Knowing that CMS has and will continue to perform audits for medical necessity and insufficient documentation, keep them away from your money!

1. Orthopedics, Physical Therapy
and Chiropractic
UnderstandingYourImpactin
Fraud,Waste&Abuse
ElitePrecisionConsulting

2. ElitePrecisionConsulting
GENERATEMORE
NETREVENUE
THANMOST
SPECIALTIES
Ortho, Chiro
& PT
Combined
MAKESTHESESPECIALTIESAHIGHER
TARGETFORSCRUTINYTHROUGHCMSAND
OTHERFEDERALAGENCIES
HighVolume
&Frequency
HighDollar
Services
Personal
Injuries
LET'SGETTOTHEPOINT
$95 BILLION
Total estimated in 2018

3. Previous OIG reviews found that
Medicare inappropriately paid for
chiropractic services that were
medically unnecessary, incorrectly
coded, or undocumented.
This has similarly happened for ortho
and PT providers.
In calendar years (CYs) 2014 and
2015, Medicare allowed payments of
approximately $1.3 billion for
chiropractic services provided to
Medicare beneficiaries nationwide
When It All Started..

4. ElitePrecisionConsulting WHATDOESITREALLYCOST?
RECOUPEDBY
FEDERAL
GOVERNMENT
IN2018
$2.3
BILLION
RECOUPEDBY
FEDERAL
GOVERNMENTIN
2019
$6
BILLION
OIGRECOVERED
$4.00FOREVERY
$1.00SPENTINFWA
DETECTION
300% ROI
Check Our Sources

5. ElitePrecisionConsulting HEATISTURNEDUP
INFWA
RESOURCESWILL
OCCURIN
UPCOMINGYEARS
40%
INCREASE
BASEDONHIGH
DENIALRATES&
ABERRANTBILLING
PATTERNS
CHIRO
TARGETED
REPORTSARE
SENTONLYTOTOP
5,000HIGHEST
PAIDPTs
COMPARATIVE
BILLING
Check Our Sources

6. OUR EXPERIENCE
MOSTPROVIDERSDONOTKNOW
WHATTHEIRLEVELOFRISKISORWHAT
REALLYMATTERSFORTHEIRSPECIALTY

7. Fraud, Waste & Abuse
ElitePrecisionConsulting WHATITLOOKSLIKE
ITISNOTWHATYOUMAYTHINK
30 Board- Certified Orthopedics Surgeons
100 Physicians
"Coordinated Health settles
for $12.5 million..."
Due to improper billing primarily using the -59 modifier to unbundle
services. This included many total joint replacement and
arthroscopic surgeries. Changes to their documentation prompted
additional scrutiny.
Check Our Sources

8. Fraud, Waste & Abuse
ElitePrecisionConsulting WHATITLOOKSLIKE
ITCANHAVEMANYFACES
Only 100 sample claims reviewed by auditors within
a 2 year period
"Chiropractic, Twin Palms
settles for $317,038..."
54% were improper payments due to medically unnecessary
services, insufficient documentation and incorrect coding. OIG
recommends refund and establish policies & procedures to ensure
accuracy.
Check Our Sources

9. Fraud, Waste & Abuse
ElitePrecisionConsulting WHATITLOOKSLIKE
ITCANHAVEMANYFACES
Only 100 sample claims reviewed by auditors within
a 2 year period
" Fox Rehabilitation settles
for $29.9 Million..."
85% were improper payments due to the amount, frequency and duration being
considered medically unnecessary. Fox disagreed and ensured that their
internal compliance program ensured OP therapy were documented in
Check Our Sources

10. Grab Your Pen and Paper
ElitePrecisionConsulting LOOKINGFORWARD
WhattoLookOutFor
New or Improved Injections such as
Viscosupplement under Fluroscopy:
Improved Outcomes yet Higher
Reimbursement and Increase
Documentation Requirements
Orthosurgeons: Bundled Procedures
Orthotic Braces: Revised in 2016 and
continuing in 2020
Chiropractic Services: Announced
2015 and continues to 2020 for
medically unneccessary, incorrectly
coded or underdocumented
Physical Therapy: High Use of
Outpatient Services: Began in 2014
Evaluation & Management: Medical
Decision Making Level 4s and 5s-
Time documentation vs MDM. Starting
2021 yet focus is being made now on
your documentation and billing
patterns
Physical Therapy Assistant: Finalized
rule in 2019 implement statutory
requirements

11. Request: Please provide top 10 areas of potential risk based on my
claims data from CY 2017-present
Educate: Please provide 1 hour training to clinical and operation
staff to ensure our documentation is up to par with new
regulations
Visualize: Please share with me how you have monitored our
claims data on a monthly basis to ensure our office is not
exposed to unnecessary audits from our payers
If you cannot obtain this information from your Coder, Biller or Office
Manager within 24 hours, your risk is higher than you think.
What is Your Risk Score? Is your biller, coder and Practice Manager caring
about your money as much as you do?
High Risk
Medium Risk
Low Risk
ElitePrecisionConsulting

12. We Are Here
to ServeWith specialized technology, industry expertise and a team dedicated to
keeping you prepared and profitable, don't take the chance of being
uninformed.
Phone: 800-674-3732
Email: info@eliteprecisionconsulting.com
Website: www.eliteprecisionconsulting.com
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