Blog | Saturday, April 13, 2013

IM 13: Scrutinize what you sign when authorizing rehab


Alberto Esquenazi, MD, ended his Saturday morning session on physical medicine and rehabilitation by instructing his audience to pay attention to what they're signing when authorizing a rehab session for their patients. He noted the following:

--You are responsible for the prescribed therapy.

--Even when the therapist designs and provides the care, you are approving the plan of care.

--If the care is not indicated or medically necessary, you could be helping to commit fraud.

He also reminded physicians of the allowable benefit per calendar year and noted that they must collaborate with therapists to wisely manage their patients' benefits. In 2013, for example, skilled services beyond $3,700 require that supporting documentation be sent to the CMS intermediary for manual medical review, and retroactive denial is a possibility. Patients are financially at risk for therapy that exceeds $3,700, and if medical necessity is not determined, he stressed, patients could be personally financially liable.