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A Missouri Physical Therapy Practice Claimed Unallowable Medicare Part B Reimbursement for Some Outpatient Physical Therapy Services

A Missouri physical therapy practice (the Therapy Practice) claimed Medicare reimbursement for some outpatient physical therapy services that did not meet Medicare reimbursement requirements. Of the 100 beneficiary days in our random sample, the Therapy Practice properly claimed Medicare reimbursement on 65 beneficiary days. The Therapy Practice improperly claimed Medicare reimbursement on the remaining 35 beneficiary days. On the basis of our sample results, we estimated that the Therapy Practice improperly received at least $151,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements. Accordingly, we made procedural and monetary recommendations to the Therapy Practice.

The Therapy Practice disagreed with our findings on all of the 51 beneficiary days that our draft report identified as not meeting Medicare reimbursement requirements. After reviewing the Therapy Practice's written comments, we revised our findings to disallow 35 instead of 51 beneficiary days.

Filed under: Center for Medicare and Medicaid Services