ICD-10 for physical therapists

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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.



Is Your Practice Ready for a Medicare Audit? – Part 7

In this seventh in our series of blogs asking the question “Is your practice ready for a Medicare audit?” we discuss Treatment Notes.

“If you did not write it, you did not do it.” This is usually one of the first lessons we learn as clinicians. Simply stated, Treatment Notes are where you write what you did. These notes are the source document auditors look to when reconciling what was done vs. what was billed. We have seen audits swing on the quality of the Treatment Notes many times.

Medicare requires that the clinician create medical record documentation for every treatment day. Sufficient detail must be provided for every therapy service provided to justify the use of codes and units on the claim. From a clinical perspective, these notes provide a chronology of precisely what you did for the patient. From a financial and audit risk management perspective, this is your opportunity to clearly document exactly what you did during a treatment session to justify the codes you billed.

Required Elements

The treatment note must include the following information:

Date of treatment
Identification of each specific treatment, intervention or activity provided in language that can be compared with the CPT codes to verify correct coding
Record of the total time spent in services represented by timed codes under timed code treatment minutes
Record of the total treatment time in minutes, which is a sum of the timed and untimed services
Signature and credentials of each individual(s) that provided skilled interventions
In addition, the treatment note may include any information that is relevant in supporting the medical necessity and skilled nature of the treatment, such as:

Patient comments regarding pain, function, completion of self-management/home exercise program (HEP), etc.
Significant improvement or adverse reaction to treatment
Significant, unusual or unexpected changes in clinical status
Parameters of modalities provided and/or specifics regarding exercises such as sets, repetitions, weight
Description of the skilled components of the specific exercises, training, or activities
Instructions given for HEP, restorative or self/caregiver managed program, including updates and revisions
Communication/consultation with other providers (e.g., supervising clinician, attending physician, nurse, another therapist)
Communication with patient, family, caregiver
Equipment provided; and
Any additional relevant information to support that the patient continues to require skilled therapy and that the unique skills of a therapist were provided.
In the case of maintenance therapy, treatment by the therapist is necessary to maintain, prevent or slow further deterioration of the patient’s functional status and the services cannot be safely carried out by the beneficiary, a family member, another caregiver or unskilled personnel.

Use of Grids, Flow Sheets or Checklists

Many practices use a grid, flow sheet or checklist form to record exercises/activities performed. It is a convenient way to document exercise names (e.g. pulleys, UBE, TKE, SLR) resistance levels, weights, reps, etc. It also provides a clear picture of the patient’s progress from session to session. However, this alone does not establish that skilled therapy services have been provided. This is especially true when the exercises have been performed over multiple sessions. The therapist should periodically document the skilled components of the exercises so that they do not appear repetitive and therefore unskilled.

Similarly, documenting functional activities performed (e.g., “ambulated 35 feet with min assist”, “upper body dressing with set up and supervision”) does not demonstrate that skilledtreatment was provided.The therapist should periodically document the skilled components/techniques employed to improve the functional activity.

You must include the signature and credentials of the qualified professional/auxiliary personnel who provided the services each day.

Documenting Treatment Time

CMS requires that providers record Timed Code Treatment Minutes and Total Treatment Time for each session. They want providers to use this terminology exclusively. Do not use other language or abbreviations as these may make medical review more difficult for auditors.

Timed Code Treatment Minutes refer to those procedures that are provided in timed intervals and include many of the most commonly performed items (Therapeutic Exercise, Manual Therapy, Therapeutic Activity, etc.). These are billed in 15-minute intervals and follow the Eight Minute Rule.

Total Treatment Time refers to the actual time spent treating the patient and includes both timed and untimed codes. Times should not be rounded up to 15-minute increments; the actual treatment time must be recorded.

CMS offers the following examples:

A treatment session includes:

15 minutes therapeutic exercise (97110) timed code
20 minutes therapeutic activities (97530) timed code
25 minutes unattended electrical stimulation (G0283) untimed code
The time documented in the treatment note would be:

Timed Code Treatment Minutes: 35 minutes
Total Treatment Time: 60 minutes
A second treatment includes:

30 minute OT initial evaluation is completed (97003), untimed code
20 minutes fluidotherapy (97022) untimed code
The time documented in the treatment note:

Timed Code Treatment Minutes: 0 minutes
Total Treatment Time: 50 minutes
Time spent on the following items should not be included when computing total treatment time:

Waiting for treatment to begin
Waiting for equipment
Toileting, or
Performing unskilled or independent exercises or activities.
In our next Blog we will discuss Discharge Notes.

Genco Healthcare helps practices achieve and maintain a culture of compliance. We also assist Healthcare Attorneys in defending their clients who have been audited or subject to pre payment review. Consequently, we have our finger on the pulse of precisely what Medicare’s expectations are when it comes to medical documentation. Contact us by email David@Gencohealthcare.net or visit our website www.gencohealthcare.net.

Is Your Practice Ready for a Medicare Audit? – Part 6

medicare-auditIn this sixth in our series of Blogs asking the question “Is your practice ready for a Medicare audit?” we explore specific coverage guidelines and documentation requirements for some of the most common Modalities, Exercises and Activities therapists use in treating their patients. CMS is quite explicit in defining what the clinician is required to document the medical record to establish the medical necessity of what was provided.  These are fully defined in LCD L26884.

Practicality will guide where in the patient record the therapist should document the required information.  Certain elements will be noted in the Plan of Care and updated in the 10 Session Progress Note.  Visit specific information and data on should be recorded in the daily SOAP note or Flow Sheet.


CPT 97035 – Ultrasound (to one or more areas)

Covered ultrasound may be pulsed or continuous width, and should be used in conjunction with therapeutic procedures, not as an isolated treatment.  Specific indications for the use of ultrasound application include but are not limited to:

  • limited joint motion that requires an increase in extensibility;
  • symptomatic soft tissue calcification;
  • neuromas.

Supportive Documentation Requirements

  • Area(s) being treated
  • Frequency and intensity of ultrasound
  • Objective clinical findings such as measurements of range of motion and functional limitations to support the need for ultrasound *
  • Subjective findings to include pain ratings, pain location, effect on function*

If no objective and/or subjective improvement are noted after 6 treatments, a change in treatment plan (alternative strategies) should be implemented or documentation should support the need for continued use of ultrasound.

Documentation must clearly support the need for ultrasound more than 12 visits.

*Required at least every 10 visits

CPT G0283 – Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care.

Most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283.  It is classified as a “supervised” modality, even though it is labeled as “unattended.”  A supervised modality does not require direct (one-on-one) patient contact by the provider after skilled application by the qualified professional/auxiliary personnel.

Most electrical stimulation conducted via the application of electrodes is considered unattended electrical stimulation. Examples include Interferential Current (IFC), Transcutaneous Electrical Nerve Stimulation (TENS), cyclical muscle stimulation (Russian stimulation).   Electrical Stimulation should be utilized with appropriate therapeutic procedures to effect continued improvement.

When used for control of pain and swelling, there should be documented objective and/or subjective improvement in swelling and/or pain within 6 visits. If no improvement is noted, a change in treatment plan (alternative strategies) should be implemented or documentation should support the need for continued use of this modality.

Some patients can be trained in the use of a home TENS unit for pain control. Only 1-2 visits should be necessary to complete the training (which may be billed as 97032). Once training is completed, code G0283 should not be billed as a treatment modality in the clinic.

Supportive Documentation Requirements for G0283

  • Type of electrical stimulation used (e.g., TENS, IFC)
  • Area(s) being treated
  • If used for pain include pain rating, location of pain, effect of pain on function*

Documentation must clearly support the need for electrical stimulation more than 12 visits.

*Required at least every 10 visits


The use of these procedures in attempting to reduce impairments and restore function is expected to result in improvement of the limitations/deficits in a reasonable and generally predictable period of time. These procedures require the therapist or qualified assistant to have direct (one-on-one) patient contact. The expected goals documented in the treatment plan, affected by the use of each of these procedures, will help define whether these procedures are reasonable and necessary.  Documentation must support the use of each procedure as it relates to a specific therapeutic goal as defined in the Plan of Care.

CPT 97110 – Therapeutic Exercises to develop strength and endurance, range of motion and flexibility (one or more areas, each 15 minutes).

Therapeutic exercises for the purpose of restoring strength, endurance, range of motion and flexibility where loss or restriction is a result of a specific disease or injury and has resulted in a functional limitation and require the unique skills of a therapist to evaluate the patient’s abilities, design the program, and instruct the patient or caregiver in safe completion of the special technique are generally covered.

Documentation should include not only measurable indicators such as functional loss of joint motion or muscle strength, but also information on the impact of these limitations on the patient’s life and how improvement in one or more of these measures leads to improved function.

Documentation of progress should show the condition is responsive to the therapy chosen and that the response is (or is expected to be) clinically meaningful. Metrics of progress that are functionally meaningful (or obviously related to clinical functional improvement) should be documented wherever possible. For example, long courses of therapy resulting in small changes in range of motion might not represent meaningful clinical progress benefiting the patient’s function.

Documentation should describe new exercises added, or changes made to the exercise program to help justify that the services are skilled.

Documentation must also show that exercises are being transitioned as clinically indicated to a Home Exercise Program. (HEP).  An HEP is an integral part of the therapy plan of care and should be modified as the patient progresses during the course of treatment.  It is appropriate to transition portions of the treatment to an HEP as the patient or caregiver master the techniques involved in the performance of the exercise.

Exercises that do not require, or no longer require, the skilled assessment and intervention of a qualified professional/auxiliary personnel and those done to promote overall fitness, flexibility, endurance (in absence of a complicated patient condition), aerobic conditioning, weight reduction, and maintenance exercises to maintain range of motion and/or strength are non-covered.  Lack of exercise equipment at home does not make continued treatment in the clinic skilled or reasonable and necessary.

For many patients a passive-only exercise program should not be used more than 2-4 visits to develop and train the patient or caregiver in performing PROM. Documentation would be necessary to support services beyond this level (such as PROM where these is an unhealed, unstable fracture, or new rotator cuff repair, requiring the skills of a therapist to ensure that the extremity is maintained in proper position and alignment during the PROM).

Supportive Documentation Requirements for 97110

  • Objective measurements of loss of strength and range of motion (with comparison to the uninvolved side) and effect on function*
  • Specific exercises performed, purpose of exercises as related to function, instructions given, and/or assistance needed to perform exercises to demonstrate that the skills of a therapist were required
  • When skilled cardiopulmonary monitoring is required, include documentation of pulse oximetry, heart rate, blood pressure, perceived exertion, etc.
  • If used for pain include pain rating, location of pain, effect of pain on function*

Documentation must clearly support the need for continued therapeutic exercise greater than 12-18 visits.

*Required at least every 10 visits

CPT 97112 – Neuromuscular Re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities (one or more areas, each 15 minutes)

This procedure may be reasonable and necessary for restoring prior function which has been affected by:

  • loss of deep tendon reflexes and vibration sense accompanied by paresthesia, burning, or diffuse pain of the feet, lower legs, and/or fingers;
  • nerve palsy, such as peroneal nerve injury causing foot drop;
  • muscular weakness or flaccidity as result of a cerebral dysfunction, a nerve injury or disease or having had a spinal cord disease or trauma;
  • poor static or dynamic sitting/standing balance;
  • postural abnormalities;
  • loss of gross and fine motor coordination;
  • hypo/hypertonicity.

If an exercise/activity is taught to the patient and performed for the purpose of restoring functional balance, motor coordination, kinesthetic sense, posture, or proprioception for sitting or standing activities, CPT (97112) is the appropriate code.

When therapy is instituted because there is a history of falls or a falls screening has identified a significant fall risk, documentation should indicate:

  • specific fall dates and/or hospitalization(s) and reason for the fall(s), if known;
  • most recent prior functional level of mobility, including assistive device, level of assist, frequency of falls or “near-falls”;
  • cognitive status;
  • prior therapy intervention;
  • functional loss due to the recent change in condition;
  • balance assessments (preferably standardized), lower extremity ROM and muscle strength testing;
  • patient and caregiver training;
  • carry-over of therapy techniques to objectively document progress.

It may not be reasonable and necessary to extend visits for a patient with falls, or any patient receiving therapy services, if the purpose of the extended visits is to:

  • remind the patient to ask for assistance
  • offer close supervision of activities due to poor safety awareness;
  • remind a patient to slow down;
  • offer routine verbal cues for compensatory or adaptive techniques already taught;
  • remind a patient to use an assistive device;
  • train multiple caregivers; or
  • begin a maintenance program.

In these instances, once the appropriate cues have been determined by the qualified professional/auxiliary personnel, training of caregivers can be provided and the care should be turned over to supportive personnel or caregivers since repetitive cues and reminders do not require the skills of a therapist.

Supportive Documentation Requirements for 97112

  • Objective loss of ADLs, mobility, balance, coordination deficits, hypo- and hypertonicity, posture and effect on function*
  • Specific exercises/activities performed (including progression of the activity), purpose of the exercises as related to function, instruction given, and/or assistance needed, to support that the skills of a therapist were required

Documentation must clearly support the need for continued neuromuscular reeducation greater than 12-18 visits.

*Required at least every 10 visits

CPT 97140 – Manual Therapy Techniques one or more regions, each 15 minutes.

  • Manual traction may be considered reasonable and necessary for cervical dysfunctions such as cervical pain and cervical radiculopathy.
  • Joint Mobilization (peripheral and/or spinal) may be considered reasonable and necessary if restricted or painful joint motion is present and documented.  It may be reasonable and necessary as an adjunct to therapeutic exercises when loss of articular motion and flexibility impedes the therapeutic procedure.
  • Myofascial release/soft tissue mobilization, one or more regions, may be reasonable and necessary for treatment of restricted motion of soft tissues in involved extremities, neck, and trunk. Skilled manual techniques (active or passive) are applied to soft tissue to effect changes in the soft tissues, articular structures, neural or vascular systems.
  • Manipulation, which is a high-velocity, low-amplitude thrust technique or Grade V thrust technique, may be reasonable and necessary for treatment of painful spasm or restricted motion in the periphery, extremities or spinal regions.

When the patient and/or caregiver has been instructed in the performance of specific techniques, the performance of these same techniques should not be continued in the clinic setting and counted as minutes of skilled therapy.

CPT code 97124 (massage) is not covered on the same visit as this code.

Supportive Documentation Requirements  for 97140.

  • Area(s) being treated
  • Soft tissue or joint mobilization technique used
  • Objective and subjective measurements of areas treated (may include ROM, capsular end-feel, pain descriptions and ratings,) and effect on function.*

Documentation must clearly support the need for continued manual therapy treatment beyond 12-18 visits.

*Required at least every 10 visits

CPT 97530 – Therapeutic Activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes.

Therapeutic activities are considered reasonable and necessary for patients needing a broad range of rehabilitative techniques that involve movement.  Movement activities can be for a specific body part or could involve the entire body.  This procedure involves the use of functional activities (e.g., bending, lifting, carrying, reaching, catching, pushing, pinching, grasping, transfers, bed mobility and overhead activities) to restore functional performance in a progressive manner.  The activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination.

Therapeutic activities require the skills of the therapist to design the activities to address a specific functional need of the patient and to instruct the patient in their performance.  To be considered a covered service, these dynamic activities must be part of an active treatment plan and must be directed at a specific outcome.

In order for therapeutic activities to be covered, the following requirements must be met:

  • the patient has a documented condition for which therapeutic activities can reasonably be expected to restore or improve functioning;
  • there is a clear correlation between the type of therapeutic activity performed and the patient’s underlying medical condition;
  • the patient’s condition is such that he/she is unable to perform the therapeutic activities without the skilled intervention of the qualified professional/auxiliary personnel.

Documentation must clearly support the need for continued therapeutic activity treatment beyond 10-12 visits.

In our next Blog we will discuss the required elements of SOAP Notes.

Genco Healthcare helps practices achieve and maintain a culture of compliance.  We also assist Healthcare Attorneys in defending their clients who have been audited or subject to pre payment review.  Consequently, we have our finger on the pulse of precisely what Medicare’s expectations are when it comes to medical documentation.  Contact us by email David@Gencohealthcare.net or visit our website http://www.gencohealthcare.net/.

Nearing the Finish Line? | Physical Therapy Documentation

ONC certified EHR and Physical Therapy DocumentationHow can Shannon be proactive about the ONC certification requirements?

“So what did you decide about the meaningful use certification thing?” Mike asked Shannon. He could tell she’d had a long day, but she also looked more confident and calmer than she had when she’d told him about the problem facing her practice.

“Oh, Mike, you’d have been proud of me!” Shannon crowed. “I told my team that I wouldn’t be pressured into a hasty decision, that I was going to find the best, most economical solution, the one that would be best for our patients. Then–” by now Shannon was miming her movements from earlier in the day — “I went into my office and shut the door.”

She took a superhero stance and waited for Mike to tell her how great she was.

It didn’t happen.

“So what decision did you make?” he asked.

“I haven’t made one. That’s just the point. I don’t have a deadline, so I can just take my time and find the best possible solution.”

Mike still didn’t look convinced. “Couple of things–” he started.

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Shannon’s heart sank. That always meant she was about to get a lecture. A useful lecture, maybe, but she wasn’t in the mood. She wanted to celebrate her victory.

“First of all, PTs don’t have to follow this rule now, but does that mean that you won’t have to follow it next year?”

Shannon hadn’t thought of that. It was true, though, that regulations for one specialty often spread to others.

“Second, your referring doctors have to meet that October deadline and you said they all wanted your system to be compatible with theirs. What if you don’t do that? How fast will they start referring patients to someone who has a compatible system instead?”

“I was feeling pretty good when this conversation started,” Shannon grumbled. “Now I can see that I don’t really have all the time in the world.”

“So when you talked with doctors about this certification thing and they said they wanted you to have a compatible system,” Mike continued, “did they tell you what they were going to use?”

“Actually, it seemed as though most of them hadn’t made up their minds. They were asking me, I was asking them, and at the end they just said they hoped I’d pick something that was compatible with what they were using.”

“So how about you pick first,” suggested Mike. “You’re happy with your current system. Give them a call and ask if they’re certified or whatever it is –”

“ONC certified,” Shannon reminded Mike.

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“ONC certified, okay. And if they are, ask what products are compatible with theirs. Find out what they would recommend for an orthopedic surgeon or for a geriatric doctor or a hospital. Then you call up all the referring doctors and tell them what you’ve found out. It could be a good little marketing move, as well as making sure that your system is compatible with theirs.”

Shannon nodded slowly. “I’d be helping them out and reminding them about my practice at the same time.”

Mike agreed. “It’s better than waiting around to see what happens.”

“You’re right. Like when you take a run, you make sure to wear the right shoes, warm up first, make sure you’re fully prepared before you get up to speed. By being proactive, I’ll be sure to be ahead of the pack, not lagging behind and having to react to what others are doing.”

“Want to go for a run?” Mike asked.

“After the day I’ve had, I think I just need to hang out with the kids and rest. But you gave me what I need to hit the ground running in the morning.”

How can Shannon be proactive about the ONC certification requirements?

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Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

How to Select Physical Therapy Practice Management Software | WRAP | Part 5

physical therapy software selection part 5By Yuval Lirov, PhD and Shecanna Seeley, PT

Prepare to Be Wrong

Bookend the Future

To stack the deck in favor of her decisions, Shannon should prepare for both failure and success. Thinking about the future as a set of one or two scenarios limits our ability to prepare for for the unknown. Instead, Shannon should

  1. define her key performance indices (KPI)
  2. define a range for each one of them
  3. prepare a premortem (as opposed to postmortem) and preparade (as opposed to parade) for each of the two limits of the range she defined for each of her KPIs

For instance, the percent of the AR beyond 120 is one of the most useful KPI of her practice billing performance. It gives Shannon a sense of the speed of her cash flow as well as the amount of money she is leaving on the table for the payers. Her current %AR>120 is at 21%, which happens to be an average physical therapy value for this KPI.  The reduction of this value down to 10% would be a clear success as it would double Shannon’s practice profitability.

What if the %AR>120 doubles and grows to 40%?  That would be a real problem as it would slow down her cash flow and make her unable to pay her bills. If this problem persists, she could be out of business within 6 months.

Measuring patient flow growth is equally important. Patient growth is the result of subtracting patient attrition from new patient arrival.  If your objective is to grow your practice to the point you can sell it, Patient Growth must remain positive. Shannon’s practice at this point shows PG = 1%. Is she staffed adequately, if installing the new system will double her PG to 2%, to 10%?   Conversely, what would she do if her PG dropped down to negative 2%?

By asking this kind of questions, Shannon sharpens her focus on relevant decision-making criteria. She can also use this experience as a learning tool to review her progress down the road.

Set a Tripwire

We develop routines to be able to go on auto-pilot so we can focus on exceptions. But slipping into auto-pilot has a shortcoming, especially in the presence of slow, gradual changes that have cumulative effect:  we leave past decisions unquestioned. Slowly, we develop bad habits, we gain weight, we miss quality of life, we keep sub-performing staff, and eventually we miss our goals, often surprised by our inevitable failure – when did we give up?

The main problem with the routine is that it often continues unchecked.

So, if Shannon is unable to make a decision at this point, it means that she is making a decision to wait and see. The only important change she must make is to set up a tripwire – a mechanism to snap her  awake and make her realize she always has a choice.  Tripwires also provide a safe time limit for experimentation, giving Shannon peace of mind until one of the tripwires is triggered.

The most obvious tripwires are the 10% changes in KPIs:

  1. payments dropping by 10%
  2. patient visits dropping by 10%
  3. no-show rate growing at 10%
  4. no-future appointments growing at 10%
  5. unsigned notes growing at 10%
  6. percent of Accounts Receivable beyond 120 days adding 10%
  7. neglect claim backlog growing at 10%
  8. neglected workflow ticket backlog growing at 10%

The second kind of tripwires have to do with time limits for your staff:

  1. on a monthly basis review the monthly goals and previous month accomplishments
  2. set up clear deadlines, spelling out what happens in terms of compensation and responsibilities if the monthly accomplishments do not cover 80% of the goals

The third kind of tripwires have to do with patterns rather than dates or metrics:

  1. escalate when something feels wrong
  2. make an independent decision according to your core values

Your practice will grow faster, your staff will become more productive, and you will gain your peace of mind by establishing and clearly articulating the tripwires across your entire practice.

Trusting the Process

Shannon made a good choice.

She avoided framing her dilemma too narrowly. Instead of thinking “Should I replace my billing system or keep it as is?” she thought broader about the goals of her business and found a way to improve her patient’s experience and practice workflow, achieving faster growth and better profitability at the same time.  She embraced “AND not OR.”

Shannon reality tested her assumptions, talking with colleagues who have replaced their office systems and implemented workflow management processes in their clinics.

She ooched into her ideas, rather than diving in headfirst. She tested the new software and the processes in one of the locations and carefully measured and compared patient growth, cashflow metrics, and compliance, before making a decision to implement them in the other two locations.

Struggling with the tough choice, she attained distance on the decision. She imagined how would she feel in 10 years about replacing the software she has today, and that thought alone relieved some of her anxiety.  Her personal priorities demanded that she expanded her practice, and that realization drove her decision to modernize her workflow processes and her enterprise management software.

Together with her husband, she tried to bookend the future, brainstorming the reasons why the new workflow and software implementation might fail and what would the consequences of such a failure. Most importantly they set tripwires to alert her about either success or failure of her new direction.

Shannon followed a good decision process, while avoiding a list of pros and cons and taking into account her personal priorities and ambitions. The process she followed gave her confidence to take risks and make bold choices. Shannon knows that in 10 years, she will not regret that she missed an opportunity to grow.


1. Chip Heath  and Dan Heath,   Decisive: How to Make Better Choices in Life and Work, Crown Business; 2013
2. Yuval Lirov and Shecanna Seely, “How to Select the Best Physical Therapy Software for Your Office,” Impact APTA PPS, August 2013, pp. 46-50.


How to Select Physical Therapy Practice Management Software | WRAP | Part 4

Physical therapy billing software selectionBy Yuval Lirov, PhD and Shecanna Seeley, PT

Attain Distance Before Deciding

a) Overcome Short-Term Emotion
As a practice owner, Shannon is emotionally engaged with every little detail and every event that happens in her practice.  We prefer familiarity to convenience, and we prefer convenience to objective benefits. She needs to be aware of three kinds of emotions that bias our decisions:

  • Fleeting emotions
  • Loss aversion
  • Familiarity

Fleeting emotions tempt us make decisions that might not be good in the long term. Shannon should make a disciplined effort to delay making a decision.  “10/10/10” is a good rule of thumb for taking a long-term perspective about your current emotions. Ask yourself: how would you feel about your decision in 10 minutes, in 10 months, and in 10 years?

For some reason, we are wired in a way that losses are more painful than gains are pleasant.  We are also prone to like something more just because we have been repeatedly exposed to it. The combined effect of the two tendencies is that Shannon is biased to maintain status-quo, even if objectively, an option she considers is more beneficial to her practice long-term.

To overcome her emotional bias, Shannon needs to distance herself from her practice. Asking yourself “what would I tell my friend to do in this situation?” might help her take the right distance.

b) Establish Your Core Values and Priorities
Core priorities make resolving complex dilemmas easier. What’s more important:

  • staff teamwork or predictable cash flow?
  • patient perception or practice growth?
  • compliance or patient flow?
  • peace of mind or new opportunities?

By making a list of her own core values, Shannon can compare her core values with those of the vendors she is considering and quickly rule out the vendors with mismatching priorities. For instance, if Shannon’s top priority is patient’s satisfaction, then she should rule out any vendor who only focuses on the practice owner and does not show enough interest in the patient.

The core priority list is a powerful communication tool not only with your vendors but also with your patients and with your office staff.  It puts the patient’s mind at ease and it empowers your staff to act more autonomously, responding to patient’s needs faster, without administrative delays.  The more coherent and autonomous your staff is, the more satisfied they are with their jobs, resulting in less staff churn.

Which brings us to the next question:  what’s your overall purpose for your practice?  Do you consider it a success or do you think it should grow bigger and generate better profit margin?  How do you know?  When was the last time you compared your practice to an industry standard?


1. Chip Heath  and Dan Heath,   Decisive: How to Make Better Choices in Life and Work, Crown Business; 2013
2. Yuval Lirov and Shecanna Seely, “How to Select the Best Physical Therapy Software for Your Office,” Impact APTA PPS, August 2013, pp. 46-50.

How to Select Physical Therapy Practice Management Software | WRAP | Part 3

physical therapy software selection part 3By Yuval Lirov, PhD and Shecanna Seeley, PT

Reality Test Your Assumptions

So now Shannon has expanded her options and we can ask Shannon how will she assess them?

Our Confirmation Bias is the main problem at this decision-making stage: we prefer data that confirms our selection. We spotlight only favorable data.

Consider the Opposite, to Avoid Self-Confirmation Bias

The best way to avoid the Confirmation Bias is to instigate a disagreement. For instance, disagreements are built-in in our legal system. The judge is made to consider two opposing points of view.

If Shannon is considering eliminating the system and outsourcing her billing to a 3rd party (2nd option), she should appoint a devil’s advocate on her team to argue a case against eliminating the system or outsourcing her billing.

To collect more trustworthy information, Shannon may ask rejecting questions, such as:

  1. How many times did your cloud-based system lose access to internet?
  2. Have you received complaints about your follow up billing person being rude?
  3. have you received patient complaints about wrong patient statements?

Zoom Out, Zoom In

Shannon would do well if she reviewed the Outside View, which is performance statistics about the software and billing service vendors she is considering. That’s in addition to interviewing specific clients – the Inside View, a close-up. Relevant software statistics cover the entire gamut of software ratings across

  1. Functionality,
  2. Quality,
  3. Ease-of-Use, and
  4. Support.

Relevant billing service statistics cover the Key Performance indicators, such as

  1. Percent of AR Beyond 120 days,
  2. Average Delay Until 50% of AR Paid,
  3. Percent of Clean Claims Paid

Shannon would waste her time asking experts for predictions about how well specific products would do in her practice, but she would learn tons of useful information if she asked experts for average performance data about the same products in an average practice. At best, Shannon would look for both a comparison of her practice to industry standards and a forecast of her potential revenue if she hired a service.

Ooching = Running Small Experiments to Avoid Predicting the Future

Ooching is counterproductive in situations that require commitment.  Installing a computer system or hiring a billing service requires changes in your office processes, and so they require major commitment and training.  The best Shannon can do is to:

  1. review on performance statistics and other client testimonials
  2. test the performance of new software and new process in one of her offices first
  3. visit other clinics, learn from experience

Read the next part of this series on physical therapy software selection on our bestPT blog next week!


1. Chip Heath  and Dan Heath,   Decisive: How to Make Better Choices in Life and Work, Crown Business; 2013
2. Yuval Lirov and Shecanna Seely, “How to Select the Best Physical Therapy Software for Your Office,” Impact APTA PPS, August 2013, pp. 46-50.

How to Select Physical Therapy Practice Management Software | WRAP | Part 2

By Yuval Lirov, PhD and Shecanna Seeley, PT

physical therapy software selection part 2Widen your Choice

Consider Opportunity Cost

Learn to distrust “whether or not “ decisions. Instead of asking: “Should Shannon replace her billing software,” ask: “Is there a better way?  What else could she do?”

Surprisingly, too much focus at this early stage hurts your decision process. Focusing is great at comparing your options but it prevents you from identifying more options. When we focus, we sacrifice our peripheral vision. That’s why you have your Radar chart on the homepage – to help you see more alternatives, more important ways to measure your practice success.

Alternatively, suppose replacing the current billing software with another billing software was not Shannon’s option. What else could she do?

Well, she could at least consider two other options:

  1. Outsource her billing to a 3rd party provider
  2. Search for an integrated cloud-based software solution that includes billing software as one of its essential components.

How much would each of these two options cost and what other functions could be automated or eliminated if somebody else did her billing or if her software would cover more functionality than just billing?


So at this point you might consider three options:

  1. Replace your billing software. Keep your billing in-house. Consider if your current and project patient flow justifies an investment in scheduling and documentation software.
  2. Outsource your billing to a billing service
  3. Purchase an all-in-one cloud-based software solution that includes workflow management, scheduling, documentation, and billing. Preferably ONC-certified with a clear plan for ICD-10 transition.

Note that the third option may also allow working with either option 1 or option 2, depending on Shannon’s preference to keep billing in-house or outsource. What if there was a software company that offered both alternatives?

Our minds often think “this OR that” but we should always try to think “this AND that”.

Find Someone Who Has Solved Your Problem

Shannon is not alone in her predicament. Thousands of PT practice owners have wrestled with the similar problems and found different solutions. This is a perfect time to solicit other opinions from your colleagues, relevant Linkedin Groups, or professors.

Read the next part of this series on physical therapy software selection on our bestPT blog next week!


1. Chip Heath  and Dan Heath,   Decisive: How to Make Better Choices in Life and Work, Crown Business; 2013
2. Yuval Lirov and Shecanna Seely, “How to Select the Best Physical Therapy Software for Your Office,” Impact APTA PPS, August 2013, pp. 46-50.

How to Select Physical Therapy Practice Management Software | WRAP | Part I

By Yuval Lirov, PhD and Shecanna Seeley, PT

physical-therapy-software-selectionShannon, a mother of two and an owner of a mid-size Physical Therapy practice, must juggle many priorities: she has a husband and two wonderful children, an 8-year old boy and a 5-year old girl. She is a Physical Therapist and she cares for her patients. She also owns a practice across three separate locations she started about five years ago. And now she has a dilemma.

Shannon is agonizing about replacing her physical therapy billing software.  Over the past year, her billing software suffered several outages, the vendor asked extra fees for upgrades, and the new biller she hired was unfamiliar with it and required expensive retraining.

Unfortunately, replacing the billing software would cause problems in the short-term.  The local database has accumulated patient records and claims for the past 10 years. Besides, Shannon knows this physical therapy software like the back of her hand, she feels comfortable using it, and she really has no time to start learning new billing software features or changing the workflow of her office to take advantage of the features available in the new software.

What would you advise her to do?  Should she replace her physical therapy billing software or not?

Most billing software vendors try to help you by offering a decision table approach, which is a glorified pros-and-cons analysis. It’s familiar. It makes lots of sense. Yet it is wrong.

Brothers Heath describe four most pernicious villains of decision making and a process to counteract their influence:

  1. You encounter a choice. But narrow framing makes you miss options.
  2. You analyze your options. But your bias leads you to gather self-serving data.
  3. You make a choice. But your emotion tempts you to make a wrong choice.
  4. Then you live with it. But you are overconfident about the future scenario.

So to make the right choice, you need to use WRAP:

  1. Widen your choice – take a different perspective.
  2. Reality-test your assumptions
  3. Attain distance before deciding
  4. Prepare to be wrong

Read the next part of this series on physical therapy software selection on our bestPT blog next week!


1. Chip Heath  and Dan Heath,   Decisive: How to Make Better Choices in Life and Work, Crown Business; 2013
2. Yuval Lirov and Shecanna Seely, “How to Select the Best Physical Therapy Software for Your Office,” Impact APTA PPS, August 2013, pp. 46-50.

Physical Therapy Software | Compare Cost of Visit Documentation with EHR

physical therapy documentation_compare cost with xDocsYou can easily reduce your visit documentation frustrations with Best PT’s xDocs. xDocs simplify and expedite your daily physical therapy documentation process. This cuts your documentation time and improves your profitability while maintaining compliance.  After all, you are not getting paid for time spent on completing or searching for documentation.

So you will sleep better because you won’t have to worry about failing audits, or unpaid claims due to missing patient info. Best of all, you can complete your documentation in a few clicks with xDocs while still table-side with your patient. Then simply submit your claim in one single click as soon as you are done with your notes since xDocs documentation is located on the same screen as your physical therapy billing platform.

This optimized physical therapy billing and documentation process also makes it easy for you to send your patient documentation to referring doctors as well as payers with the appropriate ICD and CPT codes. The various customization options available are handled by Best PT’s support team so that your documentation keeps its familiar look, even in digital format.

Reducing your documentation time from ten minutes down to two minutes with xDocs will also improve your efficiency. Improved efficiency results in more income for your practice since you will reduce the amount of lost income due to time spent on documentation.

You can figure out just how much time and money your practice will be able to save when switching to xDocs. Simply replace the assumptions below with your own practice numbers and complete the calculations.

For example:


  • Your average monthly revenue: $20,000.
  • Your average patient visits per month: 280.
  • Your monthly hours of operation: 180.
  • Your average documentation time per patient: 10 minutes.

Calculations: Potential savings with reduced documentation time of 2 minutes:

  • Your average time per visit: 180 hours/ 280 visits = 39 minutes
  • Time with patient: 39 minutes – 2 minutes= 37 minutes
  • Your efficiency: 37 minutes/39 minutes = 95%

=> Total Monthly documentation time with 2-minute documentation time:

280 visits x 2 minutes = 9 hours

Compare to efficiency with documentation time of 10 minutes:

  • Time with patient: 39 minutes – 10 minutes = 29 minutes
  • Your efficiency: 29 minutes/39 minutes = 74%
  • Your hourly value: $20,000/(180 hours x 74%) = $150

=> Total Monthly documentation time with 10-minute documentation time:

280 visits x 10 minutes = 47 hours

=> Time Savings with 2-minute documentation time:47 hours – 9 hours = 38 hours

By reducing your documentation time from ten to two minutes, however, you can save $67,200 per year ($5,600 per month). Additionally, you will be saving 38 hours per month that you can now spend on treating more patients.

If you need help comparing the real cost of your current physical therapy documentation software to xDocs’ improved documentation time and cost, please request an Individual Practice Evaluation. One of bestPT’s profitability specialists will assist you.