Appeal Process

Written By: Kathy Boyarko, PT, CDP, Program Development Manager

The clinical focus for Blue Sky Therapy during the month of February is the appeal process.  The appeal process can be both timely and costly especially when the person completing the appeal is new to the process. 

Obviously the best way to deal with appeals is to avoid the denial altogether.  Blue Sky provides intense training to our therapists on the art of documenting skilled care effectively, including annual webinars and weekly tips/suggestions about documentation, a multi-leveled chart auditing system and of course, a recognition program for our therapists who excel in this art. 

However, even with all the best preventative measures in place, denials for therapy services are bound to happen.   Medicare is on a mission to cut their costs and therapy seems to be a major target in these reductions, leading some experts to even call it an “attack on therapy”.    While most therapists are providing excellent care, their documentation does not always reflect that which leads to Medicare questioning what “skilled care” is taking place and couldn’t that service be provided by an unskilled person?

Blue Sky’s training involves taking the skill that we know is taking place in the clinic and painting a picture through the documentation so the auditors have a clear impression of the skilled care being provided.  This ability also carries over to the art of writing appeal letters to ensure we are demonstrating the need for the care that was provided that has been denied.  Our therapists have become mini-experts in this area. 

Some issues and concerns with the appeal process is that the process itself takes up a lot of the therapists’ time and it can be difficult for some therapists who prefer treating their patient’s to filling out paperwork, but unfortunately it is a necessary evil.  Again, the better trained the therapists are in completing thorough and effective documentation the first time around, the less denials they will receive and need to address.