Physical Therapy Billing | most used CPT codes 2012

Readers have asked us to add “by specialty” analysis, hence we looked at PT (065) OT (067) and SLP (235Z00000X). Naturally there is way more resemblance between PT and OT than with SLP.

physical therapy billing most used codes 3

Very few CPT codes are responsible for the majority of the “action”:

physical therapy billing most used codes 4

9 CPT codes were used in 87% of all PT claims,  8 CPT codes were used in 90% of all PT units and generated 93% of all PT payments.

physical therapy billing most used codes

9 CPT codes were used in 76% of all OT claims,  8 CPT codes were used in 84% of all OT units and generated 88% of all OT payments.

physical therapy billing most used codes

6 CPT codes were used in 93% of all SLP claims,  5 CPT codes were used in 93% of all SLP units and generated 97% of all SLP payments.

physical therapy billing most used codes 2

2012 L codes (DME braces) analysis is coming soon.

Physical Therapy Billing | BestPT is ready for Medicare changes!

There are new reporting requirement and billing requirements that go into effect in 2013. They started in January, but will not be required until July 31, 2013 so now is the time to learn about them! BestPT wants to make sure you have all of the information that you need to stay ahead of the Medicare curve.

During February, look for a webinar about G-codes, modifiers, and functional testing. We will also release information regarding documentation changes as well. We can’t wait to talk to you about this.

Physical Therapy specific G codes have been in effect since January 1, 2013. Full time use of these codes will not be mandated until July 31, 2013. BestPT has you prepared for these changes.

We are in the process of developing a Medicare compliant XDoc template with areas to document your G-Codes, modifiers, and functional testing. We anticipate completing this in the next month.

new members for our pt billing software

Physical Therapy Billing | Welcome to the BestPT team!

Welcome New Members to the bestPT Team!

Ten New members joined bestPT in August 2014.

Each of our new members benefit from and contributes to our network strength.  A billing problem solved for one practice will then be automatically applied to all of our clients.

Let’s welcome bestPT newest members!

PT Clinic Control 3 | Costs-Benefit Analysis of Documentation

Best practices for physical therapy billing

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Chris Martin: So, are you saying that the cost of visit documentation is much higher than just the cost of the SOAP system [as part of the physical therapy billing process] because it takes YOUR time to document?

Dave Macolino: Precisely. The practice owner’s time is the most expensive component of their practice and they should be maximizing that value. Obviously, when they spend that time seeing patients, they maximize their value and time writing notes, reduces it.

Chris Martin: So, how do you compute the cost of writing a SOAP note? More importantly, how do you compute the cost of writing all your SOAP notes for the next ten years?

Dave Macolino: A successful enterprise must generate more revenue than costs and a practice owner must get used to thinking about his or her time in terms of revenue and cost.

So, the first question is: what is the cost of your time?

The answer depends on your productivity. Suppose your practice can handle 4 patient visits per hour and it requires you personally to supervise them for 15 minutes each. If an average visit pays $80, then your hour is worth $320. So, in this case, your optimal performance is $320 per hour.

That also means that if you spend your time on other activities that earms you less than $320 per hour, you’re losing money.

The amount of money you’re losing depends on the time you spend not generating $320 per hour. So, if you can only write 2 notes per hour then each note basically costs you $160. If you are writing 200 notes a month, then you lose the time equivalent of $32,000 a month! Extrapolate this forward to 10 years, and you get to $3,840,000 or very close to $4 million dollars in lost productivity and earnings!

Chris Martin: OK, I got it. It costs millions of dollars if I use a slow documentation system. So what should I do now? It all seems so confusing…

Dave Macolino: It’s not so much a slow documentation system as it is a system that has a flow of information and is set up with consistent phrases and measurements that are often used in the daily notes.

This computation is just an example of how you should think about your costs of any activity. Once you identify all your activities and attach cost to each one of them, you can focus on those activities that matter the most and eliminate or optimize those that don’t.

You can also set very clear requirements for the kinds of processes and systems you need to have in your office to help you spend as much time generating $320 per hour and very few hours that generate less or even worse, cost you as high as $320 per hour.

Think about it this way. If you personally spend 1 hour a week on practice administration and 3 hours a week on say billing, then over the next 10 years, you will spend the equivalent of $640,000.

So now you can add up all of your costs (add office rent, equipment, staff costs) and start thinking about what processes and systems do you need that reduce these costs?

Since documentation, administration, and billing are the largest components of your cost, then you need to design processes and install a system in your office that address these costs first.

Physical Therapy Billing | BestPT gets me paid

Jason Barnes: You’re spending 30 minutes a day on your physical therapy billing?

Michael Walsh, PT: Max yeah.

Jason Barnes: Does that include documentation?

Michael Walsh: That would include documentation.

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On a busy day, say like Monday is my heavy AR day, you guys have it all posted by Wednesday or Thursday the latest. So I get to do some stuff in there and make some comments. It’s just part of my routine.

I have made it part of my work flow so I don’t have to take it home.

You know I used to take a laptop home everyday but I don’t want to play around with it. I would rather play with my kids. So that’s the thing I mean it’s done for me. Its part of my day.

I opened up my practice with bestPT from scratch. We had a 30-day downtime while we were getting loaded so we did some paper claims for workman’s comp, I hand typed my notes but I had a template. My template notes still took about 90 seconds because I had to print them out and sign it.

My receptionist tried to make copies, send a 1500 form out. So I’d say the whole process of doing one bill took about five minutes. While now, it’s just an instant, boom, boom, boom, click, bill. It’s done.

And they’re gonna drag their feet, you know. There’s a big fat cat up on the hill. I’m a little guy but if we do it right, it’s good.

Jason Barnes: What sort of feedback do you get from the insurance companies on bestPT?

Michael Walsh: Well I got to tell you, on the commercial nothing because the transactions are so fast. I mean like I said, Blue Cross is usually three days. Tricare I just got a payment from them on a patient, I’m getting paid in less than seven days on them. Medicare looks like five or seven days.

But on the workman’s comp companies and the other companies, they hate you guys and I mean that as a positive because they sometimes call and ask me, tell your billing company to quit calling us, we’re working as hard as we can.

So I say, they’re doing their job, their job is to get me paid.

Top 10 Physical Therapy And Rehabilitation Golden Opportunities!

Physical Therapists and private practice rehabilitation owners continuously struggle with ways of marketing their services to the community where they provide services. We advertise, develop web sites and create elaborate marketing materials. In this marketing campaign, we often overlook our most valuable resources; ourselves and our staff.

Every day, in every thing we do, we are presented with opportunities to market our Physical Therapy service, skills and knowledge. Simple opportunities present themselves when attending local sporting events, going to a doctor visit with your child, or even offering words of advice to a local community group. When presented with these opportunities, it is important to remember to take a moment to make a connection with the other person and use the strategies listed below to make a lasting, positive impression. Making a good first impression is a singular opportunity! An opportunity which can change the profitability and success of your Physical Therapy and Rehabilitation practice.


1. Provide written schedule of appointments-A written schedule of appointments will improve the customers’ attendance by decreasing opportunities for cancellations due to not remembering the date/time of the appointment, location or phone number to call and reschedule.

2. Discuss what to strive for/goals-establishing goals with the client in cooperation with the Physical Therapist clarifies what therapy can and can not do for the client. A clear level of communication and expectations are established.

3. Provide written information-Home exercise programs, internet and written references provide ongoing learning at the client’s own pace and contributes to the client’s increased level of responsibility for their own success.

4. Start and end your session on time-Respect your client’s time and they will respect your time in return.

5. Send reports in a timely manner-Documenting treatment and delivering this information to the team of care providers effectively and efficiently helps to manage the timeliness of treatment protocols.

6. Discuss other therapies and their benefits-An informed client who makes their own choices will participate in the therapy plan of care with an increased level of commitment and success.

7. Serve as a referral source for family/client-The Physical Therapist is the coach. We must help the client access and successfully utilize the resources in their community in an appropriate manner to compliment, support and eventually be a replacement for the physical therapy program once they have achieved their rehabilitation goals.

8. Look for opportunities to promote yourself, coworkers and services-You are your own greatest advocate! Share conferences you have recently attended, materials you have read, and provide access to information your coworkers and team-mates are learning!

9. Provide business cards to contacts-Business cards do more than share vital statistics about credentials and contact information. They are a tangible reminders of your interaction which represent you and your company.

10. Send thank you note in appreciation for the visit-Common courtesy and appreciation are hallmarks in treating our clients with respect.

Physical Therapists and Rehabilitation practice owners can use the Top 10 Daily Golden Opportunities to market their services and skills. They take very little time or financial resources to implement. If you consistently capitalize on everyday opportunities, you may find the “small” impressions you make today will take root and grow into big returns in the future.

Gerilyn M. Gault, BSPT, is co-owner of the rehabilitation company and Account Specialist for bestPT. Gerilyn is an advanced neurological clinician with years of experience in professional staffing, private practice, contract and fiscal management.

Physical Therapy Billing | Best Practices from Michael Walsh, PT

Michael Walsh, PT: I’m doing my documentation as I go. The hardest thing for me is if I become swamped or have a patient who just kind of shows up and they’re a new patient.

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I’ve got some establish patients here and stuff like that, I’ll make notes occasionally you know little range of motion things here and there but overall, if I have an established patient and their notes are already in the system, I can just plug in with the change. Did some of the treatment change? Maybe it did. Did their pain levels change? I hope so.

If certain things change, I may actually see I would…I can knock on a note for an established patient in probably 30 seconds. As I work I do my notes so I would say like on the hour, if I’m seeing, say I’m seeing two patients an hour, after I get them treated or doing some kind of exercise, I’ll knock out part of the note and then I’ll check the work bench.

With the insurance companies, I try to make sure I follow the rules to the T so at the end of the day, I get compensated and I stay compliant.

You guys call them with all the other stuff you know, why should I pay them? I don’t like this stuff, and for the most part I don’t want to hear from them.

Jason Barnes: Any chance you have a note that you need to complete right now?

Michael Walsh: You know it’s funny, while I was fooling around I just did my last note.

Jason Barnes: While you were here?

Michael Walsh: Yeah, while you guys were setting up. I did my last note then.

Jason Barnes: Can you give bestPT a rating right now.

Michael Walsh: It’s you know I’d say A+

I mean, its tough to find people who know how to do this stuff.

Having people on your payroll who call out sick, claims don’t go out. Phone calls don’t get made you know headaches, headaches, headaches.

You’re like me, where would you go? If I’m not getting paid, you’re not getting paid. If you’re not doing your job, I’m pissed off I mean its as simple as that.

You guys are a commission-based company so it forces you to do your job. Then you celebrate the 15th of the month, when that payment comes out. Seriously, that’s how it is.

Fair OT Coverage Under Medicare: LCDs FAQ

rehab, PT, physical therapy, software, billing, notes, SOAP notes, EMR, rehab-software, rehab-billing, rehab-notes, rehab SOAP notes, rehab-EMR, PT-software, PT-billing, PT-notes, PT SOAP notes, PT-EMR, Physical Therapy software, Physical Therapy billing, Physical Therapy notes, Physical Therapy SOAP notes, Physical Therapy EMR How to Advocate for Fair OT Coverage Under Medicare: LCDs FAQ

Regional Medicare Local Coverage Determinations (LCDs) are undergoing some changes. Under the Medicare Program, Medicare contracts with regional corporate entities that process and pay claims for services provided in their regions which may range from one state to multiple states to parts of states. These entities, usually insurance companies, have in the past been called “carriers” or “fiscal intermediaries” but due to recent legislative changes are moving to be called Medicare Administrative Contractors (MACs). This article presents key issues about LCD changes already underway, and opportunities for advocacy.

What is an LCD?

LCDs are coverage and payment policies that have been used by current carriers and fiscal intermediaries but will also be used in the regions covered by the new MACs to interpret national Medicare policy issued by the Centers for Medicare and Medicaid Services (CMS). LCD coverage policies may be based on discipline (e.g., an LCD might be titled “occupational therapy” or “physical medicine and rehabilitation”) or type of service (e.g., wound care services; dysphagia services and so forth).

What is Changing?

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) enabled CMS to make significant changes to the Medicare fee-for-service program’s administrative structure. The key feature is that the MACs will gradually be identified over the next several years to replace the old carriers and fiscal intermediaries. Under the law’s provision for Medicare Contracting Reform, CMS will integrate the administration of Medicare Parts A and B into one regional entity-a MAC. All Part A and B fee-for-service claims will be processed through these new entities. As part of the reform, CMS is conducting open competitions to replace contractors but it will take time. Affected regions are being phased in from 2005-2011.

What is Affecting Occupational Therapy Now?

The MACs are currently being selected and as part of the reform process, LCDs are under review. As MAC contracts are awarded to local Medicare contractors, these contractors are re-examining existing LCDs that govern Physical Medicine and Rehabilitation policies in their coverage region and are consolidating and revising the LCDs, typically through a stakeholder notice and comment process.

What Should Occupational Therapy Practitioners Do About the Changes?

The changing contracting process is one reason for the recent explosion of open LCDs and requests from new MACs for therapists to provide comments on an LCD. LCDs are required to allow for some public comment. It is imperative that practitioners follow the changes in the process and entities that affect their Medicare billing by watching the Web sites of current and new entities.

While some LCDs recognize the full scope of occupational therapy practice, LCDs frequently present inappropriate or erroneous information on the occupational therapy scope of practice and that of other therapy disciplines. Further, these inappropriate LCDs may lead to AOTA members receiving widespread Medicare denials of claims for services that occupational therapists are educated and licensed to provide. There have always been efforts made by therapists and sometimes state associations to affect and change LCDs; AOTA also weighs in with comments on many LCDs. With the many changes now happening, it is important that all in the field watch what entities are doing to protect occupational therapy practice, payment, and scope of practice. The best source of information is the Web site of your current fiscal intermediary or contractor. Changes to MACs will be posted there.

What Materials Are Available to Help Me Be an Advocate on LCDs?

AOTA wants to provide members with the following tools and resources to respond to requests for comments on LCDs:

  • LCD Advocacy Packet: This packet provides the materials and resources necessary to enable state associations and individual practitioners to monitor and advocate for OT services under Medicare, critical fact sheets, AOTA official documents, and sample LCD comment letters are included.
  • Medicare Benefit Policy Manual – Presents frequently used citations. (See Chapter 15)
Chapter / Section / Subsection / Title
15/220 – Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance
15/220.2 – Reasonable and Necessary Outpatient Rehabilitation Therapy Services
15/220.3 – Documentation Requirements for Therapy Services
15/230 – Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology

Article from www.

Physical Therapy Software is used by Mike Walsh, PT.

Physical Therapy Software | bestPT gets me paid – Michael Walsh, PT

Billing Dynamix and bestPT gets Michael Walsh, PT “PAID” at his Physical Therapy Practice

How? By using the physical therapy software that was developed with physical therapy practices in mind.  The documentation can be completed in a matter of clicks and the claim scrubbers ensure quick payment from the notoriously slow Payers.

Physical Therapy Business Control | How Do You Get What You Want in Your Own Clinic? Part 1

Chris Martin interviews Diane McCutcheon

Chris: In your experience, what are the top 3 reasons for sub-optimal practice performance, Diane?

Diane: Any service has 3 key components: process, people, and technology. When the practice owner neglects any one of them or fails to operate all three of them correctly, the practice starts operating sub-optimally, or bleed cash.

The cost of doing business will increase without a concerted effort on the part of management and staff to focus on the company’s mission and vision by working smarter not harder.

Steps to developing a well-organized and seamless operation will take time and effort on the owner’s part to learn signs and symptoms that are indicative of problems or concerns. This skill is key to insuring that matters are handled immediately – before they get out of hand and begin costing the practice money.

Let me give a few examples for typical reasons for sub-optimal performance:

  1. Processes not conducive to a seamless operation – for instance, no set procedures in place that commit to follow through.
  2. No system to set goals, lacking understanding what outcomes help to identify deficiencies in the system, e.g., denials, referral and authorization management.
  3. Untrained or incorrectly incentivized staff – Staff is “shown what to do” instead of being trained on the methodology behind the processes in place.
  4. The staff and owner not understanding what is needed to run a seamless operation.
  5. The staff receiving a flat hourly salary regardless of practice collections or their performance.
  6. Weak technology – out of date hardware and software. Staff fear of moving from paper to electronics.
  7. Insufficient software functionality, or conversely, multiple systems instead of an integrated approach that eliminated redundant data entry and identifies errors.

Chris: Diane, you said there are three parts to any service: process, people, and technology. Let’s talk a little about the people component. Isn’t this kind of obvious: we just look for nice and diligent people who work hard and accept low salaries? What else do we need to know about hiring the right staff?

Actually, the people component of the service starts with the practice owner. Again, control is key aspect. The question is: how to set their incentives and how to select your personnel in such a way that you can make adjustments midstream, every time when you discover that you are going to miss your goals?

Hiring the right staff is a major component to success. You can hire anyone to perform functions but if they are not performing functions that result in quality work then you don’t need them as they will cost you money. An owner has to know what function each staff member is performing, how long it should take to perform tasks, and what constitutes success. If staff is aware that they know much more than the boss at some point they will take advantage of that – it happens all the time.

Training must be part of orientation, standards must be set and staff must be held accountable. You cannot control what you don’t know. You cannot manage what you don’t know.

Chris: What would be the ideal way to align your staff incentives with your own?

Have them work on commission. Is it easy? Well, in some cases, yes.

Some incentives are based on percent of arrival, minimizing cx and ns, keeping slots in the schedule full. If they are doing in-house billing staff may be incentivized on keeping all accounts under 120 days or less. Sharing profits with staff on any one of these things is an excellent way to keep them motivated. If your staff is working hard to keep slots filled, reduce cx/ns and make sure the schedule is maximized more profits will come in to the practice – if staff is not motivated to do this revenue will be lost. Sharing profits is more cost effective in the long run.

And in those other cases, when it’s not so simple, think out of the box. Why do you need staff who refuse to align their incentives with yours?

Staffs who refuse to align incentives with owners (which happens all the time) is almost 100% because the owner is not an effective leader, they do not understand the value of the incentives and present a “look what I’m doing for you” attitude and do not promote a team environment.