Reuven Lirov

Time for a New Recipe?

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workflow issues at PT practice call for a new recipeTime for a New Recipe?

Quality ingredients don’t guarantee success

Does Shannon need new workers, or a new approach to practice management?

Mike set a dish before his wife with a flourish. Shannon eyed it uncertainly. “It looks like chocolate mousse,” she said, “but I thought you said you were working on healthy new dishes at the restaurant.”

“Absolutely!” Mike agreed. “When people find out that I’m married to a physical therapist, they expect my menu to include all those gluten-free, dairy-free, heart-healthy paleo vegan things, and I’m trying to accommodate them.”

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“So the super-cheerful voice is designed to make me like this better?” Shannon asked, dipping a spoon into the concoction. “I don’t think that works. I tried it at the practice this morning and you should have seen how flat it fell.”

Mike sat down at the table with Shannon and took her hand. “I thought you had a great plan for getting everyone together to work on the problems with practice management that you’ve been dealing with.”

“I thought so, too,” said Shannon, with a spoonful of Mike’s mousse paused halfway to her mouth. “Instead of banding together to brainstorm solutions the way I thought we would, everybody turned on one another. You’ve never heard such a blamefest!”

“That’s a new word for me,” Mike teased, “but I know what you mean. Everyone passes the blame along to everyone else.”

“Exactly! We already have high turnover in the front office as it is, not to mention absenteeism, and now it seems like nobody wants to accept responsibility for anything. How can we make changes when they’re all convinced that they’re already perfect?”

“Speaking of perfect, how about actually tasting this scrumptious new dessert?”

Shannon peered at the spoon. “It looks creamy and delicious, but there has to be a catch. What did the kids think?”

“The kids wouldn’t eat it,” Mike admitted. “They watched me make it, and I guess I faced the same kind of bad attitude you faced at the practice. Except that I can’t fire the kids and hire new ones.”

“If firing people and hiring new ones would help, I’d do it,” Shannon laughed, “but I don’t think I have bad workers.”

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She tasted the dessert. “Hmm… this also isn’t bad. Chocolatey, but there’s something else in there I can’t quite identify. Some kind of vegetable, maybe?”

“Avocado! Instead of cream and egg yolks with all that saturated fat, I went with avocado.”

“Avocado is delicious on its own, but if there were some way to keep the texture and make the flavor a little less vegetable…”

Mike frowned thoughtfully. “Shannon, maybe that’s what’s going on with your practice, too. It’s not that the ingredients are wrong — you’ve got good people — but the recipe needs tweaking.”

Shannon nodded. “That makes sense. But where can I find a good recipe for practice management success?”

Does Shannon need new workers,

or a new approach to practice management?

Want to know how to improve your own practice workflow? Register for our webinar ’4 Steps to Stop Your Staff from Fighting.’

 

Reuven Lirov

Prickly Issues

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Physical therapy practice performance | TeamflowPrickly Issues

Bringing up concerns results in pointing fingers, casting blame.

How can Shannon improve performance in the office without losing workers or hurting morale?

Shannon looked around the conference room. She had borrowed the room from a neighboring office and called all her staff in early, hoping it would seem more official than if she just brought up her concerns during the regular workday. On the contrary, two of her team members were busy with their phones and most of the others were chatting.

“Okay, people!” she said, worrying that she sounded too perky. “We have a problem, but I think we can all work together and make things better.”

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Definitely too perky.

“We need to step up our game in the office,” she continued. “When we have mistakes in billing it costs the practice money.”

The office staff looked offended and the trainers looked bored, but Shannon soldiered on. “Payments get delayed, claims get denied, and we can end up with interrupted care plans and unhappy patients.”

“I am meticulous about paperwork,” Theresa objected, “but I can only do so much with what I’m given.”

“Like what?” one of the assistants chimed in. “I’m meticulous, too!”

“Everybody might be meticulous,” put in a young man in orange scrubs, “but I know I got some notes last week that said, and I quote, ‘Back pain.’ What am I supposed to do with that?”

Shannon waited for the outcry to settle down and continued. “We’ve had claims going in with incorrect diagnosis codes, we don’t always collect the co-pays, and we have some documentation issues that could get us in trouble.”

Team members began talking again, each one seeming to blame another until it was time to open the physical therapy practice.

“Well, thank you all,” Shannon concluded. “I know we can all work together to solve this problem.”

“I don’t know where you get that idea,” Theresa said, helping Shannon put the room in order as the last worker left. “We just spent nearly an hour listening to people say it wasn’t their fault. What makes you think anyone is going to make changes?”

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“You did the same thing the rest of them did!” Shannon protested.

“And so did you!” Theresa snapped. “We’re all doing our best already. You didn’t give us any new ideas. You just said we were messing up. No one is messing up on purpose.”

Shannon sighed and walked back to her office in silence, a few steps behind her office manager. Theresa was right. She hadn’t made things better — in fact, she might have made them worse. The excuses and defensive accusations made in the meeting replayed in her mind as she got ready for her first patient. Turnover was high enough already, and now everyone would be grumpy.

“I don’t have time for this,” Shannon muttered to herself.

How can Shannon improve performance in the office without losing workers or hurting morale?

Want to know how to improve your own practice workflow? Register for our webinar ’4 Steps to Stop Your Staff from Fighting.’

George Konold

Avoid Medicare Penalities | PQRS Webinar

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PQRS bestPT banner
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Not knowing the PQRS requirements can cost you thousands per month in Medicare reimbursements.
 
What is PQRS? It’s the Physician Quality Reporting System – Medicare’s way of making the billing system more complex and keeping the money you’ve earned.
 
Unless you’re billing the right set of PQRS codes on 50 percent of your qualifying visits, you will lose 2 percent of your allowed reimbursements. Join us on January 30th for a 30-minute webinar to learn more about PQRS.
Learning Objectives:
  • Billing and Collections: avoid denied claims and underpayments
  • Compliance: reduce audit risk

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Kathleen Casbarro, CPC

Preparing for the Worst

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physical therapy billing_ICD10 part2Preparing for the Worst

Without proper implementation, ICD-10 could spell disaster

How will the change to ICD-10 codes affect Shannon’s physical therapy practice?

Shannon was in a bad mood. Mike could see it on her face as she came through the door, even though she tried to greet the kids in the usual way and show excitement over their news. Mike was able to leave his restaurant for a while in the afternoon so he could be home when the kids got back from school, but they always crowded around Shannon when she got home, eager to tell her about their school days and to show her their homework.

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“Okay, kids, that’s enough,” Mike said, stepping in to hug his wife. “Give me a minute with Mom, and set the table for dinner.”

As the children ran off to the kitchen, Mike smoothed Shannon’s hair. “What’s going on?”

Shannon slumped onto the sofa. “I don’t know if I’ve mentioned the upcoming changes in insurance reporting,” she began.

“Oh, of course,” Mike joked. “I’ve been thinking about insurance reporting a lot lately, and it’s completely stressing me out, too.”

“Mike, this is serious. I’ve just spent almost the whole day researching this.”

“I’m listening.”

“We have to switch to new codes on October 1st,” Shannon explained, “or we don’t get paid at all. The new code book has 1,107 pages — they don’t all apply to my physical therapy practice, but it’s not like the ones that affect me are sorted out for me. We can’t transition or try it out ahead of time, and the new codes may allow the payers to cherry-pick reasons to deny a claim based on the severity of the condition.”

“Slow down! I’m not getting all of this, and I’m sure there’s more coming, but you might be getting worried before you need to,” Mike suggested. “Everybody has to do this, right? There must be some plan for how to make the change smoothly.”

“The AMA estimates that a practice the size of mine will spend $83,000 to make the changes. They’ll affect billing, scheduling, the way we make notes in patient files… everything, really. And they’ll increase our chances of being audited, too, because the changes in workflow and reporting requirements will create disruptions.”

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“You’re always telling me how great Theresa is,” Mike pointed out. “Maybe she can–”

“Theresa’s a great office manager,” Shannon interrupted, “but these changes aren’t just her problem. Our whole billing system will have to change, and that means extra time and money, and extra chances to make mistakes.”

“I know you always hate software upgrades,” Mike teased, but Shannon wasn’t in the mood.

“Mike, I’m really worried about this. It’s not as though I was looking for a new challenge. I have to keep my equipment and my skills up to date and run my business, on top of taking care of my patients.”

“I’m sorry, sugar,” Mike sighed. “I have to get back to the restaurant to oversee the dinner service. We can talk more when I get home. Dinner’s in the oven.”

“Thanks for listening,” Shannon said, taking off her coat. “I’ll try not to cry in front of the kids, but no promises about you. You might have to listen to more complaining. I don’t know where the extra time and money to take care of this will come from.”

How will the change to ICD-10 codes affect Shannon’s physical therapy practice?

Want more information on ICD-10? Watch our ICD-10 webinar recording!

Kathleen Casbarro, CPC

Breaking the Codes

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physical therapy billing_ICD-10Breaking the Codes

For physical therapists, ICD-10 coding changes are fast approaching

How should Shannon prepare for the switch to ICD-10 reporting codes?

“I think you’ll find that the exercises will really make a difference for you,” Shannon told her last patient of the day. “But only if you do your part. You come in a couple of times a week, but you need to do these exercises every day.”

Her warm smile took any sting out of the words, but she shook her head as she carried the patient’s file to the office.

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“You know, Theresa, my work would be a lot easier if everyone followed through on their programs,” she said. “It’s human nature, though — the temporary pain of doing the exercises is much stronger than the long-term pain of lessened mobility, even though that’s much worse. than having to do the exercises.”

Theresa agreed. “Procrastination is normal. And speaking of procrastination…”

“Don’t give me that look! I know we have to switch to the new ICD codes, but the deadline is not till October 1, 2014. We have time.”

“Let’s see… eight months. So how long have you been thinking about redecorating the practice?”

“Fair point,” Shannon laughed. “It’s probably been close to a year. But that’s not just a little update. I have to make a lot of decisions, come up with the funds, get input from a bunch of people –”

“I have a feeling this reporting change is going to be like that, too,” said Theresa. “I’m not sure exactly what’s involved, but the other office managers have been talking about it and it sounds major.”

“How many different codes do we use?” Shannon asked. “I noticed that the new codes include laterality, but we’re performing a limited number of procedures, right?”

“I get what you’re saying, but one thing I know is that the new codes have seven digits instead of five. That’s a change that will affect everything — scheduling as well as billing. I don’t know if the software we’re using right now can handle it.”

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Shannon frowned. “I see what you mean. This change might have more implications than I’ve been considering. Okay, we’d better carve out some time to go over the regulations and figure out what needs to be done.”

Theresa pulled a calendar over to her. “That’s part of the problem. You don’t really have any time — our new push for profitability is a great thing for the practice, but it hasn’t freed up any hours in your schedule. Nor in mine.”

The two women stood and looked at one another for a moment.

“I guess it’s a good thing that we have till October,” Shannon said ruefully. “It may take us a while just to get a handle on how the reporting change will affect us.”

How should Shannon prepare for the switch to ICD-10 reporting codes?

Want more information on ICD-10? Watch our ICD-10 webinar recording!

Michelle Corrigan

The Roller Coaster of Collections | Where is My Money III

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physical therapy billing_roller-coaster-of-collectionsThe Roller Coaster of Collections | Where is My Money III

The Ups and Downs of Cash flow Give a PT Practice Owner Anxiety

Which areas of Shannon’s practice are most difficult to track?

Shannon was sick of the roller coaster. The ups and downs of her practice’s revenue – hurtling ahead from month to month, without knowing what was around the next corner – left her stomach in knots. She’d been planning a vacation to the Florida theme parks with her family, but kept putting it off because she couldn’t get off the wild ride of unpredictable cash flow. The irony was not lost on Shannon and her husband, Mike.

 The revenue issue was negatively affecting how Shannon felt about her physical therapy practice, and was starting to spill over into her home life.

 “I don’t get it,” she said one night as she pulled a container of leftover chicken from the fridge. “Back in January, we were averaging around 80 patient visits per month. Over the summer, we hit 200, and for the last few months, we’ve been averaging around 175. Yet over that same time period, our collections… This month’s number is almost identical to January, but there’s no predictability. Sometimes it’s thousands of dollars less; other times, I’d swear I’d won the lottery.”

 “It would be nice if you could simply take a steamroller and make it a smooth ride,” Mike said while cutting up vegetables for salad. “Instead, you’ve got potholes. It’s not really any different at the restaurant. We’ve got customers, and have to meet their needs in order to keep them coming in the door.”

 “Yeah,” Shannon said, “but your customers pay you right away. Could you imagine waiting two, three months to get paid for a bowl of pasta?”

 “Hmm,” Mike said, sliding the veggies into a bowl. ”My suppliers might extend me a little credit, but no way we’d survive if we were stretched that thin.”

 “Yet thanks to the insurance companies, that’s what I’m supposed to do, month after month.”

 After dinner, once the kids had cleared the table and settled into their evening routine of TV and computer games, Shannon and Mike picked up their discussion.

 “You ever think about your menu?” Mike asked, as he poured his wife a cup of coffee.

“My menu?” Shannon asked with a smirk. “Aren’t you the one in the food biz?”

Mike stuck his tongue out at her. “Your menu of services, Shannon.”

“What about it?”

“Let’s put it this way… how much do you make each time you see a patient?”

“You mean what makes it into my pocket? About 90 bucks per. Why?”

“When my partners and I developed our bill of fare, it wasn’t just about what we like to serve. We also had to take into account the cost of ingredients, the time it takes to make each dish, and the likelihood that people are going to order it on a regular basis.”

“So, you’re talking about sticking to the most profitable options.”

“More or less,” Mike said. “If you think about it, some of your services take longer and require special equipment, and for some things, there’s a lot less demand. If you go back and look at your practice, I’m sure there are services which really aren’t worth it for that 90 dollars — especially given how long some of them take to get reimbursed.”

“And you think I should cater my practice that way?”

“Now you’re talking,” Mike said with a wink. “And speaking of catering… you ready for dessert?”

Which areas of Shannon’s practice are most difficult to track?

Ready to tackle your own cash flow problems? Attend our free Live Training Session Seal Your Revenue Leaks and earn your PAHCOM CEU. Register now!

Michelle Corrigan

Tracking the Variables | Where is My Money II

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physical therapy billing_cash flowTracking the Variables | Where is My Money II

Physical Therapy Practice Owner Must Address Billing and Payment Delays

What variables affect how quickly Shannon gets paid?

Shannon was nervous. At her husband’s suggestion, she was meeting with Steve, a profitability coach, in an effort to find and address the cash flow problems she was experiencing in her physical therapy business. Although Steve came highly recommended by her friend Ariana, Shannon wasn’t sure just what he could do for her.

 Steve came by after hours, and they sat in the waiting room of Shannon’s practice.

 “Give it to me straight,” Shannon said after a brief bit of small talk. “What am I doing wrong?”

 “It’s not quite that simple,” Steve replied. “But it starts with the fact that you trained to be a physical therapist, not a business owner. Not only that, but unlike other business owners, you have to rely on insurance companies for most of your income.”

 “So it’s not just me?”

 “Of course not,” Steve said with a laugh. “You’re hardly the only practice owner in this kind of situation. Ultimately, there are a number of variables that affect your billing performance and cash flow.”

“So what can I do? Even when I’m crazy busy, it still feels like the money isn’t coming in like it should.”

 “You can’t be expected to keep track of it all and still focus on your patients,” Steve said. “Think of it this way: Imagine a man who hurts his back, but he doesn’t seek treatment right away. What can happen?”

 Shannon thought for a moment. “Well, depending on the nature of the injury, it can affect his gait. He may start overcompensating, which can cause other problems, in his hips, in his neck…”

 “Now you’ve got the idea,” Steve said. It’s a domino effect. All of your billing issues stem from one basic problem – an inability to track and analyze all the variables that affect your collections. You need a powerful tool – personally, I recommend an advanced billing software package, one that’s customized for physical therapy practices – to do the work for you. After all, with each passing day, your chances of getting paid for an outstanding claim decreases by one percent. Software helps determine how each variable affects the timetable of your claims payments.”

 “And once we know what causes the delays or denials,” said Shannon, catching on, “we can make the necessary changes to improve billing performance.”

 “And then you’re on your way to building your dream practice,” Steve said.

What variables can affect how quickly and efficiently Shannon gets paid?

Ready to tackle your own cash flow problems? Attend our free Live Training Session Seal Your Revenue Leaks and earn your PAHCOM CEU. Register now!

Michelle Corrigan

Where's My Money?

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physical therapy billing_inconsistent cash flowWhere’s my money?

Physical Therapy Practice Owner Struggles with Cash flow

What should Shannon do to correct her cash flow problems?

“You ready for lunch?”

Shannon looked up from the pile of bills on her office desk to see her husband, Mike, standing in the doorway. “Only if you’re buying,” she said.

“That bad, huh?” Mike replied, closing the door behind him. “I’m a little surprised. On my way in, Theresa told me that you’re booked solid.”

“Patients aren’t the problem,” Shannon said. “Revenue is. Seems like no matter how many patient visits I schedule, I’m never sure if I’m going to meet expenses that month.”

“I thought you had someone who took care of billing,” Mike said, perching on the edge of the desk. “Isn’t that their job?”

Shannon laughed, weakly. “That’s how I looked at it. And if it were just a matter of a few patients with payment issues, I’m sure my staff could handle it.”

“Then what’s the problem?”

“It’s a combination of collecting from insurance companies and then figuring out what the patient owes. Seems like we have to chase after the insurance companies for every dollar we’re due.”

“I don’t get it,” Mike said. “Your staff files the claims. Doesn’t that mean you automatically get paid?”

“I thought so,” Shannon said. “But I guess that’s why I’m a physical therapist and not an accountant. Come on, I need to get out of here.”

Shannon wasn’t really in the mood for lunch, but she needed to clear her head. She and Mike walked to their usual lunch spot and found themselves a booth. As they slid in, Shannon’s phone chimed.

“What is it?” Mike asked.

“It’s a tweet from Ariana,” Shannon said, reading the display. “She says, ‘Pain is part of the healing process.’ Hashtag ‘physical therapy.’”

“You spoken to her recently? Her practice seems to be pretty successful. Maybe she can give you some advice.”

“That’s not a bad idea,” Shannon said, sliding back out of the booth. “I’m going to give her a call. If the waitress comes, order me the soup and salad.”

It took a couple of days before Shannon and Ariana could carve out some time. Finally, they got together at Ariana’s; they talked while putting together “goody bags” for her daughter’s birthday party.

“It drives me crazy,” Shannon said. “Cash flow is so inconsistent. Feast or famine, and I never know which. Sometimes the drought lasts for weeks, no matter how many patients I see.”

“You’ve got to get down to brass tacks,” Ariana said, using a scissor blade to curl the ribbons that Shannon had tied. “Figure out what your best sellers are.”

“My what?”

“Your moneymakers. Start by checking which CPT codes, POS items sold, referring physicians and employee productivity generates the highest revenue in the shortest time possible.”

“I’m guessing my billing department could help me with that,” Shannon said as she filched a gumdrop from the pile on the table.

“There are no guarantees,” Ariana said, “but that’s what works for me. For instance, you want to avoid using the worst CPT code for the best payer. And trust me; once you’ve gotten your system straightened out, you’ll be better equipped to make vital practice decisions.”

Should Shannon follow Ariana’s advice?
What should Shannon do to correct her cash flow problems?

Ready to tackle your own cash flow problems? Attend our free Live Training Session Seal Your Revenue Leaks and earn your PAHCOM CEU. Register now!

George Konold

Physical Therapy Billing Compliance | How to audit-proof your practice

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physical therapy billing compliance audit-proof your practiceThat was definitely NOT money well spent. Shannon felt red-hot anger building up inside her like boiling lava in a volcano right before its eruption. She still had a hard time accepting that Blue Insurance fined her $30,000 for failing the audit and made her refund the payments she had received for all failed claims. She promised herself that she would do whatever it takes to reduce her audit risk from now on.

“Given the volume of claims, an automated monitoring system may be the only practical way to detect suspicious conduct or potential flagging for audit,” Shannon read out loud from the book Medical Billing Networks and Processes. That made perfect sense to her. She had been racking her brain for ways to implement her friend Ariana’s advice of tracking the notorious red flags for insurance companies: unsigned notes, unbilled visits, missed re-exams, and denied claims. An automated monitoring system sounded like a life saver to her.

“Does your physical therapy software help you stay compliant?” Shannon asked Ariana. Ariana was a successful PT who had been through several audits, but always seemed to emerge unscathed.

“Absolutely,” Ariana said. “There are just not enough hours in the day to help my patients and track all potential compliance issues manually.”

“But how exactly does it help you?” Shannon said. “I wonder what kind of system would be the right choice for me since I’m not exactly a tech whiz.”

“Oh, don’t worry,” Ariana responded. “Just find a system that is based on a workflow engine with multiple features. You should be able to build it around your workflow, not the other way around. It’s supposed to make your life easier, not more complicated.”

Shannon pondered that for a moment. Easier would definitely be better. But the most important part was staying compliant. “Could it also cut down my error rate?” Shannon asked.

“Yes, look for physical therapy software that has automated alerts and built-in claims scrubbing,” Ariana said. “That way you can fix any mistakes before you submit a claim to the insurance company.”

“So you are saying that the software alerts you of compliance issues and helps you manage your entire practice workflow,” Shannon said in stunned disbelief.

“It sure does,” Ariana said and smiled. “I use the software to assign tasks to my staff with tickets and complete my notes while I’m still with my patients. This makes my life so much easier and saves me so much time. My favorite thing is the Radar on the homepage, which gives me a quick overview of my practice stats so I know what is going on in all areas at all times.”

How would you advise Shannon?
Is there a way to audit-proof her practice?

George Konold

Physical Therapy Software | Improve Patient Retention with Care Plans

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Physical Therapy software_ patient-treatment-plansAre you worried about paying next month’s bills because your patients don’t show up for their appointments? If your patients are noncompliant with your prescribed care plans, you cannot predict the cash flow at your physical therapy practice. What’s even worse is that your patients won’t get better.

Without consistent patient flow your practice cannot grow or be profitable. But unfinished care plans can also cause compliance issues and hurt your cash flow even further when you have to return payments. You can figure out just how much money your practice might be losing due to unfinished or unused care plans. Simply replace the assumptions below with your own practice numbers and complete the calculations.

For example:

Assumptions:

  • 1 visit = $89
  • 1 care plan = 10 visits
  • Average number of no-shows per care plan: 5

Calculations: Potential income and losses from unfinished care plans per patient:

  • Potential income from 1 care plan: 10 visits x $89 = $890
  • Potential loss from no-shows per care plan: 5 visits x $89 = $445

Conclusion: You risk losing half of your income when patients don’t finish their treatment plans!

Identifying patients who don’t understand  the need for multiple visits to achieve their health goals is easier said than done, however. You really need to know what the entire plan looks like in order to track multiple visits. For instance, you need to track any patient that goes through a traditional  treatment step-down ladder, such as four visits per week for the first four weeks, then three visits per week for the next three weeks, and so on. Such unique nuances on many patient schedules are difficult to track manually, and this difficulty grows dramatically with each added care plan. Not to mention, tracking the respective discounts given for each care plan is nearly impossible without a tool.

Thousands of care plans are created for new patients every month to schedule multiple appointments and then track all payments and visits with your bestPT EHR software. When patients don’t show up for their appointments you can receive automated alerts on your physical therapy software workbench. You can also receive alerts via tickets when patients don’t have a future appointment scheduled or when they cancel their existing appointments. That way you can assign your staff the task of scheduling the next appointment. Another useful tool for helping your patients stay on track with their care plans are appointment reminders sent via phone, text, or email. bestPT physical therapy software has integrated several apps which serve this purpose.

Physical Therapy Software_ CarePlan

To set up care plans when your patients come into your practice, simply go to bestPT’s Scheduler and click on the “More” tab to open the wizard. You can also create a full care plan from the patient account. Make sure you turn on the settings in your bestPT physical therapy software for Patient Relationship Management and Reminders.