A recent audit by the Office of the Inspector General (OIG) of claims during a 6-month period in 2013 finds $367 million in Medicare funds that were overpaid to physical therapists for services that did not comply with Medicare requirements.
The OIG reviewed a total of $635.8 million of Medicare Part B claims for outpatient physical therapy services provided during a 6-month period from July 1 through December 31, 2013. In a stratified random sample of 300 of those claims, OIG determined that 61% failed to comply with Medicare medical necessity, coding, or documentation requirements.
“Specifically, of the 300 claims in our stratified random sample, therapists claimed $12,741 in Medicare reimbursement on 184 claims that did not comply with Medicare requirements,” the OIG notes in statement, according to a news story from Healthcare Finance.
According to the OIG, these overpayments occurred because Centers for Medicare & Medicaid Services’ controls were ineffective at preventing unallowable payments for outpatient physical therapy services.
OIG made several recommendations, including that CMS instruct Medicare Administrative Contractors to notify providers of potential overpayments so that they can take the necessary actions to investigate and possibly return overpayments per Medicare guidelines; implement methods of improved oversight for the appropriateness of outpatient physical therapy claims; and educate providers about Medicare requirements for submitting outpatient physical therapy claims for reimbursement.
Per the news story, CMS disagreed with these recommendations, the overpayment findings, as well as certain policy interpretations, and believes that further analysis is needed regarding whether the claims met Medicare requirements.
[Source(s): Healthcare Finance, Becker’s Hospital Review]