Outpatient Therapy Services eCBR

Outpatient Therapy eCBR
This electronic Comparative Billing Report (eCBR) focuses on providers that submit claims for beneficiaries receiving outpatient therapy services. 

eCBR information is one of the many tools used to assist individual providers in becoming proactive in addressing potential billing issues and performing internal audits to ensure compliance with Medicare guidelines.

For your personalized outpatient therapy services results log on to eServices. 

Overview of Outpatient Therapy Services 
Occupational therapy (OT) is an integral component of rehabilitative services in the areas of physical, cognitive and psychosocial impairment. OT is based on purposeful, goal-directed activity (occupation). The goal of OT is to prevent, improve or restore physical and/or cognitive impairment following disease or injury. Occupational therapists (OTs) utilize clinical history, observation, interview, standardized testing and assessment of activities of daily living skills (ADLs), work skills, and leisure skills to characterize individuals with impairments, functional limitations and disabilities. The results of these assessments are used to identify structural impairments and functional limitations and to design an individualized plan of treatment to assist in improving or restoring function. All OT services must be performed by or under the supervision of a qualified OT.

Physical therapy (PT) services are part of a constellation of rehabilitative services designed to improve or restore physical functioning, as well as, to prevent injury, impairments, activity limitations, participation restrictions and disability following disease, injury or loss of a body part. Impairments, activity limitations and disabilities are addressed by the examination, evaluation and development of a plan of care (POC) that may include implementation of therapeutic interventions tailored to the specific needs of the individual patient to achieve specific goals and outcomes. The specific interventions that may be utilized are therapeutic exercises to strengthen muscles, maintain or restore motion, integumentary repair and protection techniques, physical agents and mechanical modalities, such as heat, cold, electrotherapeutic modalities, ultrasound (US) and hydrotherapy, manual therapy and functional training or retraining an individual to perform the ADLs. 

Documentation must comply with all legal and regulatory requirements applicable to Medicare claims. 

Note: Documentation must comply with the elements outlined in CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §220.3 (PDF).

CMS works to eliminate improper payments in the Medicare Program and protect the Medicare Trust Fund, as well as beneficiaries from medically unnecessary services or supplies and their associated costs. CMS calculates a national Medicare fee-for-service (FFS) improper payment rate and improper payment rates by claim type and publishes the review results annually.

Methods
The metrics reviewed in this eCBR are the proportion of billing for claims rejected for rejection code 56900 vs. all therapy-billed claims for comparisons done to peers within the state and jurisdiction. This report is an analysis of Medicare Part A claims extracted from the Palmetto GBA data warehouse. The analysis shows the portions of your billing at each level compared to your peers in Jurisdictions J and M.

Example of eCBR 


Resources

• LCD — Outpatient Physical Therapy (L34428) (cms.gov)
• LCD — Outpatient Occupational Therapy (L34427) (cms.gov)
• CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §220.3 Documentation Requirements for Therapy Services (PDF)