Home Health & Hospice Week

If you furnish Part B outpatient therapy to patients in the home, you should pay attention to a new round of edits for therapy practices.

Heads up: Palmetto GBA will be conducting an outpatient physical therapy probe for private practices in Jurisdiction 11. Practices in West Virginia, Virginia, North Carolina, and South Carolina, will undergo review for the following CPT® codes: 97113 (aquatic therapy), 97110 (therapeutic exercises), 97530 (therapeutic activities), 97140 (manual therapy), 97112 (neuromuscular reeducation), 97116 (gait training), 97032 (electrical stimulation), 97016 (vasopneumatic devices), 97150 (group therapy), 97012 (traction), 97535 (self care/home management training), 97035 (ultrasound).

A recent data analysis by Palmetto revealed 12 private practice settings billing a "significantly" high number of these codes. "Claims review will be performed on approximately 100 claims per state for each of the procedure codes selected," Palmetto says.

The writing on the wall: All therapy or-ganizations should take this probe as a warning. "We are starting to see more pre-payment audits in the profession [and] I suspect that will only get worse," notes physical therapist Meryl Freeman, manager of outpatient rehab at Rex Healthcare in Raleigh, N.C.

Best bet: Don't cut corners on billing and documentation. "If physical therapists are doing what they should be doing, they should not have anything to worry about," says PT Flo Moses, president of Sports & More Physical Therapy Inc. in Raleigh, N.C. Having systems in place to support medical necessity is key -- and for all patients, not just Medicare, she says.

For more information on providing Part B outpatient therapy, subscribe to Eli's Rehab Report at www.elihealthcare.com.