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Essay / Research Paper Abstract
A 3 page article summary that addresses an article by John Wallace on Medicare audits as they pertain to physical therapists. Medicare and Medicaid paperwork can present physical therapists (PTs) with a complicated set of "red tape" regulations that have to be followed explicitly. Furthermore, he various audits and review processes that can be PT practices add to the confusion. In his article, "A look at who's doing the reviewing, what's being scrutinized and how best to ensure compliance," author John Wallace offers a Medicare audit and review primer for PTs. Bibliography lists 2 sources.
Page Count:
3 pages (~225 words per page)
File: D0_khpts.rtf
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Unformatted sample text from the term paper:
and review processes that can be PT practices add to the confusion. In his article, "A look at whos doing the reviewing, whats being scrutinized and how best to ensure
compliance," author John Wallace offers a Medicare audit and review primer for PTs. Wallace begins by pointing out that recent changes in Medicare requirements have resulted in many outpatient
practices redoubling their efforts to be in compliance with federal regulations. This development is fortuitous as during the past year the Centers for Medicare and Medicaid Services (CMS) and the
US Department of Health and Human Services Office of Inspector General (OIG) has escalated its review of services in regards to Medicare policy compliance. There are four primary sources of
Medicare record reviews and audits: 1. contracted payers (carriers and fiscal intermediaries (FIs); 2. the Comprehensive Error Rate Testing (CERT) program; 3. OIG; and 4. the Recovery Audit Contract (RAC)
initiative (Wallace 28). The common purpose of each of these audit and review processes is to identify and recover improper Medicare payments to health care providers and facilities. Government
statistics show that this can amount to a considerable amount of money. CMS figures show that in 2004 $21.7 billion was paid for services that did not comply with Medicare
billing stipulations. Also in 2004, spending on services rendered by physical therapists (PTs) increased dramatically. Wallace lists various areas in physical therapy were this is true and indicates the percentages
involved. Due to this factor, outpatient physical therapy services are being closely examined by federal officials (Wallace 28). Due to this scrutiny, Wallace feels that PTs should be familiar
with sources of audits and reviews and what these procedures entail. Wallace then takes each of the categories listed above and explains the review/audit process for that category. For
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