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Physical Therapy

Overview
Legal Experience
Physical Therapy Focus Areas
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Overview

Wachler & Associates has extensive expertise representing physical therapists and our attorneys have a keen understanding of the unique legal and regulatory issues impacting physical therapy practices. Wachler & Associates attorneys regularly counsel physical therapy clients regarding:

Fraud and Abuse counseling including compliance with the Stark law and federal Anti-Kickback Statute
Medicare, Medicaid and third party payor audits and appeals
Contractual and transactional arrangements
Compliance with Medicare and Medicaid coding, documentation and payment regulations
Medicare eligibility and enrollment
Licensure and re-licensure
Supervision of physical therapy assistants
Access to and collaboration with physicians, hospitals and health systems
HIPAA compliance
Operations, corporate governance, structural issues and compliance policies
Other regulatory and health care law matters

Legal Experience

Compliance – Our firm has assisted physical therapy providers in developing effective compliance plans to ensure the physical therapy provider’s billing and documentation practices sufficiently align with Medicare reimbursement policies. Today, many physical therapy providers find themselves unaware of the strict and onerous documentation requirements to properly bill Medicare for the services provided. By implementing an effective compliance plan, therapy providers can safeguard themselves from potential future claim denials.

Fraud and Abuse – Wachler & Associates has significant experience assisting clients in matters relating to the Stark Law and Anti-Kickback Statute. Physical therapy providers can find themselves susceptible to Stark violations through improper physician arrangements. Arrangements that may appear harmless could be viewed as inducing referrals in violation of the Stark Law. In addition to improper referrals, physical therapy providers must avoid business arrangements that result in illegal remuneration in violation of the Anti-Kickback Statute. Whether you are considering a business arrangement, or want to review your existing arrangements for compliance with the Fraud and Abuse laws, our experienced attorneys can help you navigate these complex healthcare laws.

Audits – Physical therapy providers often find themselves the focus of Medicare, Medicaid and third party payor auditors. These auditors carefully review the billing and supporting documentation submitted by therapy providers to determine if claims strictly comply with reimbursement rules. Physical therapy providers are particularly vulnerable to reviewing audit contractors in the following areas: certification/recertification, treatment note documentation, medically unnecessary services and therapy services exceeding the therapy cap. Wachler & Associates has expertise representing physical therapy clients in RAC, ZPIC, MAC, Medicare, Medicaid, OIG, and private payor audits. We also assist our clients when appealing claim denials through all levels of the appeals process, and advising clients who have been placed on pre-payment review or payment suspension. We understand the procedural, substantive, and strategic issues involved in audit defense, and work with our clients to understand the substantive issues unique to each physical therapy audit to develop an effective and practical audit defense strategy. Our strategies often include drafting position papers and written submissions specifically tailored to each audit.