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Teleconference: "Prepare for Audit: Will

Your Practice Pass the Test?"


Date: 12 October 2010, Tuesday 06:00 PM

"Prepare for Audit: Will Your Practice Pass the Test?"

The chances of you and your practice getting audited, scrutinized, or investigated is
much higher than ever before in the history of our profession.  Most practices are
doing things that can get them into a lot of trouble, and don't even know it.

In this teleconference, you will learn...

1) Changing your documentation and billing practices!

2) Important training and policies that MUST be in place. Don't let your
employees get you into trouble!

3) What to do and who to call if you get into trouble.

I think this is one of the most important issues in our industry.

What you do today will dramatically affect your future.

You are potentially going to be audited because Medicare has launched RAC Recover
Audit Contractors.

What RAC is?

Medicare has given private auditors this carte blanche free for all open door to go out
and audit Medicare providers.

For every dollar you collect back we’re going to give you this percentage.

They’re going out looking for easy prey and targets.

By 2014 there’s going to be 20 out of 50 that are going to audited or scrutinized.

Let’s see what you can do today so that you can be somewhat safe when you’re
audited.
I was asked to be an expert witness in court in Arizona.

A PT there was being charged with 57 counts of fraud.

90% of practices out there do not know what is going on.

The first item we’re going to address is your documentation and billing process.

You have to document a functional impairment.

You have to find a functional impairment in the initial evaluation.

Having paresthesia is not a functional impairment.

Having arthritis is not a functional impairment.

You must write down some functional impairment such as:

You’re though process

Basic 5 functional activities

Eating

Sleeping

If they cannot sleep they cannot heal

Standing

Going to the bathroom

Difficulty driving because….

Difficulty reading because bending down causes neck problems

Difficulty working at their desk

Difficulty golfing

Difficulty looking up to put away dishes

You want to have something functional

For each body part, write down at least 3 things that are functional
3 common impairments associated with each body part

Putting down some kind of functional impairment in their documentation

How much improvement?

15%, 22%, 25%

Use percentages

You want to start using percentages

Any lay person can understand percentages

They don’t understand our healthcare practice

They can easily see there’s a functional improvement each and every visit

If you don’t have a flow sheet in your practice to document who did it, a comparable
sign, a subjective sign

PT board have scrutinized my documentation and said we cannot fault you

This is not based on theory; it’s based on real life people being prosecuted for these
exact same things

Now your billing practices

The way most of you are billing is going to set you up or target you for overutilization
and billing fraud

Most of you don’t even know it

What they were trying to do to this PT practice was so unfair

We are starting a therapist advocacy group called TAG

Everybody just wanting to get money

A lot of therapists don’t know what to do when they are attacked

What should you do for billing practices?

#1 it has to do with the code 97110


Therapeutic exercise

If you have a patient comes in for their 3rd or 4th visit and you are watching them

Or a technician watching them

You might give them a verbal or tactile cue

Do you deserve to get paid?

When you get investigated they’re going to use this as a reason to take money back
unless you do something very important

They have just categorized ther ex as a one on one event that requires skilled
intervention

What you have to write down for that day’s ther ex is to write down how you actually
contributed or was involved with that ther ex

If you actually give them a tactile cue

You had to touch their lower back; I want you to flatten that or suck in your belly button

I want you to write down that you gave them a tactile cue

You can’t actually prove that you actually offered skilled intervention

It’s absolutely ridiculous, but that’s what they’re actually doing

Show how you intervened with the skill during that session

Does that make sense?

It’s outside the scope of this short teleconference

We’re creating this specific class for billing and documentation

97110 is one of the billing practices that you have to change

There is now directly from Feinberg’s office a CMS on how the 8 minute rule works

There’s still no clarification on when the timer starts or when the timer stops

The law doesn’t define when the tier starts or when the timer stops
You’re most safe by starting the timer when you start the procedure and stop the timer
when you actually stop the procedure

Secondly

There are certain training and policies that have to be in place

Therapist are crawling out of the woodwork saying James I’m getting scrutinized

#1 reason why these practices are getting in trouble

How did HealthSouth get into trouble?

Does anybody know?

The reason why they got into trouble was a disgruntled employee

A disgruntled employee is the one who opened the can of worms on HealthSouth

Your employees will get you into trouble

The court case was started from a PT student intern

The PT student intern, do they know anything about how the real world works?

A lot of interns think they know better than the owner or PT

A PT intern can get you into trouble if they think you’re not doing something right

One of the policies that you must have in place

#1 Policy

Your employees or PT student interns are not allowed to invite anyone into your facility
without specific authorization by you the owner

#2 Policy: no staff member or employee is allowed to reveal or share patient information


or documentation to anyone without specific authorization from you

What this means is this

Each employee should sign it

If they break any of these policies it’s immediate grounds for dismissal
The PT board, consumer affairs, RAC, and Medicare act like they are FBI when they
are not

They will come to you facility unannounced and will utilize to go to you when you are
most vulnerable, when you are not there

They will flash a badge

They will actually walk in and flash their badge and say I’m senior investigator so and so
from consumer affairs division

Is it ok to look at your patient charts

If the receptionist is not trained ahead of time what is she going to say

99% of the time the receptionist is going to say of course

They are intimidated

Here’s another things

#3 Policy: No staff members are to answer any questions about the daily operation,
about the financial operation, or about the clinical operations until specific authorization
from you, the owner

They are not to answer any questions regarding the clinical, financial, or operational of
the facility

Their appropriate response was to say you have not right to come in until I get
authorization from James Ko

They’re going to use that testimony from that pressurized interview

They don’t record it, they write it down

It’s very unfair

You have legal rights to not let them in

They have to get specific authorization to come in before they interrogate you staff

Have those 3 policies in place

#4 Policy: this specifically refers to PT board, consumer affairs, insurance companies


representatives, and Medicare representatives
If they come in, you as an employee are not allowed to let them in or see any
documentation, or question you without specific authorization from the owner

Make sure you address these with your staff immediately; it can happen to you anytime

They’ve used unscrupulous methods to try and prosecute

They will use your employees to turn against you

What do you do and who do you call if you get into trouble

First thing

If you get into trouble

If you get investigated or get served with papers

You do not want to answer their questions without legal representation

You must do it with our attorney represented

The attorney can advise how and what to answer or not

They’re specifically going out to prosecute and indict

They’re trying to rack up as many indictments as they can

They really don’t care if you’re a common, decent therapist

You call IndeFree

Therapist Advocacy Group

We will tell you exactly what to say and what to do

We will get you in contact with an attorney who know what they’re doing in your state

You will not want to fight this fight alone because you will lose

You don’t want anyone to look at your documentation without legal representation

The thing you don’t want to do is get an attorney who doesn’t have experience with
physical therapy

They will charge you upwards of 50 to 200,000 dollars if you have to go to court
Someone who has experience will be better and cheaper

There aren’t that many that are good for physical therapy

Out of all the boards, like nursing boards, medical boards, dental boards

Physical therapy boards are the most aggressive of all the boards
The PT board is almost becoming radical

Almost religious about it

And those of you that thought the PT board is you friend

They are far from being your friend

Their job is to prosecute you, not to help you

Look at your state practice act

If you state allows you to utilize 1 or 2 aides

They can render services under supervision and it’s like coming from you

But Medicare wants you to see one patient at a time

That’s something you can prove in court that you did nothing wrong

These experts are not experts

If you saw them in court see how they handle themselves in court

They’re like religious fanatics

They’re so absurd

What they’re trying to justify in their mind about what they’re doing

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