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Wrenched m’elbow again

Here’s another Physical Therapy cartoon for your amusement!

 

physical therapy cartoon

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

 

Physical Therapy Software Patient Education Promotes Compliance

handshake_0

A Handshake

Will collaboration lead to improvement, or should Shannon take a more aggressive path?

Teresa and Tana looked up when Shannon arrived the next day — and then exchanged looks.

Shannon felt her muscles tense, but then decided that she wasn’t going to get defensive. They were all on the same side, and they could work together to come up with the best solution.

“Good morning!” she smiled. “What are you two talking about?”

“Tana was just lobbying,” Teresa said with a smile.

“I’m talking about noncompliant patients,” Tana jumped in. “I think they affect Teresa, too, since she’s the one who has to keep up with scheduling and cope with no-shows.”

“That’s true,” Teresa agreed. “They affect all of us, really. Especially since they affect the bottom line of the whole practice. Tana was telling me that you think improved patient education is the answer, Shannon.”

“And I was also telling you that I have a problem with that,” Tana said firmly. “Patients who are open to education are not the non-compliant ones! The ones who listen to us get better results and that brings us more referrals. We should just get rid of the ones who don’t follow through.”

“Some patients may need more from us than others,” Shannon said. “The body is a complex system, and a simple explanation isn’t enough for all of our clients to understand why their part matters so much.”

“It still comes down to responsibility,” Tana insisted. “It’s not fair that they drop the ball and so I have to change my routine, add more work to my day, and–“

Shannon held up a hand. “Hold it. I was just reading a report about PTs and the importance of patient education. Tell me if you agree with their findings. It said that we regard patient education as a very important part of care. Yes?”

Tana grumbled, “Yes.”

“And that we are involved in patient teaching in some way”

“Yes,” Teresa said, more enthusiastically.

“But most physical therapists feel inadequately prepared for patient teaching.”

“Inadequate!”

Shannon could see that Tana was getting worked up again. “Look, we’re all about improvement here. When you brought this issue up, it showed me a way that we could improve our practice. I appreciate that. Now we just have to figure out the best way to do better at patient education and help our patients help themselves — and us.”

“That sounds good to me,” said Teresa. “If we can find a way to standardize and improve patient education, that will benefit all the patients — and maybe make some of those difficult ones adhere to their treatment plans better. I know Tana’s worrying that it’ll be more work, but I don’t think it has to be. Better isn’t always harder.”

Shannon smiled at her office manager gratefully. “That’s true. We’ve never really developed a system for patient education and we don’t have any patient education materials beyond just telling people things. This could really be a good new initiative for us.”

Tana looked from Teresa to Shannon and back. “Okay,” she said with a smile, “I’ll give it a shot. You let me have some input on the system of patient education we come up with, and I promise to give it a fair try before I try to get Teresa to drop those patients.”

“Done,” said Shannon. She held out her hand, and after a moment Tana shook.

Will collaboration lead to improvement, or should Shannon take a more aggressive path?

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

Working the core

Here’s a Physical Therapy Cartoon that’s kinda silly!

If you work the core, will that keep it from becoming a rotten apple or keep it from going back to an apple shape? I’m just sayin’.

Physical Therapy cartoon is funny!

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

Physical Therapy Software Easy Patient Education

Show Time

Does Shannon need to show her patients more information so they’ll adhere to their treatment programs?

“Shannon? The sitter’s here!”

Shannon grabbed her purse and gave her hair a last touch. Her husband was dressed and ready, the kids were already engrossed in a game with the sitter, and she was looking forward to some time with her husband — no kids, no work, just the two of them. Except”¦

“What’s going on?” Mike asked. “You seem preoccupied.”

“I am,” Shannon admitted. “I wasn’t going to bring it up, since this is the first date we’ve had in weeks–“

“It’ll be more like a date if you tell me about it,” Mike said. “That’s what single people do, right? Talk about what’s going on in their lives?” He opened the car door for his wife and closed it after her.

Shannon waited for Mike to take his place next to her. “I’m not sure I can remember what single people do,” she said. “But I would like to tell you about an issue at work. In two words: non-compliant patients.”

“I don’t think that’s just at your work. I heard about that on the radio today. They said it was an epidemic,” Mike observed. He cocked his head. “That’s another thing single people do — talk about current events!”

“This definitely qualifies. I’ve heard that even with something as simple as taking prescribed medication, fewer than half of patients in studies actually follow through. In one study where they asked people, 75% admitted that they didn’t follow their doctors’ orders.”

“The radio program said that non-compliant patients cost $290 billion dollars every year. I don’t know where they got the figures, but I can believe it,” Mike said. “I mean, if patients don’t follow through with their treatments, the treatments are bound to be less effective, so the patients end up needing more care.”

Shannon agreed. “And those figures I mentioned are just about taking pills, which is easy. We ask our clients to do things that are harder, like doing exercises or showing up for treatments several times a week even though those treatments might be uncomfortable.”

“You ask for lifestyle changes, too. Speaking of which, I think this is as close as we can park, so we’ll be getting a bit of a walk this evening.”

“It’s a beautiful evening! I’ll enjoy a walk. But you’re right. It’s easier to stay on the couch — even though clients who follow through are happier with their results. And need I add that the staff will also be happier and our reputation will benefit?”

“So what’s the solution?”

“Tana thinks we should have strict policies and drop people who skip sessions, but I’d rather start with education.”

Mike took Shannon’s arm and guided her up the stairs. “Isn’t that what you already do?”

“In some ways, but I think we might need better tools. In my experience, people who really understand their bodies and how the treatment will help are more likely to follow through. But a lot of people are pretty fuzzy on anatomy. We might think we’re explaining completely clearly, but if we don’t think about it, we might be using words that make complete sense to us and not to the clients.”

“Skeletons all over the room?”

“We need them to have muscles,” Shannon pointed out. “And maybe posters — but I’d really like to be able to send a picture home so the patients get support from their families, too. You know the way the kids bring home stuff from their teachers for us to put on the fridge? If they relied on the kids, we might have a very incomplete idea of what they were learning.”

“I like your idea, even if talking about the kids spoils the illusion of being single people.”

Shannon and Mike took their seats. “No kids, no work — till after the show, at least.”

Does Shannon need to show her patients more information so they’ll adhere to their treatment programs?

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

Okay, how would you categorize your shoulder pain? Mild, serious or mythical, eternal curse of the gods?

Shoulder Pain this bad is epic!

Have you ever had shoulder pain that feels this bad?

shoulder pain is huge

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

Is Your Practice Ready for a Medicare Audit? – Part 7

In this seventh in our series of blogs asking the question “Is your practice ready for a Medicare audit?” we discuss Treatment Notes.

“If you did not write it, you did not do it.” This is usually one of the first lessons we learn as clinicians. Simply stated, Treatment Notes are where you write what you did. These notes are the source document auditors look to when reconciling what was done vs. what was billed. We have seen audits swing on the quality of the Treatment Notes many times.

Medicare requires that the clinician create medical record documentation for every treatment day. Sufficient detail must be provided for every therapy service provided to justify the use of codes and units on the claim. From a clinical perspective, these notes provide a chronology of precisely what you did for the patient. From a financial and audit risk management perspective, this is your opportunity to clearly document exactly what you did during a treatment session to justify the codes you billed.

Required Elements

The treatment note must include the following information:

Date of treatment
Identification of each specific treatment, intervention or activity provided in language that can be compared with the CPT codes to verify correct coding
Record of the total time spent in services represented by timed codes under timed code treatment minutes
Record of the total treatment time in minutes, which is a sum of the timed and untimed services
Signature and credentials of each individual(s) that provided skilled interventions
In addition, the treatment note may include any information that is relevant in supporting the medical necessity and skilled nature of the treatment, such as:

Patient comments regarding pain, function, completion of self-management/home exercise program (HEP), etc.
Significant improvement or adverse reaction to treatment
Significant, unusual or unexpected changes in clinical status
Parameters of modalities provided and/or specifics regarding exercises such as sets, repetitions, weight
Description of the skilled components of the specific exercises, training, or activities
Instructions given for HEP, restorative or self/caregiver managed program, including updates and revisions
Communication/consultation with other providers (e.g., supervising clinician, attending physician, nurse, another therapist)
Communication with patient, family, caregiver
Equipment provided; and
Any additional relevant information to support that the patient continues to require skilled therapy and that the unique skills of a therapist were provided.
In the case of maintenance therapy, treatment by the therapist is necessary to maintain, prevent or slow further deterioration of the patient’s functional status and the services cannot be safely carried out by the beneficiary, a family member, another caregiver or unskilled personnel.

Use of Grids, Flow Sheets or Checklists

Many practices use a grid, flow sheet or checklist form to record exercises/activities performed. It is a convenient way to document exercise names (e.g. pulleys, UBE, TKE, SLR) resistance levels, weights, reps, etc. It also provides a clear picture of the patient’s progress from session to session. However, this alone does not establish that skilled therapy services have been provided. This is especially true when the exercises have been performed over multiple sessions. The therapist should periodically document the skilled components of the exercises so that they do not appear repetitive and therefore unskilled.

Similarly, documenting functional activities performed (e.g., “ambulated 35 feet with min assist”, “upper body dressing with set up and supervision”) does not demonstrate that skilledtreatment was provided.The therapist should periodically document the skilled components/techniques employed to improve the functional activity.

You must include the signature and credentials of the qualified professional/auxiliary personnel who provided the services each day.

Documenting Treatment Time

CMS requires that providers record Timed Code Treatment Minutes and Total Treatment Time for each session. They want providers to use this terminology exclusively. Do not use other language or abbreviations as these may make medical review more difficult for auditors.

Timed Code Treatment Minutes refer to those procedures that are provided in timed intervals and include many of the most commonly performed items (Therapeutic Exercise, Manual Therapy, Therapeutic Activity, etc.). These are billed in 15-minute intervals and follow the Eight Minute Rule.

Total Treatment Time refers to the actual time spent treating the patient and includes both timed and untimed codes. Times should not be rounded up to 15-minute increments; the actual treatment time must be recorded.

CMS offers the following examples:

A treatment session includes:

15 minutes therapeutic exercise (97110) timed code
20 minutes therapeutic activities (97530) timed code
25 minutes unattended electrical stimulation (G0283) untimed code
The time documented in the treatment note would be:

Timed Code Treatment Minutes: 35 minutes
Total Treatment Time: 60 minutes
A second treatment includes:

30 minute OT initial evaluation is completed (97003), untimed code
20 minutes fluidotherapy (97022) untimed code
The time documented in the treatment note:

Timed Code Treatment Minutes: 0 minutes
Total Treatment Time: 50 minutes
Time spent on the following items should not be included when computing total treatment time:

Changing
Waiting for treatment to begin
Waiting for equipment
Resting
Toileting, or
Performing unskilled or independent exercises or activities.
In our next Blog we will discuss Discharge 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 www.gencohealthcare.net.

Physical Therapy Patient Education Increases Compliance

3DRx-blog1-bestPTBack to School?

Is patient education the solution to Shannon’s problems with noncompliance?

“Shannon, can I talk with you?” Shannon looked up, startled. She had been engrossed in a report and hadn’t heard Tana enter her office. She took one look at Tana’s angry face and took a moment to calm her own breath. Tana was quick to get upset, and it would not help if Shannon got upset, too.

“Of course,” she said. “Have a seat.”

Tana plopped into a chair. “I’m feeling very frustrated about some of the clients I’m working with,” she began.

Shannon nodded and reminded herself to stay calm. It was always hard for her to listen to complaints without getting defensive. “Can you tell me why you’re frustrated?”

“They’re not doing their part!”

Shannon was beginning to feel confused.

“I take my work very seriously–“ “I know you do–“ Shannon began, but Tana wasn’t ready to hear her.

“–and I can’t help people who won’t show up for their appointments and don’t follow through on their treatments.”

Shannon sat back. She wasn’t going to have to watch what she said after all. “You’re right,” she agreed. “It’s very frustrating to try to work with people who skip visits and don’t follow instructions.”

“We need stricter policies!” Tana continued.

“Like what? We already charge for missed visits. We can’t give them bad grades or ground them.”

“Maybe we should drop patients who won’t comply.”

Shannon frowned. “Maybe we can find some patterns if we look more closely — maybe some group of patients is less likely to comply, or maybe there’s something about the way we’re handling certain patients that leads to failure to comply.”

“There’s nothing wrong with the way I handle my patients!” Tana crossed her arms over her chest and glared at Shannon. “They’re lazy or they don’t feel like doing the work. They want it to be something we do for them.”

“Maybe they don’t understand the importance of what we’re asking them to do. Maybe we need to explain the treatment plan better.”

“You’re making this be all about what we do, and it should be all about what they do. We’re trying to help them. They owe it to us to cooperate — heck, they owe it to themselves.”

Shannon knew just what Tana was talking about. But she also had seen that patients who fully understood their treatments plans were more likely to follow through. “We have more control over what we do than over what they do, though,” she suggested. “Patient education might be the first step–“

Tana snorted. “We’re already too busy around here. We don’t need to add more things to our to-do lists. We need to get some things on the noncompliant patients’ to-do lists.”

Again, Shannon could relate, but she was also beginning to realize that there might be some missing links in their patient education procedures. If each of the technicians explained things in a different way, and perhaps the doctors and office staff in various places the patients went also explained things in different ways, and then the clients looked things up online”¦

It was pretty clear that the clients weren’t getting a consistent patient education experience.

Would it make difference if they were? Shannon thought so. Tana didn’t seem to, but Shannon knew that Tana could bring just as much determination and enthusiasm to her work as irritation and anger. If Shannon could come up with a good plan and get Tana on board with it, they might be able to make a difference.

“Thank you for bringing this to my attention, Tana,” Shannon said, getting up from her chair. “Let me give it some thought and I’ll see what solutions I can come up with.”

Maybe, Shannon thought, there would have to be some staff education as well as patient education.

Is patient education the solution to Shannon’s problems with noncompliance?

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

Let’s start with some trunk rotation

Trunk Rotation for an Elephant can be taken two ways.

Trunk rotation is something that this PT is passionate about.

Trunk rotation can be taken two ways.

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

Bruce, I think it’s time you start thinking outside the box.

Thinking Outside the Box

How often do you think outside the box when it comes to your Physical Therapy Billing practices?

thinking outside the box cartoon

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

We need to look at metrics? I never learned the metric system!

Do you use the metric system in your in your Physical Therapy Practice?

The metrics typically used are for No Shows, No Future Appointments, Collections and other aspects of patient care.

metric system is not necessary for PT billing software.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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