Wisconsin Physician Services (WPS) has published the results of their recent Targeted Probe and Educate (TPE) audit. The TPE impacted Indiana and Michigan and CPT codes 97112 and 97530. For private practices, the results of the TPE audit for 97112 was a 15% error rate. For all other settings, the results of the TPE audit for 97530 was a 23% error rate. Most likely, the two main issues were: if you have a concern about the documentation, or lack thereof, occurring in your practice or organization, I would recommend the following 2 webinars:

The Centers for Medicare and Medicaid Services (CMS) and commercial insurance carriers, such as Anthem BCBS and UnitedHealthcare, have increased their requests for medical records for dates of services to ensure not only proper CPT coding and billing, but that the services provided meet the definition of medical necessity and required the unique skills of a therapist, or an assistant under the supervision of a therapist, to provide. Unfortunately, providers are not submitting all of the required information and thus, are being denied even when the daily note does support the CPT codes and units billed. In this article, I

Palmetto GBA, Medicare Administrative Contractor (MAC) for Jurisdiction J which includes the states of Alabama, Georgia and Tennessee, currently has two active medical reviews for outpatient therapy services for non-private practice settings. The two reviews are focused on CPT code 97110 (therapeutic exercise) and CPT code 97140 (manual therapy). When the results of the review are posted, I will write an article on the findings.