Medicare forked out $367 million in overpayments to physical therapists during a 6-month period in 2013, according to a recent audit by the Office of the Inspector General.
The OIG reviewed outpatient physical therapy services claims totaling $635.8 million for services provided by therapists from July 1 through December 31, 2013. OIG looked at a stratified sample random sample of 300 of those claims. The OIG said 61 percent of the claims for outpatient physical therapy services they reviewed didn't comply with Medicare medical necessity, coding, or documentation requirements.
"Specifically, of the 300 claims in our stratified random sample, therapists claimed $12,741 in Medicare reimbursement on 184 claims that did not comply with Medicare requirements," the OIG said in statement.
The agency estimated that during the 6-month audit period, Medicare paid $367 million for outpatient physical therapy services that did not comply with Medicare requirements. OIG blamed the Centers for Medicare & Medicaid Services' controls for not preventing "unallowable payments" for outpatient physical therapy services.
OIG made several recommendations, including that CMS instruct the Medicare Administrative Contractors to notify providers of potential overpayments so that they can take the necessary actions to investigate and possibly return overpayments per Medicare guidelines; implement methods of improved oversight for the the appropriateness of outpatient physical therapy claims; and educate providers about Medicare requirements for submitting outpatient physical therapy claims for reimbursement. OIG said CMS largely disagreed with their findings and recommendation that providers be notified.
They said CMS also disagreed with certain policy interpretations and believes further analysis as to whether the claims met Medicare requirements is needed.
"We maintain that the error determinations by our medical reviewer were correct and that all of our associated recommendations are valid," the OIG said.
Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com