Posts by Tom Ambury

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The PT’s Guide to Surviving a Medicare Audit

“How can I avoid being audited by Medicare?” This is one of the compliance questions I hear most frequently, and the honest answer is, quite simply, that you can’t. Just because CMS or one of its auditing entities hasn’t come knocking on your door doesn’t mean you’re not being audited.

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Creating a Compliance Plan for Your Practice

Today, we will "chat" about the system of checks and balances your practice should have in place to ensure you follow compliance regulation requirements—in other words, your compliance plan. I know, at least lately, it seems the regulatory requirements to participate in health care have been sharply increasing. At PT Compliance Group, we have been focusing on the federal level, but state regulations and private insurance requirements also are changing. Below, I’ve addressed some of the questions I commonly hear regarding compliance plans.

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HIPAA Rules for Marketing and Sales

Before you get too far into your plans to beef up your clinic’s sales and marketing efforts, remember that you’re a healthcare provider first, which means you’ve got some HIPAA hoops to jump through (ahem, rules to follow) that the small business owner down the street probably doesn’t have to worry about. Before we get into that, though, let’s establish a bit of background.

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Compliance Expert Tom Ambury Talks ICD-10

Everyone has been gearing up in preparation of the October 1, 2014, ICD-10 implementation deadline. (Even CMS changed their claim form requirements: beginning on April 1, 2014, if you submit paper claims, you must use CMS1500 version 2/12 instead of version 8/05.) No one thought there would be another delay—that is, until Thursday, March 27, when the House of Representatives passed HR 4302, a bill that contained a provision to delay the implementation and extend the therapy cap and its exception process until 2015.

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ICD-10: Is Your Clinic Ready?

Today, the ICD-10 implementation date is less than a year away. I know a year away can seem like a long time, but this will most likely be the major compliance initiative of 2014, so it’s good to be ready. With that in mind, let’s take a look at ICD-10, and hopefully I can provide you with some practical advice on how to prepare.

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Functional Outcome Measures

By now, I hope most of you are using functional outcome measures. If you haven’t started yet, you might want to consider taking the next few weeks to get prepared and begin the process in January of 2013. Why? Let’s start with the fact that physical therapy documentation is coming under greater scrutiny especially regarding demonstrating the medical necessity of the treatments provided.

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Details and Discussion on the $3,700 Threshold Update

We are now well into the exception process associated with the $3,700 threshold. The clinics that I’ve been working with have done fairly well in that they have not received any outright denials of services. But let's look at the responses we have received: The responses from the Medicare Administrative Contractors (MACs) have fallen into three categories: Approval, Partial Approval, and Additional Documentation Requests (ADRs). Let's go through each one to see what Medicare will require of you.

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