PT Evaluations related to prepayment medical review of certain inpatient DRG claims

[Guest guest]

By 01/01/2012, the Medicare administrative contractor for Florida will begin

performing 100% prepayment medical review of Florida inpatient

hospital claims of 15 DRG's, the review of which will affect both the Part A

hospital surgery claim and related Part B services.

As it pertains to the following four DRG's ....

458 -- Spinal fusion except cervical w/spinal curve, malign, or 9+ fusions w/o

CC460 -- Spinal fusion except cervical w/o MCC470 -- Major joint replacement or

reattachment of lower extremity w/o MCC490 -- Back and neck procedures except

spinal fusion w/CC/MCC or disc device/neurostimulator

Our Rehab Dept is interested in finding out if anyone has developed PT [and OT]

evaluation formats, designed to facilitate meeting prepayment claims

requirements. If so, and if possible, please share the details or any insights.

Thank you,

D.M. Goldson-Piper, PT

Health First, Inc

Cocoa Beach, Florida