Nov 2017 Newsletter: Teaching Documentation in a DPT Program

November, 2017 Newsletter

Teaching Documentation in a DPT Program

by Tiffany Enache, PT, DPT, Assistant Professor and Director of Clinical Education

Documentation is an important part of the daily life of a physical therapist, and APTA presents high standards in their Defensible Documentation resources (1) and also in the Guide to Physical Therapist Practice (2).  These both serve as very useful resources when designing learning experiences related to documentation in a Doctor of Physical Therapy (DPT) curriculum.  There are many challenges in teaching physical therapy documentation in a DPT curriculum, one of which is the variety of templates that exist throughout differing clinical settings, both in written template format and in electronic format.  Students in our DPT program expressed confusion when each faculty member introduced a new documentation template for their specialty setting, and the students similarly struggled to produce high-quality documentation in the clinical setting during their internships.  Our DPT faculty therefore sought to create a template that could be utilized across all physical therapy settings: from outpatient orthopedics to neurologic to pediatric to acute care.  The faculty standardized the way that we teach such aspects as goal writing and narrative assessments, and encouraged our students to be descriptive in the ways that they write about current level of function, motor control, and functional mobility.  With one consistent framework for teaching documentation, our students grew in skills and articulation, and documentation shifted from a curricular weakness to a curricular strength.

The final remaining challenge was to utilize an Electronic Health Record (EHR) system to teach documentation.  Even though our students were demonstrating significant improvements in their documentation skills, the way that we were teaching documentation, as one student stated, “needed updating”.  In the search for an EHR that would meet our needs, there were several features we were looking for: 1) a template that was intuitive enough for both novice learners and faculty; 2) a template that included sufficient breadth to cover all physical therapy settings; 3) a template that encompassed the high standards presented by APTA; 4) an interface that would pass university internet security review; 5) an interface that would be compatible with the academic learning environment; and 6) a company that would be willing to price their product fairly, considering that it would not be used to generate revenue.  

The DPT academic faculty excluded many EHR systems due to price, a common finding being that there was either no price model available for a usage that did not involve billing, or the base price significantly exceeded the budget of the department and would therefore increase the financial burden on the students.  The next triage of exclusion related to the template design.  Now that our students were finally understanding documentation standards, we felt it critical that we not lower our standards in order to embrace the EHR world.  We became increasingly frustrated as we reviewed templates that either lacked high standards, did too much of the work for the student (thereby decreasing their clinical reasoning), or were not usable across different physical therapy settings (many EHRs are built for the outpatient adult orthopedic population).  We struggled to find an EHR company that was willing to customize a template for us, especially considering our financial constraints.

Our solution was bestPT by Billing Dynamix.  From the very first conversation, their sales team was willing to listen to our needs and offered to create a template that met all of our requirements at a fair price.  Even though they had never before offered their EHR for use in the academic setting, they saw the value not only in this collaboration, but also the value in educating future professionals in the field.  We currently use Billing Dynamix for various classroom activities.  For example, students early in the program will enter data into the EHR as their professor conducts a patient examination in front of the class.  This is an excellent introductory learning activity because the instructor can then use the EHR to write up his/her initial evaluation, then spend class time explaining their choice in wording, the location of particular content, and how a narrative assessment, goals, and treatment plan are constructed.  Intermediate and advanced students in the program use the EHR during simulated patient encounters, and are graded on their documentation content and structure.  Future hopes for this EHR include use at the program’s pro bono clinic.  We have been able to construct our EHR templates to give just enough prompting to provide guidance to novice learners, yet not so much prompting such that students would lose the opportunity for development of clinical reasoning and professional language.  

Thank you, Billing Dynamix, for this collaboration.  You are helping to elevate the standards for future DPT professionals!  I look forward to a longstanding relationship with your company.

Tiffany, PT, DPT

(1) http://www.apta.org/Documentation/DefensibleDocumentation/

(2) http://guidetoptpractice.apta.org/

 

 


 
Let’s welcome bestPT Billing’s newest members!
Harry Morgan & Samantha Andrew
 
Mallory Boyd & Stephanie Petrycki
Bit-by-Bit Therapy, Ft Lauderdale, FL
 
Stephanie Grace
 
Amanda Newman
 
Walden Parsons
Integrated Mechanical Care, Sandy Springs, SC
 
Travis Smith
O&W Enterprises,  Stanleytown, VA
Melissa Talley, Roslyn Evans, Carol Howder,
Joanne Principe, & Lisa Ingenito
 

Each new member benefits from and contributes to our network strength.

 


 Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!



physical therapy billing software ICD-10 cartoon

A New Online Learning Tool On How to Reduce ICD-10 Transition Pain for Physical Therapy Practice Owners

ICD-10 GEMs PLUS Solution Is Now Available with bestPT Billing and EHR Software

bestPT Billing and EHR Software helps their clients make a smooth transition to ICD-10. Their 5 part strategy called bestPT GEMs Plus ensures that Physical Therapists make the best ICD-10 code selection. bestPT’s code selection tool remains effective beyond the transition helping practice owners to keep up with continuous changes inflicted by insurance companies. Click here to learn more.

According to Dr. Eldad De-Medonsa, bestPTs’ President and PhD in Artificial Intelligence, the effects of the transition to ICD-10 will remain unknown for some time. “The only thing that is certain about the transition to ICD-10 is that insurance companies leverage its challenges and uncertainties to delay longer and underpay more insurance claims. Because of a huge increase in the number of codes, a simple one-to-one mapping between the old and the new codes does not exist, as demonstrated in the standard GEMs tool. We leverage the cloud, billing experts, and Artificial Intelligence to analyze millions of insurance claims and generate effective transition rules,” says De-Medonsa.

Click here to learn more.

About BestPT and Billing Dynamix, LLC.:
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. bestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee.

physical therapy billing cartoon

A New Online Learning Tool On How to Accelerate Physical Therapy Practice Growth Using Checklists

Checklist Technology Is Now Available in bestPT Billing and EHR Software

Practice owners fail to control and scale up patient visit experience when they rely exclusively on their memory and do not measure their practice performance. Without measuring, practice owners do not know that they have a revenue or a patient retention problem. Learn about it here.

According to Jason Barnes, COO for bestPT Billing and EHR Software, the first step in building any repeatable and scalable process is to define process performance and uniformity metrics. “The tasks are grouped together in a category for tracking purposes. The tasks can then be measured using the Task Manager Console across all patients or filtered down to a patient, to measure the success of the process across the practice or with an individual,” says Barnes. “For instance, the patient intake process might have 10 steps. If one of the steps is neglected, the problem would be manifested by the Task Manager Console reading a completion rate of 90%. The tasks can be sorted and the offending task can be rooted out and either changed or have additional staff training to achieve better results.”

Learn about bestPT Billing and EMR Software checklist technology here.

About BestPT and Billing Dynamix, LLC.:
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. bestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee.

physical therapy billing cartoon

Physical Therapists Now Use bestPT’s Workflow System to Manage Revenue Cycle and Improve Billing Processes

bestPT adds powerful new reporting features to its revenue cycle workflow control software to help practice owners improve collections and profitability

CLEARWATER, FLORIDA (PRWEB) JUNE 21, 2015

bestPT simplifies revenue cycle management through the use of it’s revolutionary workflow management process. More money to the practice creates financial stability for the owner and the employees and results in a stronger practice that is able to grow and serve more patients. Transparent reporting includes real-time automated alerts to notify process owners and participants about any problems or delays. This system enables practice owners to keep track of their claims, along with all other relevant work, in a single location. bestPT helps practice owners create a systematic revenue cycle management improvement process while providing them complete quality monitoring and control. View our free webinar here to learn more.

See exactly which claims were underpaid or delayed, and what needs to be done to fix that.

According to David Alben, the princial consultant at Genco Healthcare Management, the efficiency of bestPT system is the reason why their reimbursements are paid in full and on time. “Which claims have been paid and which claims haven’t been paid? Who owes you the money? How long have they owed you the money? The whole issue between insurance approved amount and usual and customary charges. All of those things are confusing. Insurance companies have placed barriers to payments because it’s in their interest to do that.”

According to Tom Jorno, PT Excellence Center Director at Billing Dynamix, bestPT’s Revenue Cycle Workflow automates the process of claim submission, follow up, and control. “Claims are automatically created with a preselected fee schedule and scrubbed against millions of rules prior to submission,” says Jorno. “The software allows them to see exactly which claims were underpaid or delayed, and what needs to be done to fix that.”

At the end of the day, bestPT summarizes all of this information into a single metric that can be monitored helping ensure that no claim is left behind and every underpayment or delay has been followed up on. The practice only has to clear one backlog a day with specifically worded instructions to maximize revenue. Any claim not addressed is easily identified by both practice stakeholder and practice success coach to locate the breakdown in process or ownership. Click here to sign up for the free webinar about bestPT’s workflow.

About BestPT and Billing Dynamix, LLC 
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. BestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee.

physical therapy billing is painless

What We Say When We Talk to Our Patients About Pain

As physical therapists we know the scenario quite well. The new patient intake forms come across our desk right before an evaluation and the body chart is completely covered in “X” marks indicating areas of pain. There is no clear nerve root pattern, no dermal pattern, no pattern at all – just X’s spanning across the body. Perhaps there was an initial trauma several years prior, though many times the onset is insidious.

Often times the medication list is extensive and includes opiates or narcotics. During the history taking portion of the evaluation the patients often recounts a long tail of failed medical remedies. Perhaps they have seen countless health care professionals of various types in various locations. Perhaps they express disdain that their physician has sent them to you because in the past physical therapy has done nothing for them. And perhaps a little voice inside our head gives a deep sigh and says “oh dear.”

There is growing concern over distribution and overuse of opioids by chronic pain patients. Medical practitioners are under pressure by third party payers and the medical boards to prescribe in a safe and conservative manner, though due to the addictive nature of the opioids and narcotics, when denied continuous access to medications some patients may seek a string of new physicians.1 While there is evidence to suggest that opioids can provide analgesic effects to a chronic pain patient for up to eight weeks, they have not been seen to provide pain relief for the same dose after 2 months. 1

Further conversation with our chronic pain patient may reveal how horrified the patient truly is at how their pain has been managed. We know that most of them are not drug seekers for the sake of drug seeking. Chronic and excruciating pain has lead them to seek whatever may get them through their day and many times the pain medications offer a window of relief.

We as physical therapists are the most equipped health care professionals to treat patients with chronic pain. So why then have we found ourselves beating our heads against our desk when we fail to make them better?

Lorimer Mosely, David Butler, Paul Hodges, and Adriaan Louw suggest that we explain pain to them to get them better. These physical therapists come from various research groups using MRI, Ultrasound imaging, mirrors, and various other techniques to develop a profound understanding of what pain is, how it behaves, and what we can do to treat patients suffering from it.

Books such as Explain Pain by Mosely and Butler (of the Neuro Orthopaedic Institute) use beautiful art and laymen’s terms to explain these concepts to patients and healthcare providers alike.2 Mosely’s book Painful Yarns uses a collection of relatable stories to explain how pain behaves (the Australian term Yarns means stories)3. The gift that Mosely gives to patients and healthcare providers alike is humor. The reader gains a sense of neuroscience through anecdotes and analogies in a empathetic and lighthearted manner.

It is the job of your brain to protect you. This is a process that has been in place since the day you were born to ensure that your needs were met. When your brain perceives a threat to you, it sends a perceivable message of pain.

The importance of this concept is that the ability to correctly and succinctly explain pain to patients is producing results. Anecdotally, it has changed the way I practice. The concept lies in explaining the concept of neuroplasticity, the brain homunculus, and physiological adaptations that take place as a result of the this process. Adriaan Louw of the Spine and Pain Institute explains that the role the sympathetic and parasympathetic nervous system in his series of books Why I Hurt.4 This series of books covers topics including general pain, back surgery, whiplash, as well as pelvic pain.

Louw demonstrates his conversations with patients in several continuing education formats. At the end of the day we as therapists are generally good at reviewing evidence based literature regarding pain, neuroscience, and therapeutic management, though conveying this subject matter to patients with a variety of educational and psychosocial backgrounds can be a challenge. The following dialogue is one that I commonly use during evaluations and treatment sessions with patients. I find that this has enhanced my ability to gain trust and build rapport with chronic pain patients.

I begin by stating that their case is one that I am familiar with. Many patients feel that their symptoms may be baffling since no single health care professional has been able to explain to them why or how their symptoms persist. Often times I hold this conversation during manual therapy when the patient is lying still and is in a relaxed and comfortable position. I assure them that their symptoms are not in their head, though the brain plays an important role in the experience of pain.

I state the following “It is the job of your brain to protect you. This is a process that has been in place since the day you were born to ensure that your needs were met. When your brain perceives a threat to you, it sends a perceivable message of pain. For example, if you fall and sprain your ankle, your brain will tell you that it hurts, so that you will stop walking on it and allow the tendons to rest.

However if you were to step off a curb and sprain your ankle, and a bus was coming at you full speed, your brain would not inform you of pain, but to get out of the way of the bus. It is in this manner that the brain decides what the greatest threat to you is.

If there was an initial injury to the patient that resulted in a chronic pain cycle I would recount the following: Your brain acts like a security system to your body, similar to how a security system would protect a house. If someone threw a brick into the front window of your home and robbed it, you would buy a very loud, noisy security system, and perhaps get a guard dog.

This security system may be so sensitive that it went off when anyone came to the door – not just a criminal. Under a high security threat some alarms go off whenever someone approaches the door. Your brain acts in the same manner to protect your body- it will become weary of normal, non-threatening movements, positions, and activities because it wants to protect you. In this way it can become so sensitive that it does not know the difference between a real threat and a perceived threat. I then explain to the patient that the goal of physical therapy is to address the true mechanical threats and to reteach them safe movements.

This dialogue has opened the doors to communication with my patients. My perception of my practice is that I am earning earlier trust and rapport which merits quicker results with evidence based physical therapy treatment of manual therapy, therapeutic activity, and exercise.

  1. Fields H. The Doctor’s Dilemma. Neuron. 2011 Feb 24; 69(4): 591–594.
  2. Butler D. Mosely L. Explain Pain 2nd Edition. Noigroup Publications; 2013.
  3. Mosely L. Painful Yarns. Dancing Giraffe Press; 2007.
  4. Louw A. Why I Hurt. International Spine and Pain Institute; 1 editiob; 2013.

physical therapy billing and patient scheduling

Physical Therapists Now Use bestPT’s Scheduling Workflow to Manage Patient Relationships

bestPT’s software adds patient appointment quality control to help practice owners improve patient experience

bestPT simplifies scheduling and patient relationship management through the use of it’s revolutionary workflow management process. This system enables practice owners to keep track of their patient visits, along with all other relevant work, in a single location. bestPT helps practice owners create a systematic patient relationship management process while providing them complete quality monitoring and control.

According to Nick Roselli, OTR/L, CHT, owner of NR-OT network of Occupational Therapy practices, the efficiency of bestPT system is the reason why their reimbursements are paid in full and on time. “Do I take this insurance patient and lose money or do I turn them away and risk losing a referral source? That’s everything. You talk about efficiency? That’s efficiency with bestPT.”

According to Tom Jorno, PT Excellence Center Director at Billing Dynamix, bestPT’s Scheduling Workflow automates the process of patient appointment scheduling, follow up, and control. “…it allows the practice owner and their staff to see precisely which patients require attention on any given day. The software allows them to see exactly which patients missed their appointments, which ones don’t have a future appointment scheduled, and what needs to be done to fix that,” says Jorno.

That’s everything. You talk about efficiency? That’s efficiency with bestPT

At the end of the day, bestPT summarizes all of this information into a single metric that can be monitored helping ensure that every missed appointment and every patient without future appointments has been followed up on. Click here to sign up for the free webinar about bestPT’s patient no-show workflow management.

About BestPT and Billing Dynamix, LLC
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. BestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee at http://bestptbilling.com/

physical therapy billing reimbursement

Reimbursement in Physical Therapy

On April 16, 2015 Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This act is intended to repeal the flawed sustainable growth rate (SGR) formula, and is the final and permanent piece of legislation in a long line of annual temporary adjustments since 2003 that had prevented the SGR from activating a large payment cut for physical therapists and other healthcare professionals. Most importantly, MACRA further extends the Medicare therapy cap exceptions process to December 31, 2017, and includes numerous other provisions that will impact physical therapy. With the passage of this law, Congress has laid the groundwork for significant changes to Medicare reimbursement for physical therapists and other health care professionals1.

Active immediately, physical therapists can expect to see a positive payment update of 0.5% from July of 2015-2019. Physical therapists and other health care professionals who participate in alternative payment models (APM) will receive a 5% bonus annually from 2019-2024, and the fee for service model is retained. In 2026 and beyond, physicians, physical therapists, and other health care professionals in APMs may qualify for a 0.75% annual update. PT’s participating in all other payment plans will receive a 0.25% annual update. Perhaps the most exciting upcoming advancement is the fact that technical support is provided for smaller practices, funded at $20 million per year from 2016 to 2020, to help them participate in APMs or the new fee-for-service incentive program1.

The rumblings surrounding fee for performance reimbursement will be realized in 2019. Specifically, current quality incentive and payment programs such as the Physician Quality Reporting System (PQRS) will be consolidated and streamlined into a program called the Merit-Based Incentive Payment System (MIPS) beginning in 2019. This change will be best undertaken with early implementation and use of electronic medical records to assist in tracking appropriate reporting2. A detailed list of physical therapy outcomes tools and procedures for PQRS reporting can be found at: http://www.apta.org/PQRS/, and http://ptjournal.apta.org/cgi/collection/outcomes_measurement.3

Notably, changes have also been made to the infamous Medicare Cap. MACRA provisions to the Medicare therapy cap include an annual amount of $1,940 for physical therapy and speech language pathology combined in 2015, with a separate $1,940 cap for occupational therapy.  Hospital outpatient claims for therapy services with dates of service through December 31, 2017 will continue to apply to the therapy caps. In the event that further physical therapy is deemed medically necessary, providers may obtain an exception to the therapy cap until December 31, 2017. The manual medical review process at $3,700 has been replaced with a new medical review process that becomes effective 90 days after enactment of the law, which will be right around the corner in mid-July, 2015. This new annual review process applies to exception requests for which a medical review had not been conducted by the July date.1

In the private practice domain, physical therapists can expect to continue to report in the PQRS program in 2015, however changes to to the quality reporting system will take place in 2019. Beginning in 2019, the current quality programs under Medicare part B for physicians (PQRS, Value-Based Modifier, EHR Meaningful Use) will be consolidated and replaced with a new program called the Merit-Based Incentive Payment System (MIPS)1. Performance in MIPS will be based on 4 domains: quality, resource use, meaningful use, and clinical practice improvement activities.  MIPS will implement penalties for low performing clinicians and incentives for high-performing providers and practices. Bonuses and penalties under MIPS begin at 4% in 2019 and increase to 9% in 2022.  Data-reporting under MIPS will be via electronic reporting mechanisms (such as registries). Participation in a qualified clinical data registry would also count as a clinical practice improvement activity1. It is again here where we see the value in early adoption of electronic medical record use.

All of these changes and reform should result in better and more accurate reimbursement according to the American Physical Therapy Association (APTA). “It’s an exciting time, to have this finally happening,” Helene Fearon, PT, FAPTA, said at the conclusion of the June 6, 2015 APTA session titled “Payment for Physical Therapy Care Is Changing.” The session looked at the past, present, and future of efforts to shift payment for physical therapist services under Medicare from a fee-for-service model to what another speaker, APTA Senior Director of Payment and Practice Management Carmen Elliott, called a “value mindset.”4

A look back at the Department of Health and Human Services’ mandate under the Affordable Act to meet the “triple aim” of payment reform “better quality of care, improved public health, and lower cost”and APTA’s development of the Physical Therapy Classification and Payment System (PTCPS). The PTCPS differentiates Current Procedural Terminology (CPT) evaluation codes by level of complexity for the physical therapist (PT), and further differentiates intervention codes by severity of patient condition and intensity of PT services provided. Fearon, considered one of the profession’s preeminent experts on documentation, coding, billing, and payment-related policy issues, provides greater detail on the changes for which APTA has been working, listed in full at www.apta.org/PTCPS/.4

These revisions are intended to change the payment model from isolated visit to episodic, and considers the clinical judgment of the PT, while taking into account the severity of the condition and intensity of PT’s involvement in care. In addition to APTA’s PTCPS page, two additional documents on alternative payment methodology as particularly relevant for PT’s the Medicare Benefit Policy Manual and the ICF (International Classification of Function, Disease, and Health) “beginners guide” Toward a Common Language for Functioning, Disability, and Health.4

  1. Highlights of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10). American Physical Therapy Association. Available at: http://www.apta.org/Payment/Medicare/. Accessed on June 24, 2015.
  2. Medicare Physician Quaility Reporting System. American Physical Therapy Association. Available at: http://www.apta.org/PQRS/ . Accessed on June 24,2015.
  3. Outocmes Measurement. American Physical Therapy Association. Available at: http://ptjournal.apta.org/cgi/collection/outcomes_measurement. Accessed on June 24, 2015.
  4. Reform Efforts soon will pay off-literally- experts say. American Physical Therapy Association. Available at: http://www.apta.org/NEXT/News/2015/6/6/Reform/. Accessed on June 25th, 2015. -Amanda Olson, DPT
ICD-10 for physical therapists

Are You Ready for ICD-10? We Are!

 What are you doing for ICD-10?

Is your Physical Therapy practice Ready for ICD-10?

Our bestPT software was ready last year and our Team has made further refinements this year, including testing it thoroughly.  We do not expect the October 1, 2015 deadline to be pushed again like it was last year. We have prepared for it by adding over 65,000 codes to our software and when you choose an ICD-9 code, you’ll be able to choose from the corresponding ICD-10 codes.  We even give you the ability to test everything with a test patient account.  Check with your Practice Profitability Coach for more details.  Not our client yet? Then click in the upper right or the bottom left for a demonstration.

 

 

physical therapy billing with ICD-10

Is Your Practice Ready for ICD-10?

The notion that change is inevitable is contrived but true. If at any point health care ceases to change, then we should all be worried, because if there is no change, inevitably there is no growth. The other side of this coin is the notion that change itself produces worry and confusion.

The climate of health care in the United States has been forever changed and, come what may, it will not go back to what it was. Almost in tandem we are all preparing for the global health care change from the current International Classification of Diseases (ICD)-9 to the monolithic ICD-10 coding system. There is no need to enter a sympathetic nervous system frenzy as long as you are educated on what to expect and have an electronic medical record system that will support your business and transfer to the ICD-10 system in real time.

If you visit the government site http://www.cms.gov/Medicare/coding/ICD10/index.html, you will be instantly greeted with a ticking countdown to the October 1, 2015 ICD-10 compliance deadline. Those who are paying attention recognize that the initial set date for implementation was October 1, 2013. As if awaiting a rapidly approaching train in a station, we scrambled in attempts to prepare staff, billing systems, patient’s, anyone involved in implementation or reception of health care.

Then we learned that the change would be delayed one year to October 1, 2014. More scrambling ensued. And then in August we were informed that yet again the change would be delayed for one year to October 1, 2015. Hopefully, this time around, the world will be prepared.

ICD-10 coding compliance pertains to any healthcare provider covered by the Health Insurance Portability Accountability Act.1 This of course includes physical therapists, many which are concerned about the cost surrounding updating their technology and training staff. The center for Medicare and Medicaid services (CMS) has created an online module titled The road to 10 available at: http://www.roadto10.org/. Within this site one may find tips for implementation for small practice. A five step plan is provided in effort to guide practitioners to preparation complete with a printable checklist.

The Road to 10 plan includes steps such as “updating your process” which pertains to analyzing company policies and procedures, and analyzing the quality of documentation supplied by staff. The next step is the elephant in the room for most clinics. This involves engaging with partners and vendors and includes recommendations for technology staff.

The CMS recommends ensuring that your electronic medical record vendor has updated their software and is compliant with all codes updated. A key question to ask is whether or not the version of EMR that you are engaging in has 5010 capability. This will indicate whether or not you are able to submit your diagnostic coding to third party payers3. This is also where grumblings from clinicians who have held out with paper charting may be heard echoing through the canyons.

At this point physical therapists have not been mandated to switch to electronic medical records (EMR), however all of our peers have, including family practice doctors, podiatrists, and chiropractors. It is speculated that this may influence referral patterns to physical therapists from referral sources who do not have the capability to send and receive paper charting from those physical therapists who have declined to engage in EMR.

This may create further barriers for these clinicians when the ICD-10 changes come about as training billing and coding staff who operate on a paper based system may take time away from current clinic tasks, and may result in human errors that can be costly. In this regard, EMR can be an enormous asset to small physical therapy practitioners, and the ability to accurately code, and bill electronically can pay for itself quickly due to expedited and improved reimbursement from payers.

With the fear of change one may seek comfort in the fact that Current Procedural Terminology (CPT) codes will not change for the outpatient realm. What we will find when we receive or implement diagnostic coding under the new system is that the terminology is much lengthier and highly specified.

For example, instead of an ICD-9 code of 724.2 Lumbago, under ICD-10 coding the diagnostic term becomes M54.5 Low back pain due to intervertebral disc displacement, or perhaps M54.5 Low back pain due to pregnancy; the diagnostic code involves mechanism of injury and highly specified features of the low back pain (with or without radiculopathy, etcetera).

The American Physical Therapy Association (APTA) has many resources available to practitioners in anticipation of this change as well. Key practice Impacts of the ICD-10 upgrade, Webinars with suggestions for planning ahead, and an upcoming release of clinical examples of phsyical therapy specific coding are all available at: http://www.apta.org/Payment/Coding/ICD10/.4

In the end, the train that is ICD 10 coding is approaching us, and we must board in order to continue practicing physical therapy. Get yourself a map: The road to 10 by the CMS is a good one, and pack your comfortable shoes. In the end we choose our attitude, we can embrace and enjoy this trip with the right amount of preparation and protection from appropriately updated EMR as our insurance. bestPT EMR is ready for ICD 10 and staff is available to guide each individual practice in their implementation of our new coding system.

  1. ICD-10. Centers for Medicare and Medicaid Services. Available at: http://www.cms.gov/Medicare/coding/ICD10/index.html . Accessed on June 3rd 2015.
  2. The road to 10: The small physician practice’s route to ICD 10. Centers for Medicare and Medicaid services. Available at:  http://www.roadto10.org/. Accessed on June 4th 2015.
  3. ICD 10 Fact Sheet: Basics for small and rural practices. Available at: http://www.cms.gov/eHealth/downloads/eHealthU_BasicsSmallRuralPrac.pdf. Accessed on June 4th 2015.
  4. ICD 10. American Physical Therapy Association. Available at: http://www.apta.org/Payment/Coding/ICD10. Accessed on: June 4th 2015.

-Amanda Olson, DPT

PQRS

2015 Changes in PQRS Reporting Made Easier with EMR

Previously we discussed the changes in health care provision regarding the Physician Quality Reporting System (PQRS). In this article I will present more in depth current information regarding the ever changing landscape of medicare reimbursement and how physical therapists fit into the picture. In January of this year, the US department of Health and Human Services (HHS) produced the first set of timelines for a transition away from Medicare reimbursement as we know it. The ball is now rolling to move away from a fee-for-service model in favor of a payment for outcomes paradigm. This new model will create a demand for provider accountability and increased quality in patient care in an outcomes-based reimbursement model.

The major changes in PQRS reporting for 2015 drastic changes in fee schedule payment. Specifically, private practice PTs who did not participate in successful reporting of data on quality measures in the form of PQRS reporting in 2013 will see a 1.5% reduction in their fee schedule payment in the year 2015(1). Those who do not successfully participate this year will be see a 2.0% reduction in their fee schedule which will be fully realized in the year 2017.

Additionally, private practice’s will be included in a Value-Based Modifier (VM) program which is set to begin in 2016. Under this new program, PTs must meet PQRS reporting requirements or be subject to up to a 4.0% reduction in payment in addition to the pre-existing 2.0% reduction for a total of 6.0% reduction in pay which will be realized in the year 2018.

The intention behind all of this change is that health care practitioners, including PTs, will provide higher quality services for Medicare beneficiaries. PQRS reporting began in 2007 and in the year 2011 was re-branded and tuned up through the Affordable Care Act. In 2013 it morphed from an incentive-based program to a penalty based program. There is no going back to where we came from, PQRS is here to stay, and a fixture of outpatient physical therapy practice(2).

Interestingly, the VM program utilizes PQRS data collected from clinicians to determine its penalties. Currently, physicians are experiencing these penalties, though the Center for Medicare Services (CMS) has held off on penalizing allied healthcare professionals in order to give adequate time for us to familiarize ourselves with the reporting system. Next year however, we will be held to the same standards, and in order to continue to draw in revenue as we have in the past, we must be compliant with the reporting format.

The regulations are doable. As PTs we must report at least 9 measures, which includes at least 3 National Quality Strategy (NQS) domains on at least 50% of Medicare Part B fee-for-service patients. A complete list of PQRS registries can be found at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html. Depending on the type of patients your clinic sees, some of the domains may be satisfied rather easily with patient intake forms as these include a complete checked list of medications, a pain assessment prior to initiation of patient treatment, and a functional outcome measure. The first two are easily satisfied with patient intake, and the latter may be performed as part of the evaluation of a new patient, and thus readily satisfy Medicare PQRS requirements.

 

There are notable changes in the 2015 reporting, including which cases are eligible for reporting. These changes include elimination of the Back Pain measures group, as well as the Wet to Dry Dressing In Patients with Chronic Skin Ulcers. G code G8406 Diabetic Neurologic Evaluation was removed as well, while G codes G8980, G8983, G8986, G8989 and G8992 were added for FOTO outcomes measures #217-2231.

Medicare PQRS physical therapy

Use of Code #245 is still acceptable in PQRS reporting.

To check your status as a provider, and your clinic’s success in PQRS reporting, the CMS provides claims-based participants with feedback reports through Quality Net, the contracted service provider for Medicare. Visit qnetsupport@sdps.org or call 866-288-8912 to verify that you are on track for a successful reporting year. You may also receive feedback in the way of an Individuals Authorized Access to CMS Computer Services (IACS) account from Quality Net. You can set up an account at www.qualitynet.org/portal/server.pt/community/pqri_home/212#.

Of the two methods of reporting PQRS, the registry reporting method is quickly gaining traction. This may be due to increases in claims based requirements. Thankfully, the American Physical Therapy Association (APTA) has several resources available to ensure successful reporting. A comparison of the registry based reporting versus claims based reporting may be found at the APTA website: http://www.apta.org/PQRS/(3).

Additionally, the Physical Therapy Outcomes Registry is reaching finalization and will provide outpatient PTs with an organized system for collecting data to evaluate patient’s function, in addition to other relevant measures1. This collective data will demonstrate the value of physical therapy in the betterment of our patients. Furthermore, this data may be a highly beneficial tool in our continued advocacy for lightened Medicare Caps, better reimbursement, and improved professional image. More information on this registry may be found at: www.PTOutcomes.com.

All things considered, the essence of all of these changes is to provide the highest quality care for our patients. By demonstrating progress in our patients through functional outcomes measures, we are able to show the value that physical therapy holds in the lives of our patients. What we have intrinsically known for decades, we will now be able to show to Medicare, to our patients, and referral sources.

  1. Smith, H. Compliance Matters. PT in Motion. (8-12) April 2015.
  2. Registry Reporting . Center for Medicare Services. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html. Accessed on April 20, 2015.
  3. Medicare Physician Quality Reporting System. American Physical Therapy Association. Available at: http://www.apta.org/PQRS/. Accessed on April 20, 2015.

-Amanda Olson, DPT