Catch Me If You Can, Yet Again! RACs Looking to Bust Therapy Providers for Billing Untimed Codes

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Original story posted on: September 27, 2017
The automated review focused on “excessive units” of untimed therapy, approved by CMS for the RACs, continues to vex therapy providers.

Automated review focused on “excessive units” of untimed therapy has been approved by the Centers for Medicare & Medicaid Services (CMS) for all four Recovery Audit Contractor (RAC) regions. In plain English, this is billing for untimed units numbering greater than one per visit. For example, if a patient received mechanical traction (as indicated in the plan of care) for 23 minutes, only one unit can be billed, as mechanical traction is an untimed, service-based code. The minutes do not count toward timed code treatment minutes; rather, they are tallied in total treatment minutes, as required by Medicare.

Longtime subscribers to RACmonitor may recall my 2009 article on this same topic: it was one of the first automated issues announced when the permanent RACs rolled out: https://www.racmonitor.com/catch-me-if-you-can-staying-ahead-of-the-rac-reviews-of-untimed-codes.

What is more than a bit perplexing about the posting (reissuing) of this CMS-approved issue is the fact that the Medicare Administrative Contractors (MACs) should have long ago instituted payor side edits to prevent the payment of untimed therapy codes that are billed in units greater than one (what they are labeling as “excessive units.”) Providers should know and understand the billing rules, that is a given, and the money should be recouped if units greater than one were billed and paid. But now we are going through a process that demands time from everyone concerned to manage and adjust, because MAC preventive edits were not in place.

Of note, in the 2009 vetting of this automated issue, we reported that therapy providers were getting denials for two separate untimed codes on the same claim, which is permissible (given other coding rules to the contrary). For example, such a scenario would be billing for a physical therapy evaluation (untimed code), and for the same visit billing for unattended electrical stimulation (untimed code). Another problem we noted during one of our first Monitor Mondays broadcasts was automated adjustments by a RAC for two different speech codes, not subject to CCI edits, in the same visit.

Here is how it is framed up by each of the RACs, using the following reference citations:

RAC Provider Types Description
Region 1
Performant
Outpatient Hospital; Part B Professional Services; Outpatient Non-Hospital Facility; Skilled Nursing Facility (SNF); Outpatient Rehab Facility (ORF); Comprehensive Outpatient Rehab Facility (CORF); Physician and Non-Physician Practitioner/Provider Specialty When reporting service units for untimed codes (excluding Modifiers -KX, and -59), wherein the procedure is not defined by a specific time frame, the provider should enter a “1” in the units billed column, per date of service.
Region 2
Cotiviti
OPH; OP Non-Hospital; SNF; ORF; CORF; Physician When reporting service units for untimed codes (excluding Modifiers -KX, and -59), wherein the procedure is not defined by a specific time frame, the provider should enter a “1” in the units billed column, per date of service.
Region 3
Cotiviti
OPH; OP Non-Hospital; SNF; ORF; CORF; Physician When reporting service units for untimed codes (excluding Modifiers -KX, and -59), wherein the procedure is not defined by a specific time frame, the provider should enter a “1” in the units billed column, per date of service.
Region 4
HMS
Critical Access Hospital (CAH); Other Carrier Biller; Other FI Biller; Outpatient Hospital; Part B Professional Services (Physician/Non-Physician Practitioner); Skilled Nursing Facility When reporting service units for untimed codes (excluding Modifiers -KX, and -59), wherein the procedure is not defined by a specific time frame, the provider should enter a “1” in the units billed column, per date of service.

 

This is a great opportunity to update your therapy compliance risk assessment, and given the new posting by the RACs, to frame up an “automated audit” of your facility’s billed untimed codes. In instances wherein two units of an untimed code were billed and paid, review the therapy note, the corresponding claim, and remittance advice to determine the relevant facts: did the provider bill for units greater than one, as noted on the daily note? Did your billing system or clearinghouse scrub the claim and submit the claim appropriately, for one unit of service for an untimed code? Did you receive payments for excess units of untimed codes?

A further reminder for therapy providers is to continue to look for other known areas of concern regarding therapy that have been cited by your MAC, starting with posted probe reviews and Comprehensive Error Rate Testing (CERT) findings. The CERT Task Force has posted guidance for therapy providers than can be found at your MAC’s website. For those 15,000 physical therapists in private practice that received a comparative billing report (CBR) earlier this year, take some time to review your report and determine if your individual analysis with respect to your state and national peer group requires further attention.

A handy reference of my articles for RACmonitor is summarized here: https://nancybeckley.com/racs/rac_articles_by_nancy_beckley/.

They all link back to the source articles at http://racmonitor.com.

Nancy J. Beckley, MB, MBA, CHC

Nancy Beckley is founder and president of Nancy Beckley & Associates LLC, providing compliance planning and outsourced compliance services to rehab providers in hospitals, rehab agencies, and private practices. Nancy is certified in healthcare compliance by the Healthcare Compliance Certification Board. She is on the board of the National Association of Rehabilitation Providers and Agencies. She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities. Nancy is a familiar voice on Monitor Mondays, where she serves as a senior national correspondent.

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