First Coast to Audit Therapy Claims in Puerto Rico
On July 24, 2012, First Coast Service Options activated a prepayment edit for therapy services rendered by specialty 25 (Physical Medicine and Rehabilitation) in Puerto Rico. This was due to medical review findings that revealed this specialty presents an 88 percent error rate. The purpose of the edit is to prevent the payment of non-covered, incorrectly coded, and inappropriately billed services. Also, with medical review assistance, customer service now advises providers in correcting the billing and documentation errors. Data for October 1 through December 31, 2013, show an error rate of 81 percent. A significant amount of this error rate