“CMS auditing systems failed to recognize that 61 percent of Medicare payments for outpatient physical therapy claims in 2013 were improperly filed, which cost the Medicare program nearly $367 million, says a new report by the OIG.”
“Only 116 out of 300 sample claims were submitted correctly, the report states. The remaining 184 claims were improperly filed for $12,741. OIG used the sample findings to determine that the majority of Medicare physical therapy claims from July 1, 2013 to December 1, 2013 were improperly filed.”
“OIG believes that CMS did not have the tools to identify medical necessity of physical claims, several coding errors, and documentation deficiencies…” Read the full article here.
Source: OIG: Medicare Could Save $367M by Auditing Improper Payments – By Thomas Beaton, March 29, 2018. HealthPayer Intelligence.
