{"id":7117,"date":"2019-09-05T11:35:53","date_gmt":"2019-09-05T15:35:53","guid":{"rendered":"https:\/\/systems4pt.com\/staging\/?p=7117"},"modified":"2020-02-21T09:35:17","modified_gmt":"2020-02-21T14:35:17","slug":"medicare-audit-lessons-learned-from-six-months-of-scrutiny","status":"publish","type":"post","link":"https:\/\/systems4pt.com\/staging\/medicare-audit-lessons-learned-from-six-months-of-scrutiny\/","title":{"rendered":"Medicare Audit: Lessons Learned from Six Months of Scrutiny"},"content":{"rendered":"

Medicare Audit:\u00a0 Lessons Learned from Six Months of Scrutiny <\/strong><\/h1>\n

Interview with Scott Gardner, DPT and owner of FYZICAL Delmarva<\/em>.\u00a0 Scott owns practices in Delaware, Maryland, and Virginia, and just completed dual Medicare audits.<\/strong><\/h3>\n

Interview<\/strong><\/h2>\n

The following acronyms are used throughout the interview:<\/h3>\n

UPIC<\/strong>:\u00a0 Medicare Unified Program Integrity Contractor
\nTPE<\/strong>:\u00a0\u00a0 \u00a0Medicare Targeted Probe and Educate program
\nMAC<\/strong>: \u00a0Medicare Administrative Contractor
\nLCD<\/strong>:\u00a0 \u00a0\u00a0Local Coverage Determinations<\/p>\n

Hi Scott.\u00a0 Congratulations on your recent Medicare audit results!\u00a0 After successfully passing a three-month UPIC (Medicare Unified Program Integrity Contractor) audit, your network then underwent a subsequent TPE (Medicare Targeted Probe and Educate program) audit.\u00a0 The TPE audit scored 100 out of 100 possible points.\u00a0 <\/strong><\/p>\n

Thank you.\u00a0 It was a pretty intense distraction. \u00a0I\u2019m thankful we had the systems in place to succeed like we did.<\/p>\n

Most practice owners have not been audited by Medicare, let alone audited by both the UPIC and TPE \u00a0within the same year.\u00a0\u00a0 What advice would you give the practice owner who receives notice that they\u2019re going to be audited?<\/strong><\/p>\n

You want to be prepared BEFORE they knock on your door. The UPIC audit occurred last October. The TPE audit occurred this May about 3 months after passing the UPIC. \u00a0They will ask you a lot of questions about your practice. \u00a0The key to passing these audits is to keep your cool, have your policy and procedures up to date, and make sure your documentation will pass their review.\u00a0\u00a0 Every MAC (Medicare Administrative Contractor) will have an LCD (Local Coverage Determinations) manual. Make sure you are following the guidelines set forth in it.<\/p>\n

What was it like being audited?\u00a0 My imagination conjures up stark figures in trench coats.\u00a0\u00a0 What were the people like?\u00a0 What type of information did they ask for?<\/strong><\/p>\n

Just individuals doing their job. They were very nice. \u00a0They are looking to see if you are following what is in the LCD.\u00a0 They want to know if the documentation supports the need for skilled physical therapy. \u00a0They will ask for the entire chart, so make sure every \u201ci\u201d is dotted and every \u201ct\u201d is crossed.\u00a0 The UPIC Audit is different than the TPE audit.\u00a0 I suggest you familiarize yourself with both.<\/p>\n

How long did the process take?<\/strong><\/p>\n

Three months for each audit.<\/p>\n

What were the auditors looking for?\u00a0\u00a0 And what did they find?<\/strong><\/p>\n

They were checking whether my documentation had all the requirements that are in my MAC\u2019s LCD manual.\u00a0 Fortunately, I knew my LCD well and my documentation reflects what they look for when reviewing a chart. Using Systems 4PT helped tremendously as the hard stop at visit 10 ensured that we always had a 10th<\/sup> visit progress note. Current and forecasted functional limitations were important, and these were easy to document with the EBM (evidence-based medicine) button. \u00a0Also, the hundred or so words of defensive documentation that defend the severity of each evaluation code were another key point.\u00a0 I appreciate that this defensive documentation is built into S4PT.<\/p>\n

They found our documentation to be good and it was easy for them to follow the progression of patient through rehab. All paperwork supported the need for skilled intervention. All claims reviewed passed the audit on both UPIC and TPE.<\/p>\n

I honestly think that choosing Systems 4PT was a huge factor in us passing. The constant prompting during evaluations makes certain you have the proper documentation, the loading of defensible documentation after completing the patient\u2019s automated check in,\u00a0 the webinars that go over changes in Medicare requirements\u2026this all helped to keep us on the cutting edge. \u00a0But ultimately, it\u2019s up to the therapist to take the time to document progression. The days of \u201cfeeling better\u201d and\u00a0 \u201ctolerated treatment well\u201d are over.<\/p>\n

Silly question, but were the auditors happy that you were compliant?\u00a0 Were they complimentary?\u00a0 Or were they bummed that they didn\u2019t find problems?<\/strong><\/p>\n

They were smart, focused, and professional, but they held things close to the vest.\u00a0 I didn\u2019t know where we stood in the audit unit the final report.\u00a0 It was pretty nerve wracking. \u00a0After it was all said and done, they were very pleased and they were complimentary.<\/p>\n

What advice do you have for practice owners who are reading this?\u00a0 How can they position themselves to be super compliant the way you did?<\/strong><\/p>\n

We focus on documentation. We try to establish and document functional improvements as often as possible. We use the tools that Systems 4PT has put into the EMR to the best of our ability. It\u2019s tough to be compliant and treat patients and get your notes done in a timely matter. We have started using rolling carts in our clinic to perform point of service documentation whenever possible.<\/p>\n

It\u2019s now been verified that our clinic was able to achieve this 100-point Medicare audit score without sacrificing hands-on treatment time.\u00a0 That\u2019s very important to us. We don\u2019t want to give up the time spent with a patient to spend time typing.\u00a0 \u00a0We are thrilled that, rather than spend the time manually entering data, Systems 4PT recommends over 1,200 words of really-patient-specific defensive documentation in each evaluation.\u00a0 Obviously, we scrutinize the documentation.\u00a0\u00a0 But this workflow leaves us with significantly more hands-on treatment time with the patient.<\/p>\n

My advice is:\u00a0 Read over your documentation. Make sure it meets the demands on the LCD.\u00a0\u00a0\u00a0\u00a0 Assume the audit is coming and be ready when they come calling!<\/p>\n<\/div>

Want to be prepared for a Medicare Audit?<\/strong><\/h2>\n

Sign up for a free demo and learn how.<\/strong><\/h2>\n<\/div>[contact-form-7 id=\"5393\" title=\"Free Demo_copy\"][fusion_blog layout=”grid” blog_grid_columns=”” blog_grid_column_spacing=”” blog_masonry_grid_ratio=”” blog_masonry_width_double=”” equal_heights=”yes” number_posts=”3″ offset=”0″ pull_by=”category” cat_slug=”” exclude_cats=”” tag_slug=”” exclude_tags=”” orderby=”date” order=”DESC” thumbnail=”yes” title=”yes” title_link=”yes” content_alignment=”” excerpt=”” excerpt_length=”10″ strip_html=”yes” meta_all=”no” meta_author=”yes” meta_categories=”yes” meta_comments=”yes” meta_date=”yes” meta_link=”yes” meta_tags=”yes” scrolling=”pagination” grid_box_color=”” grid_element_color=”” grid_separator_style_type=”” grid_separator_color=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” \/]<\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":7118,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[56],"tags":[50,8,49],"class_list":["post-7117","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general","tag-billing","tag-documentation","tag-emr"],"yoast_head":"\nMedicare Audit: Lessons Learned from Six Months of Scrutiny - 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