November 2, 2009

Florida Providers Report Receiving Demand Letters

By

nbeckleyFlorida outpatient therapy providers report receiving Demand Letters under the Recovery Audit Contractor Program from Connolly, the Region C RAC, according to Nancy J. Beckley, MS, MBA, CHC.

Beckley reports that Connolly was the first RAC to post CMS approved issues for automated review.  Among those issues posted was Untimed Codes, as noted in the RACMonitor article predicting likely outpatient rehab targets: http://racmonitor.com/news/43-special-bulletin/198-likely-outpatient-rehab-rac-targets-hiding-in-plain-sight.html .

A Florida therapy provider, who asked not to be identified, reported to Beckley about receiving several demand letters related to the billing of speech therapy untimed codes in units greater than one.

Beckley said the provider has multiple Florida facilities and the improper billing was found, upon internal investigation to be limited to one facility and individual and likely due to a communication error.

"The provider also reported receiving an additional RAC demand letter regarding speech therapy untimed evaluation codes being billed simultaneously with therapy untimed treatment codes," said Beckley. "The provider is in the process of an investigation to determine all the facts on this situation."

"Untimed Codes being billed in increments greater than one were noted in the RAC Demonstration in California, New York and Florida.  The issues with Speech untimed codes raised eyebrows in the rehab community due to the $3.2 million in improper speech therapy payments discovered in the RAC demo," said Beckley.  "Following Connolly's lead HDI (Region D) and CGI (Region B) both posted Untimed Codes as a CMS approved issue for automated review.  It is likely that DCS Healthcare (Region A) will also have this issue approved by CMS."

According to Beckley, Connolly describes the issue as "CPT Codes (excluding modifiers KX, and 59) where the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one (1) in the units billed column per date of service."  Additional information for providers provided as a reference by Connolly:  CMS Pub 100-04, Transmittal 1019, dated 8.3.06, pages 7-11, and CMS Pub 100-04, Ch. 5, § 20.2.  The Connolly reference can be reviewed at: http://www.connollyhealthcare.com/RAC/pages/approved_issues.aspx

For a refresher on avoiding problems with the issue of Untimed Codes there are suggestions in the following article:http://www.racmonitor.com/news/43-special-bulletin/215-catch-me-if-you-can-staying-ahead-of-the-rac-reviews-of-untimed-codes.html

For more news on this developing story keep watching RACMonitor.

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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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