The other one says the third bullet, “Records submitted generally do not include any patient-generated information.” Fourth bullet, “Exams very limited. Little variation between patients, insufficient history.” You can see here and I'm not going to overly bore you with each of these details but notice they're looking for unusual patterns, things that are done the same, or that there's just really no change. Here's another example of one and you'll see here just highlighted in yellow it says, “A high number of CPT codes were billed per office visit. The billing pattern reflected a high frequency and duration of treatment per episode based on slow recovery of the condition.” That certainly is reasonable for some patients but if it's on every patient, not every patient should response slowly. There are three examples here on the three bullets note, “Excessive number of procedures and modalities per visit was found by the reviewer. The number of physical therapy codes was not supported by the diagnosis.” Notice, diagnosis and severity definitely is going to indicate how much care of patients you get. Bullet number two, “CPT codes 97110 and 97530 were billed routinely without documentation of clinical indication to substantiate the procedures.” In other words, did the doctor just document the services were done. It says, “The adjunct therapies require a documentation of postural, propioceptor, structural and physiological function.” In other words, they're looking to see if you’ve billed me a service, was that service properly done for the condition. The final thing here, and this is the highlighted part, “The conditions were treated for several months with very little functional improvement as demonstrated with Neck Pain Disability or Revised Oswestry.” Now, this is something I want to highlight. This was an audit where the provider was sent information to say, "Hey, we want to see what's going on. We're going to ask questions about how these services were done." This is not necessarily punitive for the most part but it's something we're going to have to respond to. Prevention of this would be, what do we want to start to do for documentation? Well here's another example here of what you should do when you get a request. The first thing I'll say when you get a request do not panic. Getting a request does not indicate that you've done anything improperly but simply that it's unusual, and because it's unusual there's a greater tendency that they may want to look. Let's take a look at this example here.
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