Unfortunately it was no joke that on April Fool's Day the Manual Medical Review went into process.
This means that there will be pre-payment review (therapists will not be paid for services until after the patient has been seen) for patients who have exceeded the combined $3700 allowed per year for PT and Speech therapy combined in the following states: Florida California, Michigan, Texas, New York, Illinois, Louisiana, North Carolina, Pennsylvania, Ohio and Missouri.
For those who practice in states that are not affected by the pre-payment review, Medicare can take your money back in a post-payment audit.
It is likely that pre-payment review will become a national policy in the near future.
I watched an informative webinar on this topic that can be found at http://www.clinicient.com/4307-2/ It goes into what is happening and how to document best way possible to defend your services to an auditor.
One of the comments made by the instructor during this presentation that really stuck with me was "CMS (Center for Medicare and Medicaid Services) has designed a system to limit therapy services to Medicare recipients."
They have managed to do this in the following ways:
1. Monetary rewards for auditors. Auditors get paid on a percentage of the money that is recovered, so they are biased.
2. Making the process of review painstaking and lengthy. Reviewers claim it is 10 days, but in reality by the time delivery of documentation and approval and or denial is received (approvals and denials are sent by mail) it is double that time.
3. Documentation of additional codes: Developing difficult systems like G-codes, PQRS codes, KX modifiers etc... that easily allow for screw ups on a claim and cause a denial to occur. To ensure compliance check out these courses on G-codes found at http://www.sigproed.com/online_courses.html
4. Forcing the Therapist into a difficult moral and ethical circumstance. The therapist now has to decide if they can monetarily afford to provide services to a patient, knowing that they will likely be denied or have to waste time and energy to fight for their money.
