Professional Documents
Culture Documents
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.
2) Important training and policies that MUST be in place. Don't let your
employees get you into trouble!
You are potentially going to be audited because Medicare has launched RAC Recover
Audit Contractors.
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.
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.
The first item we’re going to address is your documentation and billing process.
Eating
Sleeping
Standing
Difficulty golfing
For each body part, write down at least 3 things that are functional
3 common impairments associated with each body part
Use percentages
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
This is not based on theory; it’s based on real life people being prosecuted for these
exact same things
The way most of you are billing is going to set you up or target you for overutilization
and billing fraud
If you have a patient comes in for their 3rd or 4th visit and you are watching them
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
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
Show how you intervened with the skill during that session
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
Therapist are crawling out of the woodwork saying James I’m getting scrutinized
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
The PT student intern, do they know anything about how the real world works?
A PT intern can get you into trouble if they think you’re not doing something right
#1 Policy
Your employees or PT student interns are not allowed to invite anyone into your facility
without specific authorization by you the owner
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 actually walk in and flash their badge and say I’m senior investigator so and so
from consumer affairs division
If the receptionist is not trained ahead of time what is she going to say
#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 have to get specific authorization to come in before they interrogate you staff
Make sure you address these with your staff immediately; it can happen to you anytime
What do you do and who do you call if you get into trouble
First thing
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
They can render services under supervision and it’s like coming from you
That’s something you can prove in court that you did nothing wrong
If you saw them in court see how they handle themselves in court
They’re so absurd
What they’re trying to justify in their mind about what they’re doing