AAOS Now

Published 12/1/2013

Bits and Tidbits

RAC prepayment reviews
Current procedural terminology (CPT) codes 99205 and 99215 have been identified as among the top 15 codes for improper payment rates. National Government Services, a Medicare recovery audit contractor (RAC), plans to conduct service-specific prepayment reviews of CPT codes 99205 and 99215 for claims submitted to Jurisdiction 6 Part B for Illinois, Minnesota, and Wisconsin. Providers whose claims are being reviewed will receive a request for additional documentation and will have 30 days from the date of the letter to submit the requested documentation. AAOS has recommended to the Centers for Medicare & Medicaid Services that RACs not be allowed to audit E & M codes such as 99205 and 99215.

Saying “I’m sorry”
Physicians in Pennsylvania can now offer expressions of sympathy to a patient after a poor medical outcome without fearing that their words will be used against them in future litigation.

The Benevolent Gesture Medical Professional Liability Act received unanimous support from lawmakers and permits healthcare providers, including hospitals, long-term care facilities and physicians, and was signed into law by Gov. Tom Corbett. The measure protects any action, conduct, or statement that conveys a sense of apology, condolence, explanation, compassion, or commiseration “emanating from humane impulses”; factual statements or admissions of guilt for a medical outcome or error are not covered.

Physician-owned physical therapy
Effective Jan. 1, 2014, physical therapists (PTs) and other healthcare professionals can legally be employed by a licensed medical corporation in California. The change is the result of passage of Assembly Bill (AB) 1000, which was cosponsored by the California Orthopaedic Association, the California Medical Association, and the California Physical Therapy Association.

The law gives patients the ability to seek treatment directly from a PT without first being evaluated by a physician for a limited period of time (45 calendar days or no more than 12 visits). The bill does not expand or modify the scope of practice for PTs and reinforces that they are not authorized to make a medical diagnosis.

The bill also includes patient notification requirements, a mandate that the patient be referred immediately for an in-person examination by a physician, should the patient’s condition be beyond the scope of the PT, and a clarification that carriers are not required to pay for services rendered by the PT without a medical diagnosis