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

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

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


CPT 97035 – Ultrasound (to one or more areas)

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

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

Supportive Documentation Requirements

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

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

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

*Required at least every 10 visits

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

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

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

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

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

Supportive Documentation Requirements for G0283

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

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

*Required at least every 10 visits


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

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

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

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

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

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

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

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

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

Supportive Documentation Requirements for 97110

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

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

*Required at least every 10 visits

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

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

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

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

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

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

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

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

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

Supportive Documentation Requirements for 97112

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

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

*Required at least every 10 visits

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

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

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

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

Supportive Documentation Requirements  for 97140.

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

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

*Required at least every 10 visits

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

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

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

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

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

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

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

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

Physical Therapy Software Sweet Dream Practice Analysis

DPAblog4-bestPTSweet Dreams

Has Shannon’s Dream Practice Analysis left her feeling like life is sweet?

“Hey, it’s my favorite customers!” Mike kissed his wife and ruffled the kids’ hair as they slipped in through the back door of his restaurant.

“Hi, Shannon,” said the chef. “I think we might have some treats for the kids.”

“Treats?” they chorused.

“Mostly broccoli and asparagus,” teased the chef, “but there might be a cookie or two as well.”

“We should probably get them out of the kitchen, Shannon,” Mike suggested. “It’s not the safest place for a passel of kids, especially when we get busy. Grab a stalk of broccoli, kids, and let’s go find a table.”

Mike checked the whole kitchen with a glance and, satisfied, shepherded his family out to a table in a quiet corner of the restaurant.”

“Runs like a dream, doesn’t it?” Shannon said, grabbing a cookie from the plate she’d carried out.

“Most of the time,” Mike agreed. “I’ve worked very hard to get it this way, but now I have just enough excitement to keep it interesting.”

Mike and Shannon smiled at each other for a moment over their children’s heads. Then Mike remembered. “Today was your Dream Practice thing, right?”

“Right,” echoed Shannon. “It was great. Really, just going through the process has clarified things for me. You were right; it’s been a while since I took a high level look at my business.”

“It’s easy to get distracted,” Mike smiled.

“Very easy. But we went through the difference between ROI and expenses and compared our practice stats with some industry benchmarks for the things we offer, and it really made sense. I’d say it gave me some direction.”

“Just going through the figures probably helped a lot.”

“With an objective expert perspective, yes. We hadn’t really identified the right metrics to track. We didn’t capture all the data we should and we didn’t really know what to do with the information we had,”

“So the Dream Practice process really showed you all that?”

“Plus some opportunities and even some guarantees. I’m really glad I did it.”

The cookies were gone and the kids were getting restless, but Shannon had just wanted to share her satisfaction with her husband. A quick visit was better than waiting till Mike got home after the restaurant closed.

“I’d better get these three home and ready for bed. Thanks for taking some time out.”

Mike bent down to get kisses from the kids and saw his family out.

Has Shannon’s Dream Practice Analysis left her feeling like life is sweet?

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

Physical Therapy Software Practice Analysis

DPAblog3-bestPTIf Life Could Be a Dream

Will crunching the numbers in a practice analysis help Shannon and Theresa get closer to the dream?

Shannon headed back in to work with a spring in her step. “Theresa,” she said, “do you remember when we first opened this place?”

Theresa smiled. “Of course. We were two crazy kids with a dream!”

“How close are we to that dream today?” Shannon asked.

“Pretty close,” said Theresa. “We’d be closer if we could redecorate the way you keep promising–”

Shannon laughed. “Seriously, how close are we?”

“Seriously, I think we’ve accomplished a lot. We have a great practice here, we’re helping our patients, supporting a lot of good people, and adding value to the community. I think that’s what we wanted to do, and we’ve basically done it.”

“There are some things that we haven’t accomplished, though, aren’t there? And maybe new things that have come up since we started, too.”

“Like redecorating,” Theresa couldn’t resist saying. Then she went on more soberly. “You’re right, though. There are a lot of things that get put off for lack of time, and I guess you and I might not be earning what we thought we would by now… and maybe not getting as much time off as we expected to, either.”

“So do you think there’d be some value in doing that Dream Practice Analysis we’ve been talking about?”

“If you want to do it, we’ll do it,” said Theresa tartly. “But I think you should consider the pros and cons. I agree that it might be helpful to have someone with a more numbers-oriented mindset to help us make sure we’re on the right path. Heck, it can be great just to have an objective outsider who doesn’t have so much emotion invested. But you’re talking about opening up our books to a stranger.”

“An expert. And I think we just share some information, the numbers they actually need and know what to do with — unlike you and me. I know we won’t have to share any information that shouldn’t be shared.”

“Fine. But will that information really let these experts give us an accurate prediction about how the software might be able to reduce our costs? We might just end up spending more because of double talk about saving.”

“I don’t think so,” Shannon objected. “I think that’s exactly why we need to go through the process. With actual data and someone who fully understands it, we could make our decision based on real information. We know that doing without things we really need is just false economy. We certainly did enough of that in the early days! But I don’t want to guess whether an investment is going to pay off. That’s why I think we should go through the process.”

Theresa agreed and turned back to the files she was working on, but she tossed a last question at Shannon as she moved away. “Can we ask about the ROI of redecorating while we’re at it?”

Will crunching the numbers in a practice analysis help Shannon and Theresa get closer to the dream?

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

Physical Therapy Software Dream Practice Analysis

DPAblog2-bestPTLife is But a Dream

For Shannon, it’s essential to look back in order to look forward

Can a Dream Practice Analysis clarify Shannon’s real-world path?

Tell me again what DPA is, said Mike, raising his voice to be heard over the shouts of the children. Mike and Shannon had come to the park to play with their kids, but they were ready for a break. Shannon had mentioned DPA on the drive over, but Mike had’t caught what it was.

It stands for ˜Dream Practice Analysis, Shannon explained. It’s part of figuring out the ROI of my practice management software. But I dont think I understand ROI well enough to be able to figure it out.

Do you have to figure it out yourself?

I asked Theresa for help, but we couldnt seem to sort it out, and shes the one who keeps the books. Shannon laughed ruefully. That sounds bad, doesnt it?

It sounds like you need some help, thats for sure. Theresa can keep track of your income and expenses, I’m sure. But ROI is about investments. By figuring out the return on a potential investment — like practice management software — you can tell whether its a wise decision or not.

I think thats the point of the DPA process, Shannon agreed. Well analyze the Dream Practice and see how much time and money I can save by automating some of our processes with software.

It sounds like a good thing to do, Mike observed. How long has it been since you slowed down enough to think about what your Dream Practice would look like?

Good question. Shannon sat back and gazed around the park. It was an idyllic setting, full of happy children, dogs, and people enjoying the sunshine. It was easier to think about her Dream Practice here than in the office.

In the office, she was often distracted by fires needing to be put out, personal issues among the staff, and a general sense of chaos. Everything seemed to need dealing with on a case-by-case basis and every problem seemed like a new issue that had to be figured out and solved¦ or worse yet, the same old problem that never got solved but still had to be dealt with.

I love my business, Shannon said at last.

I know you do. Mike put an arm around his wife’s shoulders.

But you’re right. Ive lost track of the dream.

Dreams are different from reality, but your dreams can certainly help inform your decisions. If a DPA will help you see what kind of ROI you could get from an investment and help you make the right decision about the best investments in your practice, its worth doing.

Shannon nodded. She was still watching the kids, but it seemed to Mike that she might also be seeing her Dream Practice in her minds eye.

Can a Dream Practice Analysis clarify Shannon’s real-world path?

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

Physical Therapy Software Return on Investment

DPAblog1-bestPTThe Numbers Game

Learning to distinguish between expenses and investments

Does ROI apply to Shannon’s PT practice?

Theresa stared blankly at Shannon. “I just don’t understand the question,” she said.

“I’m asking about the ROI — the return on investment. Like, which of our patients are most profitable. What kind of merchandise gives us the best return on our investment. When we do marketing, what return do we get for each kind of promotion or campaign.’

Theresa looked doubtfully at her computer screen. “I know what we spend and I know what we take in, and any time we spend less than we take in, I know I’m happy about it. I don’t think I can break things down the way you’re asking, though.”

“Say I wanted to hire a new technician. We’d have to think about all the costs of that new technician, compared with the amount of revenue we’d be able to get from being able to handle more patients, right?”

Theresa warily agreed.

“So we’d have to know exactly how much more money we’d make by bringing in those new patients and exactly how much it would cost to bring on the new technician. Like, if we could bring in another technician for a total of $4,000 a month counting benefits and extra coffee and toilet paper, and we could bring in $5,000 in new revenue by having one more technician on board, our ROI would be $1,000.”

“I know what ROI means,” Theresa objected. “I just don’t think we have the information to break it down like that. I can tell you what we pay one of our technicians now, but I don’t think I know how many new patients one new technician would allow us to bring in.”

“Not to mention the extra cost of coffee and toilet paper.”

Theresa laughed. “Exactly. The amount of time a client takes isn’t consistent — even with one client over time. Even if we imagine that each client pays exactly the same amount each time, we can’t really say that 10 new clients will bring in X amount of revenue, because it depends.”

“That’s true,” Shannon nodded. “Plus, just bringing in a new technician doesn’t automatically bring in 10 new clients, even if he or she increases our capacity by that amount.”

“Very true.” Theresa frowned at the screen some more. “Some of our cases bring in a lot more revenue than others, and some of our technicians have more patients but actually bring in less money. And we also sell a lot of merchandise now, and that income doesn’t necessarily line up with any of the technicians.”

“Or,” Shannon suggested, “we don’t keep track of things in a way that shows how it lines up.”  She leaned over the counter to look at the screen, too, but she couldn’t really get any information from the numbers she saw.”

“It’s also hard to figure out how to divvy up the costs,” said Theresa. “That’s a big part of ROI, but we don’t really know what the investment is. We can’t just divide up the cost of the coffee among all the technicians. We can say one pound of coffee lasts a week and costs five dollars, and if we have ten people on staff, that’s 50 cents per person, but really if we only have seven people on staff, we’re probably still going to finish that coffee in a week.”

Shannon’s head was beginning to hurt. “And I guess we can’t really divide the cost of coffee among all the clients, because we’ll drink the coffee no matter how many clients we have that week. I’m confused about this, really. I understand that it’s important, but I don’t know how to figure it out. People talk about fixed costs and variable costs, but where does coffee fit in?”

Theresa nodded. “I know how much it costs to keep the doors open and the lights on every month, and I can use that to figure out how many patients we have to see. But it doesn’t seem to work out in real life. The cost per hour per client always looks like it would be right, but even when we’re busy and have no unusual expenses, I never feel like things are just the way I expect them to be.”

“This stuff makes me feel like my head is about to explode,” Shannon confessed. “It seems as though we ought to be able to say the fixed costs are X number of dollars no matter how many clients we have.”

“I guess that’s true. The rent, the utilities, and the coffee really don’t depend on how many appointments we have.”

“But some of our costs must depend on the number of people we see.”

Shannon and Theresa were both staring at the screen. They fell silent, as though inspiration were about to descend on them.

At last, Theresa shook her head. “As long as I get all the bills paid and payroll covered, I’m happy.”

“Yeah, okay,” said Shannon ruefully, “but that doesn’t answer my questions about ROI.”

“Maybe ROI doesn’t apply to us,” suggested Theresa. “Maybe it works if you’re making widgets in a factory, but once you bring people into the mix, it doesn’t work any more.”

Does ROI apply to Shannon’s PT practice?

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

ICD-10: The Long and Winding Road

What a long, strange trip it’s been on the road to ICD-10. It has taken more than 30 years from inception to acceptance, with numerous detours and false starts along the way. To see where we’ve been, and where we’re headed, check out the graphic below.


What do you think about the road ICD-10 has taken.

Has ICD-10 run out of gas?

Thinking On the Run

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?

watch the workflow webinar recodring now

Boxed In?

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.”

watch the workflow webinar recodring now

“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.”

watch the workflow webinar recodring now

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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ICD-10 | Five Building Blocks | bestPT Webinar | 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, 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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