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OIG study finds physicians bill PT incorrectly

Rehab Private Practice Alert, May 10, 2006

The Office of Inspector General (OIG) of the Department of Health and Human Services found that 91% of physical therapy services billed by physicians in the first six months of 2002 failed to meet program requirements, resulting in improper Medicare payments of $136 million, according to PT Bulletin Online.

The OIG study found that the total payments for physical therapy claims from physicians rose from $353 million in 2002 to $509 million in 2004, and that the number of physicians billing the program for more than $1 million in physical therapy more than doubled in that two-year period.

The OIG said that "CMS should consider revisions, clarifications, and further study of the 'incident to' rule to ensure that Medicare beneficiaries are receiving skilled services from appropriately trained and licensed staff," reported PT Bulletin.

American Physical Therapy Association President Ben F Massey, Jr, PT, MA, urged Congress to take action this year to completely remove physical therapy as an "incident to" service in physician offices and to tighten Stark II referral-for-profit regulations to eliminate financial incentives that contribute to high physician billing of physical therapy services.

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