Medicare Audit Update

Posted by Marsha Lawrence, PT, CHT on 09/07/2014

Medicare has just completed a pre-payment audit on several areas, including orthotics and prosthetics for the second quarter of 2014 (4/1-6/30). Of the 7,700+ claims reviewed in all targeted categories, 60% were denied. While the actual percentage of orthotics claims was not revealed, the primary reasons for orthotics denials were:

No medical records were submitted

The required documentation indicating medical need was absent

The item was previously billed and the claim was processed

Make sure your documentation is up to Medicare standards! Attend the Annual Meeting Pre-Conference Institute, “Hands On With Compliance, featuring Nancy Beckley.” Nancy Beckley will be available for consultation after the session.
Register now
About Nancy Beckley
Nancy J. Beckley is the president of Nancy Beckley & Associates LLC, a firm specializing in outpatient therapy compliance. Nancy has a MS in Therapeutic Recreation from the University of Illinois, an MBA from the University of South Florida and has completed the Harvard University Course for Managed Care Executives. Nancy is certified in Healthcare Compliance by the Healthcare Compliance Certification Boards. She is a nationally known speaker in the area of rehab compliance, and has presented at the Provider Practice Compliance Conference, Florida Compliance Conference, and the Annual Compliance Institute and is a frequent speaker at APTA conferences on compliance topics. She was featured in a Healthcare Compliance Association webinar on Hospital Risks in Outpatient Therapy.  She has authored four articles for Compliance Today and written over 25 articles on the Recovery Auditor (RAC) program.  Clients include providers under Medicare probe review, progressive corrective action plans, corporate integrity agreements, ZPIC investigations and RAC audits. Nancy’s background includes 15 years hospital experience serving in management capacities at two large inpatient rehabilitation facilities, as well as the development of an outpatient work hardening center. She has extensive program management and managed care contracting experience, and counts hand therapists are some of her favorite clients!