Connolly Healthcare and Health Data Insights Inc, the Recovery Audit Contractors (RACs) for Regions C and D, respectively, will target untimed therapy codes as they begin their audit activities, according to their CMS Approved Audit Issues Web pages, reports the American Physical Therapy Association. RACs are contractors hired by the Centers for Medicare and Medicaid Services (CMS) to audit claims in an effort to identify inappropriate payments.
Connolly defines untimed codes as CPT codes for which there is not a defined or specified time frame, such as a physical therapy evaluation (CPT code 97001), says APTA, Alexandria, Va. When billing for an untimed code, a provider is allowed to bill for only one unit of service per patient per treatment encounter.
While Region C consists of several states, it appears Connolly will target its efforts in South Carolina at this time. Health Data Insights will target claims in all 20 states under its authority. RACs for Regions A and B, have not yet listed information about their auditing activities on their Web sites. More information about the RAC program can be found on APTA’s Web site.