new members in bestPT billing software

Welcome New Members to the bestPT Team in March

13 New members joined bestPT in March 2015.
Each new member benefits from and contributes to our network strength.
Let’s welcome bestPT’s newest members!

  1. Courtney Kuehn, Joni Scaparra, and Madeline Ragan of Big Sky Pediatric Therapy, Austin, TX.
  2. Jeremiah Jorgensen of Center For Spine & Sport Rehab, Lincoln, NE.
  3. Emily Stanley of On The Move Pediatrics Therapy, Lexington, KY.
  4. Denise Tavares, Katy Bowers, Regina Yusupov, and Suresh Babu of Innovative PT & Fitness Center, Monmouth Junction, NJ.
  5. Kellie Abramovitz of Kalispell Rehab, Kalispell, MT.
  6. Rebecca Sabo and Victoria Mitchell of Kid’s Creek, Suwanee, GA.
  7. Shannon Rothwell of Midlothian Village Physical Therapy, Midlothian, VA.

Physical Therapy Billing Examples: 5 Little Mistakes That Cost A Physical Therapy Practice $634,837

5 Common Processing Mistakes You Can Check Right Now…

PHYSICAL THERAPY PRACTICE TO RETURN $634,837 UPON FAILING AN OIG AUDIT

In August 2014, the Office of Inspector General (OIG) released a report of the audit that had been conducted on an Illinois physical therapist. Their review sampled 100 random claims out of the 4,298 Medicare outpatient physical therapy services, totaling $645,966, that had been provided between January 1 and December 31, 2011.

The audit found that 99 of the 100 claims in their random sample contained more than one deficiency. Therefore the government extrapolated the failure rate from the sample and applied it to the entire paid claim population.  They are now seeking a refund of $634,837. In other words, the government does not seek a refund for the 100 claims survey but rather for all the claims submitted assuming that they have the same error rate.

Moreover, these sample claims were subjected to a very high level of scrutiny.  The report details the deficiencies as follows:

  • 97 claims did not meet Medicare’s plan of care requirements (Goals not measurable, invalid or missing Therapist’s Signature, and incomplete or no Plan of Care)
  • 95 claims did not meet Medicare’s treatment note requirements (Missing specific Skilled Intervention, unsupported number of Units Billed, Invalid Therapist’s Signature, and Billed Code not in Plan of Care)
  • 49 claims had progress reports that were untimely or not contained in the medical record (Progress Reports not made at least once every 10 Treatments, and No Progress Reports)
  • 44 claims had therapy services that were not medically necessary (Goals in Plans of Care were unmeasurable, Invalid or Missing Certification of Plan of Care, Did not meet Medicare’s Physician Certification requirements, Documentation failed to support Medical Necessity, and PT was repetitive/no evidence that Skilled Therapy Services were needed)
  • 39 claims did not meet the Medicare physician certification standard (Plan of Care not signed by Physician, Physician Certification not dated, and Untimely Physician Certification)

To review the full OIG report go to http://oig.hhs.gov/oas/reports/region5/51300010.pdf.

To improve your chances of surviving an OIG audit, make sure to clearly establish medical necessity, prove that skilled therapy services are performed, and that those services are both reasonable and necessary. Studying physical therapy billing examples, expert guidance, and periodic self-audits in tandem with an automated professionally built and ONC-certified documentation system will help you achieve this goal effectively and efficiently.

 

CPT Codes For Physical Therapy 2012-2014 | Pop Quiz, February 2015

Pop Quiz:
Which two CPT codes combined were more than 50% of all claims from 2012-2014?

Answer: 97110 and 97140.

In the BESTPT billing network, what CPT codes were used during 2012, 2013, and 2014?

We saw some minor variations that can be attributed to Medicare regulation and reimbursement strategies. We saw more use of 97140 (Manual Therapy) from 2012-2014,  and less use of 97530 (Therapeutic Activities) for that same time period.

The average CPT collections per unit was $24.47 in 2012, $23.60 in 2013, and $23.82 in 2014. This is an average reduction of 3.5% from 2012 to 2013 and a modest 0.9% increase from 2013 to 2014.

CPT code pay per unit 2012-2014

CPT Codes Pay Per Unit 2012-2014

Read the full CPT story. Download the CPT Analysis eBook

 

From Paper Charting to EMR | How to Avoid 5 Most Common Mistakes

From Paper Charting to EMR | How to Avoid 5 Most Common Mistakes

As a physical therapist, I know the importance of documentation for clinical care and reimbursement.  I have performed medical documentation in paper charts, as well as several EMR systems.  I also had the great learning experience of working for a busy sub-acute rehabilitation facility during a transition from paper charting to EMR.  I learned that transitioning from paper charting should not be taken lightly; great steps must be taken for proper planning and implementation.  In my experience, I found several major mistakes during this transition period.  Here are my experiences and suggestions for a facility about to undergo the transition from paper charting to electronic medical record systems.

Mistake 1Under-training the clinicians and staff.  One of the main features of EMR is that it allows for smoother and more efficient means of documentation.  Each clinician wants a way to make documentation easier and the process of getting paid more streamlined.  So, we all have great incentive to make EMR documentation work.  However, if staff are under-trained, they can easily get frustrated with the new system.  For example, if a clinician knows how to care for their patient, but cannot find the right icon to enter their diagnosis code or treatment intervention, frustration and even anger are bound to ensue.  It is crucial that the clinicians, office managers, and all staff members are properly trained in the new system prior to launching.

Mistake 2: Expecting immediate success and high productivity.  Let’s face it; people don’t like change.  Administrators must be prepared for a little resistance from seasoned clinicians.  For some clinicians, using computer systems for documentation can be a daunting task.  They may type slowly or have difficulty navigating menu options.  Once you get past the initial resistance, you must allow for learning.  It will take time to learn a new system and you will need to re-educate continually.  You should not expect the productivity standards to be upheld during this transition period.  By allowing a little extra time for documentation in schedules, your therapists will feel appreciated and respected.

Mistake 3 Assuming the IT developers know what the clinicians need.  Healthcare clinicians are smart individuals, but most of us do not write program software.  For the IT professionals, writing programing code is mundane, yet they do not know the details or requirements of medical documentation.  When implementing an EHR system, it is important that the system has all the requirements specific to the needs of physical therapy.  With bestPT, the EMR system has been developed with the therapists in mind.  The system is thorough and complete.  In addition, bestPT offers supportive, knowledgeable and available customer service in case of difficulty with the IT portion of clinical documentation.

Mistake 4Improper planning for storing health records.  What happens to all of those large binders, paper charts, and paper reams?  Well, you must think about how you are going to store past patient records.  In addition, you will likely need to input many of these clients into the new EMR system.  Establishing a protocol for accessing and storing paper information will be crucial for a successful transition.

Mistake 5: Picking an electronic medical record program without support.  With the vast amount of EMR systems available today for healthcare providers and physical therapists, it can be confusing to know which one to choose.  Make sure that you choose an EMR system that comes with people behind the system.  You need a support team behind the EMR.  That is why bestPT is an easy answer when transitioning your clinic from paper charting to electronic charting.  The bestPT programs keep you compliant with the latest functional codes, PQRS reports and diagnosis codes.  In addition, they provide great customer care for any other clinic needs.

injury-recovery

A great strategy for a smooth transition from paper charting to EMR, is to gradually introduce components of the new system at regularly scheduled meetings, prior to launching.  By breaking down the system into components and learning modules, your staff will feel as though they can absorb the information without feeling overwhelmed. For example: first explain the system for billing, then explain the system for entering patients, accessing and inputting health information, etc.  In addition, be sure to give them resources for contacting customer service and always be open to questions and opportunities for further learning.  When choosing bestPT for your EMR system, you can ease their anxiety by ensuring great clinician support.

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

 

Dr. Amy Vant, DPT

Scheduling and the butterfly effect for higher clinic revenue | Amanda Olson, DPT

I have been a practicing physical therapist for seven years now. If I tack on three additional years for when I was in physical therapy school and rotating out on various clinical internships, than I have had ten years of experience documenting patient care in one realm or another. Within the seven years that I have held a physical therapy license, my husband and I have moved across state lines three times. Additionally, I changed my area of emphasis from pediatrics to pelvic health. All of these events lend to the fact that I have seen seven different clinical systems of documentation and patient scheduling.

Within the last ten years advances in technology, software, and gadgetry has grown exponentially. For example, five years ago my husband bought me a Garmin navigation system when we moved from Portland to Seattle. I was working in a pediatric home health care system at that time, and would have been lost every day without the use of the Garmin. I also scheduled my patients in pencil in a spiral bound paper calendar book and wrote SOAP notes in a Word document. These were then faxed by our front office to various physicians, and billing reimbursement turnaround from insurance took somewhere in the neighborhood of six months.

Fast forward five years to 2015. I sold the Garmin on ebay long ago, opting for the use of navigation applications on my cell phone. I have seen several different electronic medical record systems with scheduling software during geographical and career changes. I have seen tacky online scheduling programs that often experienced significant down time due to server issues. I have seen systems in which the front office staff had to enter a new patient into the scheduling and billing software system first, and then manually re-enter them into the separate electronic medical record and documentation system thus allowing for errors in transposition, wasting time, and draining efficiency from the clinic. And let’s be honest, efficiency has a dollar value in the business of healthcare in the year 2015.

It only makes sense that our patients should be scheduled, documented for treatment, and billed from one single software program. Wrapped snuggily in a package with a bow of checks and balances neatly tied around it, we should expect there to be no discrepancies between these three interrelated components of practice.

Ideally when a patient is scheduled into a software system, the expected benefits are clear and concise scheduling in which the patient and the therapist can clearly see the intended visits. There should be reminder calls and text messages to the patient to increase attendance rates, eliminate no-shows and decrease cancellations or misunderstandings. In turn, this should result in increased patient retention as the experience of the patient will be consistency in smooth check-ins and on-time appointments.

In bestPT I have found all of these things. In addition to all the aforementioned patient scheduling capabilities, there is a great deal more. Automated patient check in, and workflow automated task management are components that have created the experience of a finely tuned instrument.

bestschedscreenshot

An example of the how the schedule appears upon logging in for the day

With this scheduling system, patient name, appointment type (evaluation or follow-up appointment), outstanding balance, and check-in status is readily visible. Thus, when my 7:30 am patient walks in the door, the front office and I can both see the check-in status, money collection can take place if necessary, and treatment can begin on time. Furthermore, patients are readily searchable in the left upper hand corner, thus when a patient calls on the phone to schedule an appointment, office staff can quickly find the patient and get them scheduled.

Workflow xDocs

An Example of the Workflow

Workflow is made smooth with the use of an alert system that provides pertinent information regarding each individual patient. In a busy clinic staff can easily forget important tasks that must be done to remain compliant with insurance and billing. There are various intricacies involved in checking in patients (some more than others), and processing their paperwork. There are also important tasks that should be done with every patient that comes in the office that can easily be forgotten by both physical therapy and front office staff. For example, every patient should ideally have a future appointment scheduled prior to leaving the office. The alert system indicates when a patient has no-showed, and if they do not have a future appointment scheduled. This alert system is an example of the checks and balances in place so that each staff member in the office will be reminded of necessary patient tasks.

In physics, specifically in chaos theory, the notion of the butterfly effect comes to mind when analyzing the effects of something as simple as patient scheduling on the health of an entire physical therapy practice. The butterfly effect refers to the idea that the flutter of a butterfly’s wings might create small changes in the atmosphere that can ultimately alter the path of a tornado or delay, accelerate or prevent the occurrence of a tornado in a far off location.

The butterfly effect of this scheduling program on our practice has been tremendous. There is better office communication through the alert system, and daily errors in patient flow have been significantly reduced. My colleagues, office staff, and I feel less frazzled throughout the day because scheduling and check-ins occur smoothly lending to on time appointments, decreased stress on the patient, little to no scheduling errors, and less loose ends at the end of the day. This in turn has lead to better visit compliance from patients. The reminder calls and texts alert patients of upcoming visits and thus our no-show rate has decreased substantially. Thanks to the alert system I am now on time with progress notes resulting in compliance with insurance and billing. The system sends me a risk report with millions of rules calculated and checked against our practice’s actions in real time allowing for corrections to be made immediately. In the greater picture, this has lead to higher practice revenue, which is vital to the growth of our private practice.

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

-Amanda Olson, DPT

 

Electronic Health Records: Rising to the needs of the complex patient

Depending on our individual area of expertise as a physical therapy provider, we may spend a great deal of time case managing complex patients. I specialize in pelvic floor dysfunction, treating both males and females with incontinence, chronic pelvic pain, bowel dysfunction, and post-cancer treatments. Similar to my colleagues in pediatrics, TMJ, and neuro rehab, I spend a great deal of my time outside of treatments communicating (rather trying to communicate) with other healthcare providers involved with a case. My ability to provide optimal care is dependent on my ability to convey my objective test results in a concise manner, store imaging and medical test results electronically, and to quickly fax out reports for quick turn-around, without lapses in approved plan of care.

Since making the change to electronic health records, this process has become exceedingly improved. bestPT electronic health records allows me to quickly enter in case diagnoses and produces a clean report format which is immediately faxed straight to the physician from my laptop. This clears up my front office from mundane clerical tasks and allows them to focus on scheduling patients and maintaining a more smooth running clinic.

The efficiency of this system became most apparent to me during the treatment of a new patient a few months ago. My patient was a 20 year old female present for physical therapy evaluation with a diagnosis of a hypertonic pelvic floor with secondary chronic constipation. For those not in the pelvic floor field, my patient was experiencing chronic constipation as a result of a non-contracting and non-relaxing pelvic floor. She had become so distended from the chronicity of the condition that she was experiencing significant stretching on the lower bowel with subsequent nerve damage to the bowel itself and surrounding pelvic floor. In the year prior to her visit with me she had been seen by a myriad of physicians. She had seen her primary care physician, two gastroenterologists, a general surgeon, and a gynecologist. She had undergone endoscopy, colonoscopy, ultrasound, and defecography. Furthermore, she had 3 more scheduled imaging tests and procedures scheduled for that month. I was essentially one of 5 chefs in her proverbial “kitchen.”

As many of us know, keeping track of medical reports and various health care providers in any area of physical therapy can be a daunting task. My patient had made it clear during the evaluation that in her twenty years on this earth that she had seen more than her share of doctors and had fired a few of them for poor responsiveness and failure to keep up with changes in her condition. Her surgeon had essentially volunteered my physical therapy services as her last resort before colon surgery, and I did not want to fail her.

What I have enjoyed most since my choice to utilize bestPT electronic health records is the customization provided to me in my specialty practice. Each practitioner is provided with the ability to customize settings for documentation according to the needs of their practice and individual specialty. This individualization of preferences is noticeable throughout the duration of the plan of care. This begins on day one with your patient. Check in of the patient described was expedited as my front office staff was able to scan in the patient’s driver’s license, imaging reports, clinic forms, and outcome measures upon her arrival.

Furthermore, a sub-category for imaging and other test results within the electronic patient chart made it easy to view them throughout the subjective interview portion of the evaluation. On the initial evaluation I was able to quickly select the patient’s diagnosis from searchable customized database of codes. I was also able to readily enter in objective data throughout the evaluation on my laptop.  Following the first appointment I faxed the evaluation off to the referring physician and other pertinent health care providers involved in the patient’s care, receiving a signed plan of care from the referring physician soon after.

X-Ray Report2

An example of the imaging report screen

Consistency and ease of use reigned throughout the complicated plan of care. The patient required several visits spanning across several months. The neurological damage to the bowel and pelvic floor were prolific unfortunately, however the patient made progress. As she underwent further testing and imaging, data was scanned into the system. My treatments including manual therapy, therapeutic activity, neuro re-education, and biofeedback, and were documented and coded appropriately. The “Quicklinks” section in the system allowed for  easy access to the most commonly utilized applications of the system. Toggling through these features including billing and scheduling was quick and easy.

Alerts pertinent to the patient’s insurance requirements and documentation popped up upon each visit check in. The checks and balances within the system allowed me to easily track due dates for progress reports which prevented lapses in the approved plan of care. Furthermore I was able to communicate with technical and billing staff via the ticketing system if questions arose. I could even use it to communicate necessary information regarding treatment room setup for the patient with my front office staff. Often times the rush of the clinical flow throughout the day inhibits my ability to share details with staff regarding individual patient needs, and the ticketing system assisted with this. I could ensure that a sterile bedding and drapery were set up prior to patient arrival, or request reordering of gloves and other equipment.

Reimbursement for my practice became substantially quicker once I began billing straight from the bestPT electronic health record system. Instead of having to thumb through pages of documents to track the eligibility and services covered by each individual insurance provider, the organized system assisted in this process, freeing me up to provide more focused care. I was able to determine immediately that the biofeedback training so desperately needed by this patient was covered. And billing was submitted immediately following each visit.

After three months, the patient had began to plateau in progress. She had progressed significantly in functional abilities and her pain had decreased. It is common for patients with this diagnosis to panic at the thought of being discharged from physical therapy care, and though she was largely independent, she was hesitant to be set free and completely independent, worrying that she would relapse. We arranged for her to trial a three week period of independent self management. At the end of three weeks I called her to check in and we would proceed according to her needs. After three weeks, I called and indeed she was doing well. I was able to write a discharge note after our phone call and fax the discharge to her physicians. The documentation system supported us both throughout her treatment.

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

-Amanda Olson, DPT

Doctor of Physical Therapy

Onboarding: How we came to be a part of bestPT

Any healthcare provider can attest that the landscape of healthcare practice and reimbursement is rapidly changing. Medicare guidelines have become more and more demanding with less financial reward, and other insurance companies are following suit. G codes, PQRS reporting, and busy patient caseloads compound our need as clinicians to be efficient with our time. Not a single one of us spent several years in physical therapy school so that we could spend our days in front of a computer screen or buried under a pile of paper charts. The good news: paper charts are going the way of the dinosaur. The interesting news: technological based charting is here to stay, and it can truly enhance our practice.

Enter the discussion of electronic health records (EHR). The decision to change our physical therapy documenting system to electronic medical records approaches each of us in unique ways. For some, it slowly creeps up, like an awkward annual holiday party, something we dread but know we must endure to remain in good social graces. For others, the decision is made angrily after reviewing quarterly fiscal reports and realizing how much money is lost due to incomplete or unconvincing documentation of services. For others still, the decision is an enthusiastic one, recognizing the time and financial resources gained from the efficiency of electronic documentation.

“For the times, they are a changin'” – Bob Dylan

One way or another, as physical therapists, we must choose to keep up with the changes in electronic records or risk being swept away with the current. Thus, we are well suited to research various EHR systems, in order to find a system that works well for our individual facility. Secondary to finding and hiring skilled physical therapy practitioners, finding the right EHR system may be the most important decision that we make for our practice. When analyzing the cost of a new system we want to feel confident that we are gaining an asset that will hold it’s value, and with time more than pay for itself in the way of improved reimbursement.

Did you know that “Burn due to waterskis on fire is ICD-10 code V9107XA? How about the fact that ICD-10 code V9542XA describes “Spacecraft crash injuring occupant,” and ICD-10 W2202XA is “Hurt walking into a lamppost”. As outlandish as these injuries all sound (though I have treated a few lamppost-esque patients in my day), these injuries have happened, and these patients have found their way into physical therapy clinics. The upcoming change from ICD-9 to ICD-10 will increase from 13,000 available codes to 68,000. This is a 5 fold increase, waiting just around the bend in 2015. These injuries will have to be properly coded and billed according to some highly specified causes of injury, and training staff in the minutia of these codes would take a great deal of time.

Better than the most well trained human administrative and billing specialist, bestPT is capable of keeping up with the ever changing payer rules and compliance regulations. The upcoming and seemingly monolithic change to ICD-10 code billing will be handled efficiently and swiftly. This program assists with coding, denial patterns, and other mundane tasks so that we can focus on our passion of helping patients. Other available services include billing tracking which reduces delay in payment, and protects the user from audits and fines. A crisis management team is available to assist with large scale billing problems.

While administrators may immediately recognize the benefits of implementing EHR, sometimes change as grand as this one can be met with grumbling from staff. At the root of these grumblings we often find fear of change to be the cause. Older staff members may have limited experience with computers, or may worry that they will not be able to keep up with their current patient load while they are being trained in how to use the new system. The idea of typing into a computer while they are trying to speak with, evaluate, and form a relationship with a patient may seem barbaric, or cold. For a long time physical therapists have been able to boast that we spend time more face to face time with our patients than other types of practitioners, develop rapport, and see our patients through their rehabilitation on a personal level. The barrier of a computer documenting system may initially seem counter productive to this practice.

Rest assured, the staff at bestPT take the time to carefully prepare staff for the process of “onboarding” or training and then implementing all staff members in the use of the new system. Topics such as clinical flow throughout training, troubleshooting, and error modification will be covered in great lengths. Scheduled meetings with technology training staff are helpful to administrators, and training modules within the system itself assist in the preparation of general staff.

As I began the process of on-boarding, I received login capability, and was able to teleconference with technology training staff during a shared screen session. Technical support staff guided me through the daily charting system while demonstrating control panels, patient charting, task procedures, patient scheduling, and staff communication procedures, all on my computer screen. When a challenge arose during the training procedures, they were handled quickly and efficiently by multiple levels of staff.

As physical therapists, we recognize the importance of customer service. We want our patients to feel listened to, and that they are an integral part of their plan of care planning. Likewise, we expect this of our business partners. We have limited time for additional meetings, and sacred few minutes to spare for errors and mistakes. bestPT recognized and respected my time. The system operates on multiple servers, ensuring that there are no lapses in my ability to access charts, patient information, or billing activity due to a down server. The technology training staff and management team made themselves available to me through email or the ticketing system within the bestPT system itself. The customer service that I value for my own clinic was provided to me, ensuring that I had made the right decision, not only to move to electronic health records, but specifically to use bestPT.

-Amanda Olson, DPT

new members in bestPT billing software

WELCOME NEW MEMBERS TO THE BESTPT TEAM!

14 New members joined bestPT in September 2014.

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

Let’s welcome bestPT newest members!

  1. Steve Messineo of All Access Physical Therapy, Shrewsbury, MA.
  2. Tanya Legarda of Arizona Physical Therapy, Tucson AZ
  3. Soilimayli Rivera and Veronica Rosario of Axiom PT & OT Plus, Tuckahoe, NY.
  4. Katie Delaune and Lauren Burke of Big Sky Pediatric Therapy, Austin, TX.
  5. Leeann Del Pino and Mike Baylock of Bit-By-Bit, Fort Lauderdale, FL.
  6. Susan Crittenden of Healing Motion, Pittsburgh, PA.
  7. Ryan Hanigan of ISU Physical Therapy, Terre Haute, IN.
  8. Sundas Mushtaq of Kid’S Creek, Suwanee, GA.
  9. Brittany of Melwood Rehabilitation Center, Upper Marlboro, MD.
  10. Tiffany Wagner of Mike Walsh Physical Therapy, Milford, DE.
  11. Nikki Tienvieri of Total Motion Physical Therapy, Christiansburg, VA.

I said that you need lumbar support.

This Physical Therapy Cartoon depicts a misunderstanding between the therapist and the patient. Do misunderstandings really happen? I tend to think that they do.

Physical Therapy Cartoons are becoming relatively amusing.

Have a laugh with It’s a Stretch,  our weekly physical therapy cartoon. And be sure to let us know what you think in the Comments section. Share it with friends, colleagues and co-workers.

The Best Dang Physical Therapy

The Best Dang Physical Therapy practice got that way using the bestptbilling.com Practice Management Software.

Dang-borders

The Best Dang Physical Therapy looks like they do a good job on Cowboys and their saddle sores! Does physical therapy actually help with saddle sores? LOL!

Have a laugh with “It’s a Stretch,” our weekly physical therapy cartoon. And be sure to let us know what you think in the Comments section. Share it with friends, colleagues and co-workers.