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As Medicare audit and assessment efforts increase, PTs are under increasing pressure to ensure compliance with coverage, payment, coding, documentation, and billing requirements.
The following resources are intended to help PTs with compliance in preparation for an audit as well as provide tools to use throughout the audit process. If you have questions about this information, contact advocacy@apta.org.
Audit Tools
Conducting a Self-Audit. Self-audits are an important way for practice owners and managers to reduce risk of claims denials. APTA's self-audit form walks you through the process, and links to relevant APTA and CMS resources along the way.
CMS: Appeals Process. From CMS, guidance on the appeals process, including frequently asked questions and answers, and tips for filing an appeal.
Tools for the Top Audit Compliance Issues
Medicare Local Coverage Decisions. In certain circumstances, individual Medicare Administrative Contractors have the leeway to make decisions on what's deemed reasonable and necessary. Those Local Coverage Determinations can be the source of compliance and audit issues. Find out more.
Medicare Denials, Audits & Appeals: Targeted Probe and Educate Program. The CMS Targeted Probe and Education program, or TPE, uses data analysis to select providers for audits in an effort to cut down on reviews and related provider appeals. ATPA provides you with resources to better understand the system.
Coding and Billing. APTA's Coding and Billing webpage puts you in touch with a host of resources that can help you avoid claims audits.