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Fall, 2018: What Is “Defensible Documentation?”

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What Is “Defensible Documentation?”

Hannah Mullaney

Defensible documentation in the physical therapy world — what does this entail? A paper chart donned with purple gloves, yellow gown, and p99 respiratory mask? Or maybe a sleek EMR (electronic medical record) laced with the defensive skills of a black belt extraordinaire. Actually, it harkens to the diligent PT typing notes over lunch, after work, and before patients arrive the next morning.
What is documentation? It is the thorough note that a physical therapist writes explaining what happened during an appointment. How was the patient? What happened during therapy? Why should insurance pay the therapist? It needs to be detailed enough to stand trial in a court case yet succinct enough for a single person to document 6-16 appointments in a day.
The American Physical Therapy Association (APTA) website faithfully reminds practicing PTs why documentation is so important.
Health care consumers trust physical therapists to use their expert training to improve, maintain, restore, and enhance movement, activity, and health for optimal functioning and quality of life. While safety and quality of care is most important when caring for patients and clients, documentation throughout the episode of care is a professional responsibility and a legal requirement. It is also a tool to help ensure safety and the provision of high-quality care and to support payment of services.
The national organization also provides tips and tricks for making high-quality documentation.
First of all, these are the skeleton of a solid physical therapy note, with a little sample of what each part means.
  • Examination – what the patient reports (subjective, “my hip hurts right in the crease for the last 2 months”), what the PT finds using tests and measures (objective, “limited range of motion of the left hip”), and systems review (“blood pressure is 110/70 and patient is oriented to self, date, place, situation”)
  • Evaluation – what the PT concludes from the examination
  • Diagnosis – Physical therapy diagnosis is different than a medical diagnosis. For example, if a patient tore their ACL, the PT would say, “Right knee ligamentous laxity” and the MD would say, “partially torn ACL.”
  • Prognosis – patient’s potential ability to regain function
  • Plan of Care – game plan!
Defensible documentation needs some muscles to give power to the treatment. This is the evidenced-based care. Tests, interventions, and exercises that scientific study has shown to be safe and effective encompass evidenced-based care.
The ligaments and fascia that holds defensible documentation together is the risk management component. If something was not written in the documentation, it is as if it didn’t happen. Therefore, PTs need to be careful to be safe in action and documentation in every single encounter– for the patient’s sake as well as their own.
Examples of risk management in note-writing include some of the following.
  • Confidentiality — HIPAA. Enough said.
  • Incident reporting – “Mrs. J’s blood pressure dropped to 90/70 during therapy.”
  • Maintaining patient records — filling out the daily notes and re-evals every time, keeping copies of insurance records, patient test results (X-rays, labs, MRIs, etc), exercise prescriptions, and the all-important consent form.
  • Electronic health record hygiene – maintaining safe passwords, keeping other patient’s information out of sight.
  • Fraud, abuse, and waste – only giving care to patients who need it.
Whew! That’s a lot for a physical therapist to keep in mind while they do dozens of these documentations a week. However tedious it can be, it is important for PTs to stay true and keep their documentation strong. It needs to ricochet against the possible legal encounters. It needs to be armed with risk management and evidence-based care. And the tool that houses all of this defensible documentation is the electronic medical record (EMR). A defensible EMR will follow the guidelines suggested by the APTA to keep patients and practitioners safe in the current age of medicine.
 

Welcome

New Members to the bestPT Network!

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

Let’s welcome bestPT Billing’s newest members!

Chelsea Dezelia Hadfield, Adam Walsh, Dalan Abreu, Deanna Armijo, Sara Balthaser, Nicholas Blonski, Zachary Blossom, Anthony Casazza, Anthony Chavez, William Chynoweth, Roberto Cordova, Kaitlynn Craig, Renee Dupre, Lucretia Duran, Joslynn Fletcher, Allison Foulk, Micaela Gilpin, Paige Goodwin, Morgan Kerschen, Charles Kettenring,Mikaela Lazar, Ashlee Lee, Ryann Montano, Hanna Park, Christian Pearson, Alexander Phillips, Francesca Picchi-Wilson,Jane Graham, Victoria Raught, Nicholas Romero, Alicia Roussin, Sam Sanders, James Schlavin, Tomas Tafoya, Nicholas Zarasua, Michael Alicto, Kori Apodaca Cordova, Tamaya Toulouse
University of New Mexico, Albuquerque, NM
Nicole Coddington, Blake Hebert, Speight McKenzie
Julie Tran
Kathryn Gerletti
Aleksandra Gutsman

 

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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 referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

bestPT

Summer, 2018: Is Physical Therapy the Worst Kept Secret in HealthCare?

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I still believe physical therapy is the WORST kept secret in healthcare. Last year I wrote a blog titled “Physical Therapy – The WORST Kept Secret in Healthcare” which allowed for some great discussion by the readers on the topic of physical therapy and where we fit into the healthcare system.   This blog post followed an open discussion called the “Chelan Chat” at the Washington State Private Practice Special Interest Group (PPSIG) spring conference at Lake Chelan, WA.  The ‘Chelan Chat’ is a twist on the Annual Graham Sessions hosted by the Institute of Private Practice Physical Therapy and was moderated by Steve Anderson. This year I was asked to present an “I believe” speech, that I would like to share with everyone here as a means to continue the discussion and a call to action. Here it goes…
I believe we are in the “story” business as physical therapists. We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage! A vast majority of people fail to recognize the difference between a story and fact. In fact, most people view stories as facts and as Carnegie Mellon research shows, our stories carry far more weight than facts. In reality, a story is what we tell ourselves about the facts, it is not real. Our point of view is not the truth, it is our perspective. And perspective is based on our knowledge, previous beliefs, environment, the context or space we are in, our mood, our emotions, social pressures, and so on. Essentially our perspective is based on where we are at in life when we make up the story. I believe it is therefore important to remember that our perspective is just one angle on the facts, it is not the only story. Facts do not determine our point of view, our stories do.
So, I would like to invite you into my story on why I believe physical therapy is the WORST kept secret in healthcare.
Most of you are familiar with the common phrase “the best kept secret”. Being the best kept secret is great when you want to keep something a secret, such as your favorite coffee shop, restaurant or favorite place to vacation. However, when it comes to the role of physical therapy in healthcare, I believe that we are still a SECRET to a majority of consumers. This was highlighted in 2007 by Stephanie Carter and John Rizzo when they demonstrated that less than 7% of patients with musculoskeletal conditions utilize outpatient physical therapy services and again in 2012 in the Fritz and Childs study.
So, hopefully you are sitting there asking yourselves, why are we a secret? I believe we are the worst kept secret in healthcare for four main reasons:
  1. We have an identity crisis
  2. We suck at marketing
  3. We don’t know how to sell our product
  4. We are bullies to our brothers and sisters
Despite our shortcomings as a profession, I believe we are the BEST profession in a broken healthcare system and it is our time to move into the limelight.
 

Welcome

New Members to the bestPT Network!

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

Let’s welcome bestPT Billing’s newest members!

Jon Meyer
Asbury University, Wilmore, KY
Marissa Crouse
Jessica Lopez
Mary Ann Williams & Rani Patel
Caitlin Westlake
Erika Morales & Brandon Selvey
Alex Galewski
Fenn Chiropractic, Tallahassee, FL
Maddie Larsen & Robert Neise
Health Rehab Solutions, Kalispell, MY
Martha Cernicchiaro
Anna Barkins
Sheli Peterson
Physicians Vein Clinics, Sioux Falls, SD
Allison Enoch
Ventura Spine and Disc, Ventura, CA
Jeannie Hile, Ashley Astles, Francesca Foley, & Susan Leach
University of New Mexico, Albuquerque, NM

 

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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 referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

Tom Jorno

May 2018: Imposter Syndrome in Graduate Students

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Imposter Syndrome: Dealing with Feelings of Self-Doubt and Inadequacy in a Doctorate Level Program

Imposter syndrome (IS): a collection of feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence that override any feelings of success or external proof of their competence.  Imposter syndrome is something we have heard about from professors, mentors, and advisors. They tell us that it is a normal experience for many graduate students, especially those in the field of healthcare. They tell us that this feeling may stick with us well into the first few years of our practice. While this is a well-known and widely experienced issue for many students of physical therapy, it feels anything but “normal.”

On any given day of any given week, I’ll turn to any fellow classmate and we’ll crack a joke about how underprepared we feel for our next exam, clinic session, or rotation. It seems it is a constant feeling of under-preparedness, or lack of readiness, that weighs heavily on our shoulders.  All this, despite the fact that we have made it well into our second year of didactics, and may even have a 4.0 GPA. We perform well in the classroom, but this does little to nothing to boost our confidence as proficient practitioners of physical therapy. How can we best deal with this feeling of inadequacy?

An article from Psychology Today discusses tips on how to handle IS, and even make the best of it. First, appreciate your position as a novice. Consider that your perspective is fresh, and that of an outsider, due to inexperience. Therefore, the questions you ask may be very original, since you have not yet bulked up on conventional wisdom.

Next, try to shift your mindset from one that focuses on performance, to a mindset that focuses on what you are learning. Realize that we learn the most when we make mistakes, so stop seeing mistakes as failures or inadequacies, and instead view them as opportunities to enrich your knowledge base.

The third tip is to realize that perspective holds a lot of power. You may perceive yourself as the only one in the room who is truly experiencing IS, or that you are the person least worthy to be in the room. In reality, it’s likely that the majority of people in the room share that perspective, or have at some point in time. Realize that you are not alone with this feeling, that this is common, and that this is normal.  This third tip feeds into my personal experience in dealing with IS. Positive perspective has helped me deal with IS thus far, and will continue to in the near future. I had never heard of the term “imposter syndrome” before grad school, even though I had experienced it personally from time to time in the past. Thankfully, as mentioned above, our faculty was quick to address the issue of IS early on, during our first year in the program. Hearing this coming from faculty, in a non-judgmental manner, was somewhat comforting. In a way, simply being made aware of IS from the get go made it a bit easier to accept, process, and handle moving forward in the program.

 

The Impostor Syndrome and How To Handle It. (n.d.). Retrieved March 28, 2018, from https://www.psychologytoday.com/blog/adaptation/201611/the-impostor-syndrome-and-how-handle-it

 

 
 

Welcome

New Members to the bestPT Network!

 

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

Let’s welcome bestPT Billing’s newest members!

Kathleen Wiemold
Korey Wiemold
Kellie Martin
Bassett Physical Therapy, Stanleytown, VA
Kenisha Dickerson
Melwood Rehabilitation, Upper Marlboro, MD

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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 referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

 

PT billing software reconciliation
bestPT

Do you reconcile your collections monthly?

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When your practice receives payments by cash, credit card or checks, how do you reconcile your practice with your bank account every month?

Reconciling your bank account with the collections you receive at your practice is something they teach in business school, but not in Physical Therapist School.  Co-payments are being taken from your patients every day but checks from insurance companies come in by mail, weeks after the date of service.  How do you keep track of everything and everybody? How do you know the money showing in your billing software is actually arriving in your bank account?

The bestPT Billing Software can eliminate this memory management with several built-in tools to reconcile your finances.  Learn how with the free webinar that can be viewed right on this page.

physical therapy billing software
bestPT

Do you reconcile your collections daily?

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When your practice receives payments by cash, credit card or checks, do you have a way to reconcile your practice with your bank account?

Reconciling your bank account with the collections you receive at your practice is something they teach in business school, but not in Physical Therapy School.  Co-payments are being taken from your patients every day but checks from insurance companies come in by mail, weeks after the date of service.  How do you keep track of everything and everybody?

The bestPT Billing Software can eliminate this memory management with several built-in tools to reconcile your finances.  Learn how with the free webinar that can be viewed right on this page.

PT billing software
bestPT

How Many Tasks does a New Patient Generate?

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When a new patient comes to your Physical Therapy Practice, how many steps must your Front Desk person take to create a new patient account?

Typically, a new patient comes in to fill out forms and then your Staff has to remember to copy their driver’s license and their insurance card. Next, the patient’s data has to be typed into a computer. Co-payments also have to be collected and future appointments need to be scheduled. Are all of these tasks being completed for every patient?  How do you know?

The bestPT Billing Software can eliminate this memory management with a tool we call a Task Checklist. All of the steps are written down and turned into tasks that can be automatically assigned to your staff members. The Task Checklist is launched with every new patient and your staff will know exactly what to do without being told. The Practice Owner will be able to see at a glance if every task was done for every patient, which ensures a consistent patient experience in your office. It also gives you and your staff peace-of-mind knowing everything is done at the end of the day.  Learn more with the free webinar that can be viewed right on this page.

PT billing
bestPT

How to Detect Insurance Underpayments

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How can you tell if your Physical Therapy Practice is being paid in full and on time by insurance companies? How can you tell if there’s an underpayment?

The bestPTbilling software can detect insurance company underpayments and then you’ll know the details you need to address the situation.  The elimination of insurance industry underpayments is a challenge because their goal is to not pay for anything until they absolutely have to.  Their next tactic is to underpay and hope that you don’t catch on.  Our built-in tool will help you to detect and then to fight underpayments.  Learn more with the free webinar that can be viewed right on this page.

Fortis Payment Systems is integrated with bestPT
bestPT

Fortis Payment Systems is Integrated with bestPT.

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Use Fortis Payment Systems to process credit card payments in real time online, not with a slow telephone terminal.

Fortis Payment Systems is Integrated within the bestPT Software.  You can charge a patient’s card from within their account and you can charge their card easily from the Point of Sale screen as well.  The payments can be tagged separately and they’re automatically posted to the patient’s account.  View this webinar to see other features and to see how it works. Learn more with the free webinar that can be viewed right on this page.

assess your physical therapy practice
bestPT

How Do You Assess Your Practice?

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How can you get your finger on the pulse of your practice?

This week’s webinar is about your Collections. How to assess both Insurance and Cash Collections. How do you track your collections? Do you have a tool to monitor the ups and downs with a simple glance at a chart?

The tools to assess and track collections metrics are built into our software and your Practice Success Coach will help you to understand these metrics and their relationships to other metrics. These Key Performance Indicators (KPIs) must be measured to know the health of your Practice.  Learn more with the free webinar that can be viewed right on this page.