Resource Alert:Improper Fiscal Year 2000 Medicare Fee-for-Service Payments

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Resource Alert: Improper Fiscal Year 2000 Medicare Fee-for-Service

Payments

The following document has been recently published by OIG and is now

available at the PTManager.com web site. Use the drop down menu

found at the top of each page in our web site and select " OIG

Reports " . You can also find this document on the OIG

site - publication date as listed below.

February 2001

OIG Report

A-17-00-02001

Improper Fiscal Year 2000 Medicare Fee-for-Service Payments

19 Pages

EXECUTIVE SUMMARY:

This final report points out the results of our review of Fiscal Year

(FY) 2000 Medicare fee-for-service claims. Based on our statistical

sample, we estimate that improper Medicare benefit payments made during

FY 2000 totaled $11.9 billion, or about 6.8 percent of the $173.6 billion

in processed fee-for-service payments reported by the Health Care

Financing Administration (HCFA). As in past years, these improper

payments could range from inadvertent mistakes to outright fraud and

abuse. Since we developed the first error rate for FY 1996, HCFA has

closely monitored Medicare payments and has instituted appropriate

corrective actions. The HCFA has also worked with provider groups to

clarify reimbursement rules and to impress upon health care providers the

importance of fully documenting services. Additional initiatives on the

part of the Congress, HCFA, the Department of Justice, and the Office of

Inspector General have focused resources on preventing, detecting, and

eliminating fraud and abuse. All of these efforts, we believe, have

contributed to reducing the improper payment rate by almost half from FY

1996 to 2000. However, continued vigilance is needed to ensure that

providers maintain adequate documentation supporting billed services,

bill only for services that are medically necessary, and properly code

claims. These problems have persisted for the past 5 years. Our

recommendations address the need for HCFA to sustain its efforts in

reducing improper payments.

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The Institute for Rehabilitation Leadership and Administration At Oakland

University

Evidence Based Rehabilitation Management

April 7-8, 2001

Presenters:

R. Kovacek, MSA, PT

Sinnott, MS, PT

Lane, MHS, PT

Angie , PT

Oakland University

Program in Physical Therapy

Rochester, Michigan 48309-440

Course Description

This two-day course will examine rehabilitation management practice with

an emphasis on identifying:

1. Contemporary

principles of evidence based rehabilitation management.

2. What is truly known

about rehabilitation management practice?

3. Myths about

rehabilitation management practice.

4. What is not known

about rehabilitation management practice?

5. How to incorporate

principles of evidence based management into contemporary practice.

Objectives

At the completion of this course, the participant will be able to:

1. Apply principles of

evidence-based management to daily rehabilitation administrative

decision-making.

2. Recognize what is

and is not known about contemporary rehabilitation management practice

and preferred management practices.

3. Identify management

practices most in need of study and validation in management

research.

4. Develop a plan of

action to adopt evidence based management practices.

5. Apply management

practices most likely to facilitate success in a changing rehabilitation

environment.

Course Outline

Day One

8:30 9:00 a.m. -

Introductions and overview of conference.

9:00 a.m. Noon - Introduction to evidence based rehabilitation

management: What we do, don’t and should know.

1:00 4:00 p.m. -

Evidence-based organizational dynamics, structure and management: Best

organizational practices in rehabilitation.

4:00 5:00 p.m. -

Case studies, interactive session and panel.

Day Two

8:30 11:30 a.m. -

Evidence-based outcome management practices in rehabilitation: The

measurement and facilitation of competence in clinical practice

12:30 3:30 p.m. -

The truth about managing rehabilitation corporate compliance.

3:30 4:15 p.m. -

Case studies, interactive session, panel and closure.

Location

Oakland University

Hannah Hall Second floor

Rochester, MI 48309

Cost

$350.00

Early bird registration of $325.00 for paid registrations received by

March 1, 2001.

(Make checks payable to Oakland University in US Dollars, no post-dated

checks.)

Dates

April 7-8, 2001

Registration at 8:00 a.m. each day.

Target Audience

This course is intended for managers and future managers of

rehabilitation services in any practice setting. Clinical

experience or managerial experience is preferred.

Enrollment

Enrollment is limited and places in the course are reserved on a first

come, first serve basis. To ensure participation in the course, payment

in full is required. Refunds for cancellation will be subject to a

$50.00 cancellation fee.

Course Instructors

Sinnott, MS, PT

is the President of APTA’s Acute Care Section. is also

Assistant Professor at Temple University in Philadelphia and a member of

APTA’s Panel on Reimbursement.

Lane, MHS, PT

is owner and CEO of CBL-Solutions, Inc. - a national consulting

group focusing on corporate compliance and rehabilitation. is

also an active member of APTA and Treasurer of the Florida Chapter of

APTA.

Angie , PT

Angie is owner of Images, Inc. and a nationally recognized expert on long

term care and rehabilitation accreditation. Angie is a frequent

speaker at APTA conferences and workshops.

R. Kovacek, MSA, PT

is the Coordinator of the Oakland University Institute for

Rehabilitation Leadership and Administration. He is also President

and Owner of PTManager.com and President of APTA’s Section on

Administration.

Oakland University

School of Health Sciences

The Institute for Rehabilitation Leadership and Administration At Oakland

University

The Institute for Rehabilitation Leadership and Administration is a

University based resource for rehabilitation professionals throughout the

nation interested in developing management, leadership, administrative,

and health policy skills. Offering a diverse and flexible

curriculum and other professional development resources, the Institute

offers courses and educational opportunities in multiple tracks:

1. Continuing professional education courses

offering continuing education units in a seminar format for working

professionals.

2. Coming soon - Graduate courses leading to a

certificate in rehabilitation management and leadership.

3. Coming soon - Graduate

courses leading to a Masters of Science with an emphasis on

rehabilitation management.

Mission and Vision

Our mission is to serve our students, the professional community and the

University by providing high quality and relevant educational

opportunities, research and scholarship, professional service, and

student development activities to foster effective, dynamic and

responsible rehabilitation leadership and administration.

Our vision is to become the preeminent University based resource for

innovative, cost effective, evidence based leadership, business, health

policy and management practices for rehabilitation practitioners,

managers, educators and researchers in the country.

Institute Services

The Institute provides courses and educational experiences to students in

the following manner:

1. Course offerings including traditional model

courses for local students.

2. Seminar model courses for national and

regional students not local to Oakland University.

3. Alternative model courses including courses

offered " off campus "

4. Research into topics such as rehab management

structures, use of support personnel, and delegation decision algorithm

development.

The Institute’s focus is on offering flexible structures and programs

including Certificate Track, Degree Track and CEU Track programs in a

flexible format to meet the needs of working, geographically distant

students.