61.3% Of Medicare Physical Therapy Claims Failed To Meet Reimbursement Requirements

Approximately 61.3% of outpatient physical therapy services claims did not comply with Medicare reimbursement requirements. Reasons found for noncompliance include providing services that were not medically necessary, inaccurate coding to meet Medicare requirements, and documentation that did not meet Medicare requirements. This resulted in an estimated $367 million in Medicare reimbursements for all non-compliant claims.

These findings were reported in “Many Medicare Claims For Outpatient Physical Therapy Services Did Not Comply With Medicare Requirements” by the Office of Inspector General (OIG). OIG personnel analyzed a random sample of 300 Medicare outpatient claims for physical therapy services between July . . .