If your therapy practice routinely overlooks such issues as timely physician signatures on the therapy plan of care, certification of your therapists and proper documentation of time on treatment notes, take a tip from an unlucky practice in southern New Jersey: These issues can mount up in an audit, and not in a good way.
Spectrum Rehabilitation, LLC, a therapy practice in Somers Point, N. J., is fighting a recommendation by the HHS Office of Inspector General (OIG) that it pay back more than $3 million of the $4 million it received from Medicare over a two-year period, according to
an audit report issued by the OIG.
At issue is the practice’s deficient documentation of its services – including the aforementioned problems, among others.
It didn’t help that Spectrum’s Medicare administrative contractor, Novitas Solutions Inc., had already questioned some of its claims in a previous audit.
In an audit of Spectrum’s therapy claims for the years 2009 and 2010, the OIG took a magnifying glass to 100 random claims for the therapy practice and determined that more than 80% of them were not properly documented or lacked medical necessity.
On the basis of that sample, the OIG then estimated that of Spectrum’s 40,129 claims totaling $4.12 million during that two-year period, the practice needed to pay back $3.1 million.
“Spectrum did not have a thorough understanding of Medicare reimbursement requirements related to outpatient therapy services and did not have adequate policies and procedures to ensure that it billed services that met Medicare requirements,” the OIG concluded.