Questionable Billing for Medicare Outpatient Therapy Services.
(10/04/2013)
To identify questionable billing for Medicare outpatient therapy services in 2009. Outpatient therapy is designed to improve, restore, and/or compensate for loss of functioning following illness or injury. Medicare expenditures for outpatient therapy increased 133 percent between 2000 and 2009, from $2.1 billion to $4.9 billion, while the number of Medicare beneficiaries receiving outpatient therapy increased only 26 percent, from 3.6 million to 4.5 million. Medicare limits (i.e., caps) its annual per-beneficiary outpatient therapy expenditures. Providers may exceed a beneficiarys cap if the services are medically necessary and are supported by medical record documentation. If services are expected to exceed...
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Số trang: 35 |
Lĩnh vực: Y học lâm sàng |
Năm XB: 2010 |
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Questionable Billing for Medicare Outpatient Therapy Services. | Số trang: 35
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To identify questionable billing for Medicare outpatient therapy services in 2009. Outpatient therapy is designed to improve, restore, and/or compensate for loss of functioning following illness or injury. Medicare expenditures for outpatient therapy increased 133 percent between 2000 and 2009, from $2.1 billion to $4.9 billion, while the number of Medicare beneficiaries receiving outpatient therapy increased only 26 percent, from 3.6 million to 4.5 million. Medicare limits (i.e., caps) its annual per-beneficiary outpatient therapy expenditures. Providers may exceed a beneficiarys cap if the services are medically necessary and are supported by medical record documentation. If services are expected to exceed an annual cap, providers must indicate this when submitting the claim to Medicare. We identified 20 counties that had in 2009 (1) the highest average Medicare payment per beneficiary and (2) more than $1 million in total Medicare payments for outpatient therapy (i.e., high-utilization counties). We analyzed Miami-Dade County, Florida, separately because it had the highest average Medicare payments per beneficiary among the high-utilization counties and the highest total Medicare payments for outpatient therapy in 2009. Additionally, prior Office of Inspector General work has demonstrated that Miami-Dade County is a high-risk area for Medicare fraud.
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