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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.

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Physical Therapy Software | Compare Cost of Visit Documentation with EHR

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

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

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

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

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

For example:

Assumptions:

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

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

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

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

280 visits x 2 minutes = 9 hours

Compare to efficiency with documentation time of 10 minutes:

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

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

280 visits x 10 minutes = 47 hours

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

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

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

PT Clinic Control 3 | Costs-Benefit Analysis of Documentation

Best practices for physical therapy billing

[youtube_video] GbOZpWZGLIw [/youtube_video]

Chris Martin: So, are you saying that the cost of visit documentation is much higher than just the cost of the SOAP system [as part of the physical therapy billing process] because it takes YOUR time to document?

Dave Macolino: Precisely. The practice owner’s time is the most expensive component of their practice and they should be maximizing that value. Obviously, when they spend that time seeing patients, they maximize their value and time writing notes, reduces it.

Chris Martin: So, how do you compute the cost of writing a SOAP note? More importantly, how do you compute the cost of writing all your SOAP notes for the next ten years?

Dave Macolino: A successful enterprise must generate more revenue than costs and a practice owner must get used to thinking about his or her time in terms of revenue and cost.

So, the first question is: what is the cost of your time?

The answer depends on your productivity. Suppose your practice can handle 4 patient visits per hour and it requires you personally to supervise them for 15 minutes each. If an average visit pays $80, then your hour is worth $320. So, in this case, your optimal performance is $320 per hour.

That also means that if you spend your time on other activities that earms you less than $320 per hour, you’re losing money.

The amount of money you’re losing depends on the time you spend not generating $320 per hour. So, if you can only write 2 notes per hour then each note basically costs you $160. If you are writing 200 notes a month, then you lose the time equivalent of $32,000 a month! Extrapolate this forward to 10 years, and you get to $3,840,000 or very close to $4 million dollars in lost productivity and earnings!

Chris Martin: OK, I got it. It costs millions of dollars if I use a slow documentation system. So what should I do now? It all seems so confusing…

Dave Macolino: It’s not so much a slow documentation system as it is a system that has a flow of information and is set up with consistent phrases and measurements that are often used in the daily notes.

This computation is just an example of how you should think about your costs of any activity. Once you identify all your activities and attach cost to each one of them, you can focus on those activities that matter the most and eliminate or optimize those that don’t.

You can also set very clear requirements for the kinds of processes and systems you need to have in your office to help you spend as much time generating $320 per hour and very few hours that generate less or even worse, cost you as high as $320 per hour.

Think about it this way. If you personally spend 1 hour a week on practice administration and 3 hours a week on say billing, then over the next 10 years, you will spend the equivalent of $640,000.

So now you can add up all of your costs (add office rent, equipment, staff costs) and start thinking about what processes and systems do you need that reduce these costs?

Since documentation, administration, and billing are the largest components of your cost, then you need to design processes and install a system in your office that address these costs first.