Medicare Audit Report and Update from Senate Bill S.382

Medicare Audits Report

As of February 2013 there have been 151 claims audited in North Carolina and 131 of them were denied.  That is an 88% denial rate!  Other states affected by these audits are Kentucky, Ohio, South Carolina and Virginia (denial rates of 83.8%, 77.7%, 87% and 63% respectively).

The Top 4 Reasons for Denial in NC are:

– Pulmonary rehab Not Warranted for Diagnosis (When you admit COPD patients into pulmonary rehab do you have spirometry to prove they qualify based on FEV1 and FEV1/FVC ratio?)

– Requested Medical Records Not Submitted Timely (please make sure you are working with your medical records department to ensure the response to audits are complete.  Don’t assume that they will include information like a information about physician supervision or PFTs)

– Documentation Did Not Include the Required Components

– Physician Must Be Readily Available

Updates for Senate Bill S. 382

We need your help!  In our recent communication with Senator Burr’s office, he has decided not to co sponsor S. 382 and Senator Hagan is still undecided.  Please contact these offices by phone or email and communicate your desire for their support!!

This may be the most important issue that we have some control over that has ever come our way. Not only does this open the door for NPPs to supervise sessions but it also may open the door for NPPs to sign 30 day reviews and perhaps even orders for CR. If Programs are trying to gain respect within their organization, they must address these financial issues when the opportunity arises. We must be proactive on this one.

This communication can be from anyone including referral sources, rehab staff, patients, etc.  We have a form letter that we are recommending that you use.

Action steps:

Use the template letter Follow up Template email for Senator-updated 2-15-13

to email Senator Burr and Hagan.

How to find Senators:

Every email counts!  Please take action!