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ICD-10 | Five Building Blocks | bestPT Webinar | Q&A

PQRS Q&A

As you get your practice ready for the ICD-10 changeover, you are bound to have questions regarding documentation and compliance. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar “ICD-10 | Five Building Blocks,” along with the presenter’s responses. Feel free to add any new questions in the comment section below.

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Q: Where can I find CMS guidelines in written form?

A: On CMS.gov, click on the Medicare link and you will find a link for both local and national coverage determinations.

Q: When can I start finding ICD-10 codes within your software and submitting them?

A: Our software already has all the ICD-10 codes listed; we are building the crosswalk now. We recently completed ICD-10 testing with Medicare, and were successful with our front-end edits. We are looking to have this available to practices by June, to really start testing and crosswalking. At this point, payers are not accepting claims in ICD-10; they are not coming over until October 1, but we are testing with payers and clearinghouses directly.

Enjoy this ICD-10 webinar?

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Sorting It Out

Sorting It OutiStock_000015493750XSmall

by Erez Lirov

Credit cards can create a variety of compliance issues for practices

What are Shannon’s next steps to sort out her credit card system?

“Mike!” Shannon checked everything in the physical therapy facility with a practiced eye as she walked across the carpeted floor. She loved to see everyone busy and engaged, and things were going well at the moment. She had a word with the receptionist and steered her husband out the door.

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“I was hoping you’d have time to come for a walk,” Mike said. “I needed to get away from the restaurant for a bit.”

“Problems?” Shannon’s voice was concerned.

“No, just a need for a change of scenery, a breath of air.” Mike took his wife’s hand. “It looks as though things are going well at your place, too.”

“Definitely,” Shannon agreed. “I know it won’t last –”

Mike laughed. With two small businesses in the family, there were bound to be plenty of problems to discuss.

“Seriously,” Shannon continued, “I want your advice about something. It’s not really a problem, but I think I could cut costs if I made some changes with the credit cards.”

“Now you’re talking!” Mike threw his arms wide. “I can’t believe you guys post everything manually!”

“I never really thought about it before,” said Shannon, “but today I was watching and it just seems so complicated. We take cash, checks, credit cards, and debit cards for deductibles, balances, all the things we sell at the counter… And we take the information over the phone or copy it off the card. Tana took the info via text today.”

“I’d have thought that might be a HIPAA issue,” Mike said with one eyebrow raised.

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“I think it might be all kinds of an issue,” Shannon confirmed. “Plus, since we have so many different things going on, I can really see how there could be errors. Theresa said she wasn’t sure we always know when a card is declined, or if we always follow up on those cases to get alternate forms of payment, and I can believe it. It seems like practically everyone in the place took a payment at some point this morning. I don’t see how we could keep track of everything.”

“At the restaurant, the server picks up the card at the end of the meal. One type of transaction, and we know exactly who did it and when. It doesn’t sound like that’s true for you.”

“Exactly. I wonder, too, whether there isn’t a bit of psychological barrier in having to pull out that credit card.” Shannon checked her watch. “I’d better get back to work. Thanks for listening.”

“I’m happy to listen,” Mike said, turning back. “What’s your next step? I could hook you up with the company that supplied our credit card terminal.”

“I don’t know whether that’s what we need or not,” Shannon said. “Do you think we have to have something different  to be HIPAA compliant?”

“I don’t think I can answer that question,” Mike said. “Time for me to get back to my own credit card machine.”

What are Shannon’s next steps to sort out her credit card system?

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A Missing Piece

A Missing Piece Fortis is integrated into bestPTbilling software.

by Erez Lirov

In the budget of a busy practice, credit card fees can add up.

Could Shannon handle credit cards better in her physical therapy practice?

Getting the family out the door in the morning was always a challenge for Mike and Shannon, but they felt like they had a great system. Each child had a hook for a jacket and a cubby for shoes at the door. Homework went in the cubby, too, and lunches were packed and lined up on the counter. The kids knew they had to stand touching the car door till Mom or Dad arrived to unlock it, and then they scrambled into their seats and waited patiently to be strapped in with seat belts before taking off. It was noisy and it sometimes felt chaotic, but things always went pretty smoothly and everybody got where they were supposed to go.

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Once Shannon dropped off their youngest at daycare, she headed on into the office, thinking about that system. She knew that Mike would get the older kids to school on time before he went to the restaurant. Sometimes his schedule was different so they divided things up differently, but it always felt like good teamwork, and she loved that feeling.

Things had been going more smoothly at work, too. Shannon thought back to her conversation with Mike that morning as they both got ready for work. “It seems like you’ve got your team back together,” he had said, and that was just how it felt.

With that issue off her plate, Shannon could think about some of the other matters that had been on the back burner for a while. She knew the facility needed updating, for example, but that was going to need funds, so Shannon was looking at her expenses closely to see where she could cut costs and free up some cash.

It wouldn’t take much, she thought as she parked and walked into the building. There were bound to be areas where she could streamline things a little bit and achieve some savings.

She asked Theresa’s opinion as soon as she got inside, and Theresa immediately had an answer. “Credit cards.”

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Shannon was surprised. She had been thinking the free coffee in the staff room might be an avoidable expense, or that marketing costs could be cut. “What do you mean?”

“I think the fees are higher than they should they be,” Theresa said. “I know it’s a basic cost of doing business, but maybe we could shop around and see if there’s a cheaper alternative.”

Shannon nodded. They really hadn’t compared prices; when she first set up the practice, she had basically just asked the guy who installed their telephones for a recommendation, and they hadn’t revisited the question since.

“Plus, since we post all the payments manually, there’s a possibility for error. We’re all careful, of course, but I can’t swear that we catch every time when a card is declined, for example. Sometimes the person who takes the information is not the same person who posts the payment, and some are sort of automatic.”

“Sort of automatic?” Shannon hadn’t realized things were so shaky in this area.

“Well, we have clients who have set up an automatic bank draft or we have all their information in the system already, and some who are new…” Theresa’s voice trailed off. “I guess there are a lot of variables in the way we take payments.”

It was a lot like the way they got their family out the door in the morning, Shannon thought, but in this case every little extra bit of chaos could mean extra costs, not just extra noise.

“This might be the last piece of the puzzle,” Shannon said. “Or at least the next one. It sounds like a real opportunity for improvement.”

“And we could finally get some new paint in here?” Theresa joked.

Shannon smiled. “The first few hundred we save goes straight into the redecorating fund,” she promised.

Could Shannon handle credit cards better in her physical therapy practice?

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Stop Your Staff From Fighting | bestPT Webinar | Q&A

PQRS Q&A

Does your office staff argue about who is responsible for completing tasks generated by your patient visits?

How do you assign those tasks to your staff?

How can you see if the tasks have been completed?

Can you track those tasks automatically?

Do you micro-manage your staff?

How can you foster staff teamwork, promote staff autonomy and reduce the time you spend on staff management?

These are questions that each physical therapy practice owner has to answer. Each patient visit generates a list of tasks that need to be completed. Each patient needs an account set-up with their complete demographic information, their insurance information and other details you need to file insurance claims and to collect cash or co-payments.

If you break those tasks into a step-by-step list, then how do you assign those tasks to a member of your staff? How do you determine if every task has been completed for every patient? What happens if steps are forgotten? How will your patients judge your mental health practice if your staff forgets something? Would your patients think your office is unorganized?

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Q: What’s the problem?

A: Office staff including the front desk, the office manager and any employee physical therapists are supposed to make life easier for the practice owner. However they often inadvertently create additional challenges regarding patient retention, revenue and compliance. Many of these challenges are related to issues that the practice owner simply doesn’t have time for. If your staff goes on vacation or calls in sick then a backlog of tasks is created, resulting in tasks being forgotten about and mistakes being made. Every member of your staff needs to be managed and be held accountable to ensure that each task is completed correctly.

Q: Why is this problem important:

A: The short answer is Cost, Compliance and Patient Attrition.

  • Cost – Front office tasks prevent the practice owner from seeing patients, which is the only billable time for your practice. Mishandling of billing and collections results in lost revenue with denied claims and delayed payments. Ineffective patient relationship management leads to attrition.
  • Compliance – Includes incomplete/incorrect documentation, interrupted care plans, incorrect CPT/Diagnosis codes, staff unfamiliarity with procedures and staff failure to collect copays leads to overpayment by the Payers.
  • Patient Attrition – Failure by staff to follow-up on no shows, incomplete care plans and patients with no future appointments.

Q: Why is this problem difficult to solve?

A: There’s high front office staff turnover which could be due to poor training, lack of knowledge and unorganized micro-management. Some staff have a poor attitude towards training on new procedures and systems and they’re more comfortable with the old way of doing things. There’s also a lack of redundancy leaving tasks undone when somebody is absent and the ultimate responsibility falls to the practice owner.

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Q: What’s bestPT’s approach or solution?

A: A complete practice management solution for your office.

  • Improve staff teamwork with effective training to ensure optimal practice performance.
  • Improve teamwork and staff autonomy with automatic checklists of tasks that need to be completed when patients are checked-in.
  • Track practice goals to more easily improve the number of patient visits, increase revenue, submit every insurance claim, follow-up with every no show and schedule patients with no future appointments.
  • Manage staff remotely on your laptop or your smart phone by tracking task completion.
  • bestPT is a complete practice management solution that includes:
    • office workflow
    • patient relationship management
    • staff management
    • while also incorporating everything else you need like:
      • scheduling
      • billing
      • EHR
      • claim scrubbing
      • claim submission
      • claim follow-up
      • staff task checklists
      • training, etc.
    • bestPT also includes a Coach to ensure your practice uses everything in the most efficient way possible.

    Enjoy this office workflow webinar?

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The Roller Coaster of Collections | Where is My Money III

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!

Tracking the Variables | Where is My Money II

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!

Where's My Money?

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!

Physical Therapy Billing |Turning Visits into Cash

Physical Therapy practice management cash_paying_Patient“If you can’t get paid for the work you do, you can’t pay your staff, can’t pay your rent, and you can’t provide good quality service.” – David Alben, Clinic Director, Axiom Physical Therapy and Occupational Therapy Tuckahoe, New York

Axiom PT & OT sees 850 monthly visits and has six full time PTs, two OTs, and six administrative staff. David Alben tells Jason Barnes how bestPT helps Axiom meet all of their objectives.

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David Alben: You know, trying to get your arms around the receivable is a huge problem. I run a healthcare consulting practice, and I see this time and time again. Which claims have been paid, which claims haven’t been paid? Who owes you the money, how long have they owed you the money? The whole issue between insurance approved amount, usual customary charges, all of those things are confusing.
Jason Barnes:Why do insurance companies make it so hard to get paid?
David Alben: I think that insurance companies have placed barriers to payment because it’s in their business interest to do that.

Intentional billing complexity

I don’t have a problem with that as long as everybody understands the rules going in. Each of the individual payers has their own twists and turns and hoops they make you jump through to get paid. So what works for insurance company X is not going to work for insurance company Y.

Insurance companies profit on the float

We are in the business of getting paid to provide excellent physical therapy and occupational therapy. It’s a reality of running a healthcare company these days. If you can’t get paid for the work you do, you can’t pay your staff, can’t pay your rent, and you can’t provide good quality service.
Jason Barnes: Why did you select bestPT?
David Alben: You know over the years, in various different businesses, we have gone from manual systems, literally paper claims, to home grown systems, to other commercially available systems. And many of them have good and bad points.

All-in-One Solution for Practice Management

It has really been hard to find one system that galvanizes of the different components of running a physical therapy practice, the front end stuff, collecting the demographics, having a schedule that is easy to use and understand, and then the whole back end procedures of turning those visits in to cash!