questions depending on who you call or the day of the week
- You are aware that both public and private insurers are cracking down on paying for services that are not coded correctly or that are not medically necessary, and you are just hoping that your practice or facility is small enough that you do not trigger an audit of your coding and documentation
- But, you also understand that a great number of audits are purely random, and you want to make sure that if you are audited, you have done all you can to minimize the risk that you will have to pay back money, or worse, that you may be accused of committing fraud or abuse
- You have begun to read or hear about the increasing frequency of audits related to medical necessity issues, and that various government reports have highlighted physical therapy as a significant problem area, targeting their resources toward audits and investigations in the area of medical necessity of physical therapy services…
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