I saw the information below listed on the CMS website and have a few questions:
1. Does a "claim" represent a date of service or all DOS for the same patient
2. When they reference eligible claims do they mean per physical therapist or any physical therapist for a specific patient
3. Lastly, does anyone know if the information they are requesting is based on the tax ID/NPI or provider number?
July 10, 2015 ? In mid-January 2015, CMS approved the Recovery Auditors to begin reviewing Outpatient Therapy Threshold claims (those over the $3700 threshold) that were paid March 1, 2014 through December 31, 2014. In an effort to minimize provider burden, CMS set restrictions on the number of Additional Documentation Requests (ADRs) that could be sent related to these claims, as shown below.
1st ADR: can only request documentation for 1 claim
2nd ADR: can request up to 10% of total eligible1 claims
3rd ADR: up to 25% of remaining eligible claims
4th ADR: up to 50% of remaining eligible claims
5th ADR: up to 100% of remaining eligible claims
(1 Total number of claims over the $3700 Threshold that were paid March 1, 2014 through December 31, 2014)
Thanks for your help!
Peggy
1. Does a "claim" represent a date of service or all DOS for the same patient
2. When they reference eligible claims do they mean per physical therapist or any physical therapist for a specific patient
3. Lastly, does anyone know if the information they are requesting is based on the tax ID/NPI or provider number?
July 10, 2015 ? In mid-January 2015, CMS approved the Recovery Auditors to begin reviewing Outpatient Therapy Threshold claims (those over the $3700 threshold) that were paid March 1, 2014 through December 31, 2014. In an effort to minimize provider burden, CMS set restrictions on the number of Additional Documentation Requests (ADRs) that could be sent related to these claims, as shown below.
1st ADR: can only request documentation for 1 claim
2nd ADR: can request up to 10% of total eligible1 claims
3rd ADR: up to 25% of remaining eligible claims
4th ADR: up to 50% of remaining eligible claims
5th ADR: up to 100% of remaining eligible claims
(1 Total number of claims over the $3700 Threshold that were paid March 1, 2014 through December 31, 2014)
Thanks for your help!
Peggy