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Physical Therapy Patient Retention Tips

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Retain your Patience and your Patients!

View this free 30 minute webinar to see how to retain your patients and keep your patience.  To retain patients you need to educate, sell, communicate, track, measure, follow-up and solicit referrals. Our physical therapy software incorporates built-in patient education and patient communication via email, text and phone calls that can be automated to fit your needs.  Our software also allows you to track your metrics, measure them and follow-up too.  If you can use all of these features, or at least several of them, then your patient retention will increase.

physical therapy cartoon
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Automate Your Care Plans for Physical Therapy Patients

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Learn how PT Patients can have Automated Care Plans.

View this free 20 minute webinar to see how to create your patient care plans and then apply automation to them. Automatic care plans will save you a lot of time and you won’t have to memory manage any of it. You can even setup a notification when visits are running out. Plus, projecting staffing and cash flow levels will be easier and more accurate.

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Caring for the complex pelvic patient with Physical Therapy

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Physical therapists specializing in pelvic health are confronted with a myriad of pelvic floor diagnoses and impairments which may result in pelvic organ prolapse (POP). Pelvic floor weakness secondary to muscle fiber damage or connective tissue abnormality may account for this phenomenon. Extenuating circumstances, such as a vaginal birth after cesarean section (VBAC), add further dimension to the patient’s presentation clinically. A 2014 study suggests that 65% of women experience successful VBAC deliveries, and there seems to be a growing trend of women requesting them.

I recently had the privilege to treat such a woman in the clinic. The patient was a 34 year old female referred to physical therapy (PT) by her obstetrician-gynecologist (OB-GYN) for evaluation of pelvic organ prolapse. The patient presented to physical therapy para 2 grava 2 (P2G2) indicating 2 pregnancies and 2 live births. On the day of evaluation she was 5.5 weeks post vaginal birth after cesarean (VBAC) of her second child. This three part series will analyze how documentation supported the evaluation, treatment, and outcomes of the patient.

At the time of initial evaluation her physician had not assigned a grade to her pelvic floor prolapse. Furthermore, the patient had not been evaluated for prolapse during cough; bear down, or in standing position, per patient report. Her primary concern was a feeling of heaviness and a sense that her organs were falling out, especially during standing and lifting tasks. Her physician had not yet performed a complete six week post-delivery examination, though this appointment was scheduled for three days after physical therapy evaluation.

The patient reported neither pain nor unintentional loss of urine (incontinence), though she felt weak throughout the abdominals and pelvic floor. Pertinent past medical history consisted of cesarean section 11/19/12 (almost two years prior to PT evaluation date) with subsequent hematoma at the surgical site which resolved with use of an abdominal binder. She is otherwise a very healthy woman with no comorbidities. The patient lives at home with her husband and two children, works as a physician assistant specializing in hospital based gastroenterology which requires prolonged standing during procedures and patient rounds.

She is an avid runner and aerobics instructor. She reports that there is good stress in her life with the birth of her second child. She was concerned that she would be unable to safely lift her toddler, run, or teach classes in her current state. Her primary goal was to be able to safely lift each of her children without the sense of heaviness in the pelvis. Secondary goals were to return to running and teaching aerobics classes which are her primary sources of recreation and stress reduction.

Physical Therapy Electronic Documentation

Click to Enlarge the image.

 

Past medical history is easily entered and accessible in the electronic chart.

There is burgeoning evidence to support physical therapy intervention for pelvic organ prolapse. A Cochrane Database System Review analyzed three randomized control trials (RCT’s) and found that pelvic floor muscle training may result in prevention of symptom worsening, and better self-reported patient outcomes. Furthermore, there is Level I evidence via 3-D ultrasonography that supervised pelvic floor training can increase PFM volume, close the levator hiatus, shorten muscle length, and elevate the resting position of the bladder and rectum in patients with POP. The researchers noted improvement in muscle thickness in both stage I POP and in symptomatic women with stage II or greater as determined by the Pelvic Organ Prolapse Quantification Scale (POP-Q).

As a measure of functional outcome, the patient was asked to complete the Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7). This outcome measure is a patient report of impact of symptoms of bladder, bowel, and prolapse impairments, and allows the therapist to gauge the level of impact and frustration that the patient experiences due to their symptoms so that treatment may be tailored to fit their individual needs. The PFIQ-7 was found in long form to be valid and reliable for women with disorders of pelvic floor including urinary and fecal incontinence, as well as pelvic organ prolapse. It is internally consistent (0.96-0.97), and reproducible (0.77-0.92), and the prolapse section was found to be significantly correlated with the stage of prolapse of the individual. The short form is faster for the patient to complete, and was found to maintain excellent correlation with the long form (r=0.95 to 0.96), with test-retest reliability P<.001). The outcome may be analyzed in subsets for bladder, bowel, and pelvic symptoms, respectively. This patient received a score total of 0 on the bladder and rectum subsets, and a score of 19 on the pelvis subset for a total score of 19 on the scale.

Musculoskeletal screening included assessment of posture in standing and sitting as this can be beneficial as an assessment of structural alignment according to the American Physical Therapy Association’s Guide to Clinical Practice 2nd Edition. The patient demonstrated mild forward head, mild anterior shoulder positioning with mildly increased thoracic kyphosis and lumbar lordosis. Pelvic symmetry was assessed by palpating the bony landmarks of the anterior superior iliac spine (ASIS) bilaterally, and the pelvis was mildly anterior rotated on the left. This pelvic position was verified in the supine position to account for possible interaction of limb length discrepancy. Limb length was measured and found to be insignificant with the right lower extremity measuring 1 millimeter longer than the right. Abdominal strength was graded 3+/5 as she was able to lower her legs no greater than a 60 degree angle while maintaining posterior pelvic tilt, according to Kendall’s muscle testing scheme.

PT examination sought to determine the nature of the heaviness in the pelvis through observation and palpation of the pelvic floor in supine hook lying position. This is done in order to assess the response of the pelvic floor and determine which walls of the pelvic floor appear to be affected.
Musculoskeletal physical therapy differential diagnosis included pelvic floor dysfunction resulting in prolapse, and increased abdominal pressure due to visceral adhesions from previous c-section.

Physical Therapy Electronic records

Click to Enlarge the image.

Documentation to demonstrate verbal and written consent for external and internal pelvic floor examination are pertinent.

bestPT is able to create unique objective components to demonstrate that consent has been verified. Furthermore it is possible to scan in and attach release forms that have been signed by the patient.

In the next installment, we will discuss treatment techniques in this unique women’s health sub-population.

-Amanda Olson, DPT

bestPT

Physical Therapy Documentation – Turning Attention to the Patient

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Perhaps the most common thread across all physical therapists (PT) regardless of practice setting and specialty is that each of us became a PT with the intention of helping others. The process of deciding to become a physical therapist may have began at a young age (such is the case with myself at the tender age of ten years old), or perhaps for some this is a second career, but each one of us set out with the intention of participating and guiding people in healing and rehabilitation. The common thread of wanting to provide the highest level of care to our patients tends to drive us to continuing education courses, to certifications, and the most optimal practice settings. This hard work and attention to detail is reflected in the improvement of our patients. More importantly, and more concretely, this attention to detail is reflected in the thorough documentation of our treatment and plan of care.

Those of us who grew up without a cellular phone, laptop computer, or Netflix may have envisioned spending the working day one on one with patients, and quickly knocking out our written evaluations and SOAP notes before leaving at a reasonable hour each day. Or perhaps my ten year old vision of my future professional life was a little too rosy for my own good. As difficult as it can be to recognize, our ability to continue to practice in the manner we see fit is dictated by our ability to receive reimbursement for our work. In order to help others, our clinic’s lease must be paid and our lights must remain on.

Herein lies the struggle to maintain a healthy business in a phase of history where insurance requirements for reimbursement and Medicare laws are changing at the speed of light. We must reconcile the fact that there is no returning to a more simple time, and that reimbursement is most likely going to continue to become more complex. Thankfully, with every problem there comes an opportunity for growth.

Easy

Click the image to enlarge it and see the new bestPT Physical Therapy Documentation System.

 

A screenshot depicting the ease of Physical Therapy documentation by clicking through pre-programmed evaluation templates made unique for each Physical Therapy clinic. bestPT programmers are able to create unique specialty templates as well for various clinical specialties.

Several months ago our clinic underwent a significant change in how we document. Prior to this change we wrote daily SOAP notes in paper charts, and wrote initial evaluations and progress reports in PDF templates. We saw patients one on one for forty five minutes, and utilized an additional thirty minutes built into our clinical day for documentation. These initial evaluations and progress reports were typed into the PDF form and then printed by the therapist during designated charting times outside of patient treatment hours. Once printed these documents were manually faxed to the referring physician by front office staff. Prudent therapists know that medicare documentation as well as other third party payers mandate that documentation be completed within twenty four hours of patient contact. This expiration date made for a very long evening if a therapist experienced day with several evaluations and progress reports on the same day.

Once all staff members were trained in the use of bestPT electronic health record system, laptops were implemented by physical therapists to utilize for documenting during treatments. Returning to the initial rosy vision of altruistic patient care wherein we provide best services possible, there was initial worry by the staff that documenting into a computer in front of the patient would detract from building patient rapport. Some therapists worried that the time they spent documenting during treatment times would detract from actual treatment times. In reality once the system was put to the test, staff found that the easy clicking capabilities offered in the system expedited documentation time. Faster than manually writing in tests and measures, the electronic record allowed for concise documentation of all components of care from subjective report to plan of care.

Perhaps the most interesting finding throughout this transition has been patient response: there really wasn’t one. Patients were generally unphased by this transition because every other healthcare provider under the sun is already using electronic medical records. I asked a 65-year old Vietnam War veteran to Please pardon the computer as reviewed his prior medical history and he replied Oh honey you all do what you gotta do with those things, it don’t bother me none. A sweet gentleman to be sure, but truly we did not receive a single complaint during the initiation of the system.

PHI

Click the image to enlarge it and see the new bestPT Physical Therapy Documentation System.

Recording prior medical information is easy with the template. It is easy to return to this screen from others in the electronic medical record, and leads to easier continuation of care from one therapist to another as it offers a thorough and easy to read format.

Therapists now are able to complete an entire document as they treat for each and every patient. Upon completion of an initial evaluation the report is quickly sent to the physician for approval, eliminating several steps in our prior system. This has eliminated the need for additional paperwork time and actually freed up all of our schedules and allowed us each to see one additional patient per day with some remodeling of our scheduling template.

From a business perspective this has resulted of course in increased revenue. We are able to offer our services to more patients, and the turn around time on reimbursement is significantly decreased. We can all rest assured that we complete our paperwork on time, and indeed get home at a reasonable hour. This is how we have managed a win-win scenario in our clinic. We are able to provide the high quality services, still one on one, that we envisioned when we commenced physical therapy school, bright eyed and ready to heal the world. We are also able to maintain a healthy business without compromising or cutting corners. I believe that my ten year old self would be impressed.

-Amanda Olson, DPT

bestPT

Compliance | Reducing Documentation Time

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images (26)

A case of writer’s cramp

 

Is there a way for Shannon to spend less time on documentation and more time with her patients?

Shannon sat at her desk shaking out her hand, which had cramped up after 10 minutes of concentrated writing. She knew how important it was to provide accurate documentation of patient visits but capturing every detail in writing, then making Teresa type it into the computer, was eating up valuable time for both of them. Plus, Teresa was forever complaining about her handwriting, which she admitted was difficult to read.

There was a knock on Shannon’s office door. “Come in!” she called.

Teresa entered with a smile. “Hello, Shannon, I was wondering if you had a moment,” she asked.

“Of course, Teresa, what’s on your mind?” Shannon asked.

“I’ve been working on entering your patient notes from last week and it’s taking me a long time,” she explained. “I know you try to be thorough but there are times when I need to extrapolate certain tidbits of information based on what I know about the patients.”

“Well, we’re all taught when we go into medicine that if we don’t write it down, it didn’t happen,” said Shannon. “I do try to capture every detail I can.”

“And I do appreciate your efforts,” said Teresa. “But I’m not just dealing with the SOAP notes, I need to include images, forms such as Medicare, intake and verification of benefits lengthy tests and more.”

“How much time would you say this is taking you in any given week?” asked Shannon.

“I haven’t tracked my time but it takes hours,” said Teresa. “Not just in typing and attaching related documents, but also in touching base with you when I have questions that I can’t figure out from your notes or past patient records. That takes time away from your day and your patients as well.”

“It used to be so much simpler,” mused Shannon. “When I opened this practice, I could scribble myself some notes, stuff them in the patients’ paper files and forget about them until the next patient visit. I was able to spend so much more time with my patients!”

“It’s not just about spending time with the patients,” said Teresa. “Our goal is to help patients get better, and to feel so much better that they feel compelled to bring family and friends who may be suffering to see you as well.”

“That’s true we need happy, referring patients to make the practice grow,” agreed Shannon. “I wish there was a way to keep accurate, compliant notes in less time.”

“You mean besides taking that handwriting course I’m always nagging you about?” teased Teresa.

Is there a way to reduce the investment of time in documentation so that Shannon can focus on her practice and her patients?

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

 

bestPT

Physical Therapy Documentation Shortcuts

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Our most popular xDocs templates:

  • Insurance Verification: Have relevant insurance information right there on the page with our v.2014.
  • Check lists: Create a custom checklist to review treatments with your patients, plan future treatments, or provide your patients with what they need to complete.
  • Grids: Keep a top-down view of all the details you need but don’t necessarily need for reporting.
  • Daily Notes: Some providers like a simple template with basic info. Others prefer a little more detail. Either way, xDocs can provide a fast solution.

Our documentation platform is maturing into an essential part of Physical Therapy practice management. Providers are loving our improvements and new template designs for editing and printing. In the last 12 months, the number of patient visits documented on xDocs has tripled.

 

Physical therapists are beginning to realize the power of having fast, simple documentation in the travel card and on patient files. It’s easy to create, edit, review and sign documents in xDocs. Here are some trends we’ve noticed from our practices with the highest visit rates and the lowest A/R over 120 days:

  • Less is more. Extra information makes it harder for you to find relevant information later. Place only the most relevant details in addition to the compliance requirements. Payers make it hard enough on you already; there’s no need to complicate it further.
  • More than just a paper substitute. If you find yourself writing the same things again and again, you can request that the xDoc have those phrases built in as defaults, or as an option to click and fill out the form automatically. Clicking or tapping a field is much quicker than writing it out.
  • Not all in one form. The providers who use xDocs the most get paid the most — and they’re not paying for bulkier, slower systems. xDocs is organized to be quickly accessed and reviewed; providers have much better results when they keep the documents organized for their purpose. While we have and are improving the comprehensive evaluations, the providers who treat more patients and get their payments, split the reporting documents from the recording documents. The insurance companies and Medicare don’t need to see many of the visit’s details; you’re just giving them more ammo to come up with reasons to delay or withhold the payments for your work. Our combined experience is used to help ensure you document everything that you need for your payors and nothing that you don’t need.

If you do not currently use xDocs, ask your Coach about getting started.
Your Coach can review your existing documents to help you get the best results.

bestPT

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

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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.

MODALITIES

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

THERAPEUTIC PROCEDURES

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/.

Erez Lirov

Thinking On the Run

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Thinking On the RunPhysical Therapy Software

by Erez Lirov

Stretching expectations to find an ideal solution

Can Shannon find a credit card processing system that will meet her definition of excellence?

Mike and Shannon rounded the bend of the track through the park. The weather had kept them from running for a couple of weeks, and Shannon was enjoying the feeling of getting out in the fresh air and moving through the beautiful scenery.

“Isn’t this great?” Mike asked, puffing a bit. “I love getting into the moment and not thinking for a while.”

“How can you do that?” Shannon asked, slowing to a walk. “I think even more when I’m running. In fact, that’s one of the benefits. I can think more deeply as I run.”

watch the workflow webinar recodring now

“What’s on your mind?” Mike asked, slowing to match her pace.

“Credit card processing,” Shannon answered quickly. “I know I need to do some research to find the best system for the center, so I’ve been organizing my thoughts. Can I try it out on you?”

“Sure.” Mike plopped down on a bench that gave a view of the park.

“Stretch out first!” Shannon urged him. “Cool down!”

Mike stretched out flat on the bench with his arms and legs hanging down. “This is the only kind of stretching I plan to do. Now tell me your credit card processing ideas.”

“Okay,” Shannon agreed, pulling her nose to one knee. Her hair fell down to the ground, but Mike could still hear her as she continued, “I figure the least a system would have to do for it to be worth the trouble of changing would be to help us catch errors.” She drew her nose to her other knee. “If it would post the payments automatically to the patient accounts, charge the accounts back if the payment got declined, and send us a report at the end of the day, that would make it worthwhile. I figure it takes a full day over the course of a month for us to take care of those things, and I don’t see why a computer couldn’t do it.”

Mike nodded. “It sounds like that would help quite a bit.”

“Right, and it should also let us charge products to the patient accounts. That seems completely realistic.” Shannon pulled her arms behind her, stretching out her chest. “Next level up, if it would notice when recurring payment information we keep on file is about to expire, and maybe alert patients about expirations and if a payment is declined so they can take care of it. It would have to alert us, too. And it could alert us when someone is getting behind, too. That would not only prevent a lot of the errors we face, but it would also improve customer service.”

watch the workflow webinar recodring now

Mike sat up and swiveled to look over the park. “Okay, That’s the fair-to-middling solution. What does it take to reach excellence?”

“If the payment system would send out invoices automatically and let us accept payments electronically, we’d shorten the billing cycle and save a lot of time.”

“People prefer to pay bills electronically, anyway,” Mike pointed out. “Most of us are used to paying our bills that way by now.”

Shannon pulled Mike up from the bench and they headed back toward their car.

“So this paragon of a payment system,” Mike asked, “what’s it going to cost?”

“That’s part two,” Shannon laughed. “If I can find a system that meets my definition of excellence, then I’ll just have to see whether I can afford it. But I think that a system like that could result in some real savings just because of the efficiency, so it’s worth spending some time in research.”

Can Shannon find a credit card processing system that will meet her definition of excellence?

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Erez Lirov

Boxed In?

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Boxed In?

by Erez Lirov

Breaking things down helps indentify needs, avenue to expore

Will Shannon’s lack of knowledge keep her trapped in credit card inefficiency? How can she find the change she needs?

“Why Shannon, you look radiant!” Theresa said as Shannon stepped into the office. Theresa was cutting down cardboard boxes. “Taking a little break with your husband really perks you up!”

“I think that this time it’s adrenaline,” Shannon said. “I’m feeling very motivated to fix the issues with our credit cards.”

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“Issues?” Theresa cocked an eyebrow. “Like high fees, errors, and the time we spend on this stuff?”

“Exactly. I know you said we should shop around for a better rate, and Mike had some ideas, but do we have to have special HIPAA-compliant processing?”

“The compliance standard for credit card processing is called ‘PCI.’ I know we’re responsible for it and that the rules change sometimes, but I don’t know how we make sure we’re up to date on that. I have heard that penalties for noncompliance are high, though — you remember when Target had a security breach? They paid more than a billion dollars in fines.” Theresa shook her head and stacked the flattened boxes. “It’s no different for health care. Besides, look at all these boxes! This is from merchandise we sell. We’re making good money from that retail area. We should get a POS — a point-of-sale system — so we can check people out easily.”

“Hold on,” Shannon objected. “I’m trying to make things simpler here.”

“It could be like the practice management software. That seemed complicated when we were just thinking about doing it, but it has actually simplified our lives a lot — and saved us money.”

“That’s true. There might be an integrated system for credit cards.”

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Theresa agreed. “If we were able to reduce errors, we’d probably save enough to pay for it. I heard that something like 8 percent of recurring payments get declined, and I’m not sure we catch all those.”

“I’m completely convinced that errors and efficiency are enough of a reason to make changes, but do you think we can do anything about the size of the credit card processing fees?”

Theresa thought, her eyes on the pile of cardboard at her feet. “I still think it would make sense to shop around, but I know that the fees are based at least in part on how much volume we have. Maybe making the process easier would encourage people to use their credit cards more.”

“If it’s about volume, though…” Shannon shook her head. “We’re never going to have the kind of volume Target has. Or even Mike’s rest

aurant. A lot of people pay by check and of course insurance is a big part of our income, too.”

“Maybe we could get group rates, like with insurance,” Theresa suggested.

Shannon laughed. “I think we need to do some research. At least now we know what we don’t know! Come on, I’ll help you get all this out to the recycling bin.”

Will Shannon’s lack of knowledge keep her trapped in credit card inefficiency? How can she find the change she needs?

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bestPT

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

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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.

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