APTA Addresses Noridian Healthcare Solutions Notifications
Posted by [email protected] on Jan. 25, 2022 / Subscribe 0
APTA
From: Kate W. Gilliard, JD
Subject: NOTICE On SMRC Audits
APTA is aware that Noridian Healthcare Solutions has been issuing Notifications of Post-Payment Claim Reviews to outpatient physical therapy providers participating in Medicare. There is a significant issue with the criteria under which Noridian is conducting these audits. It appears Noridian is requesting records more appropriate for rehabilitation agencies, SNFs, and hospital outpatient departments but is issuing these requests to therapists in private practice.
Some of the records requested that would not be appropriate for a therapist in private practice include:
- Physician/Non-Physician (NPP) order or evidence of intent to order
- History and Physical reports
- Initial evaluation/re-evaluation signed by ordering physician
- Records of Aide Visits, Times and Dates
- List of all personnel billing services under your NPI.
In addition to the discrepancy in records requests, On the Current Project page for these audits, Noridian lists the TOB as:
- 13x: Outpatient Hospital
- 22x: Inpatient SNF Part B
- 23x: Outpatient SNF
- 74x: Outpatient Physical Therapy Provider
“74x Outpatient Physical Therapy Provider” is rehabilitation agencies – NOT therapists in private practice (see Claims processing Manual).
APTA is contacting Noridian and CMS to rectify the situation.
In the meantime, should you receive questions from members who have received SMRC audits from Noridian with Project ID: 01-308-B you should encourage them to request an extension of time allotted to submit the requested records and request clarification on the records requested. Providers subject to an audit should document all communications with Noridian.
APTA will provide updates on this issue when they are available.
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