With Payment Changes and Medicare Audits, Therapy Services Are Ripe for Monitoring

It’s hard for therapists to demonstrate their clinical judgment and support the medical necessity of CPT 97110 visit after visit because the patient performs therapeutic exercises every time and it can become repetitive, said Holly Hester, senior vice president of compliance and quality at Casamba. “If all your treatments look the same from a billing perspective, it could be a little red flag you’re waving to your MAC, saying ‘I am doing something out of the ordinary,’” she said. “CMS has told us over and over, shame on you if you change your practice based on reimbursement.”

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