Posts

Kathleen Casbarro, CPC

A Job Well Done | Physical Therapy Billing, Software, Documentation, ICD-10

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Technology Holds Promise of Easing Office Tensions

Can the right technology solution get Shannon’s team back together?

“Thanks, guys!” The last kitchen workers called a goodbye and headed out the back door, talking and laughing together.

Mike tossed a towel over his shoulder and sat back in a chair in the darkened restaurant. He often took a few minutes to decompress at the end of the dinner service, sitting in the silence and appreciating his restaurant. When it was empty like this, clean and neat and ready for the excitement of the next day, it seemed filled with promise. When it was filled with people, with the scents of cooking and the clatter of pans and shouts across the kitchen, Mike couldn’t really feel it. Things were happening too fast then.

With a satisfied sigh, Mike stood, dropped the towel into the laundry, and headed home.

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Shannon was still up when he came in. “Tough day?” he asked her. He knew things had been tense at work recently.

“In parts,” she said. Mike could see from her smile that she was having the same satisfied feeling he was. The feeling that came after all the hard work, when things had gotten cleared up and settled and the problems had been overcome. “I think we’ve got a solution for the clinicians,” Shannon continued. “The new software we’re looking at has an internal auditing process that’ll show us where our current documentation is working, and where it needs work.”

“That sounds like your style,” Mike said, taking a seat next to Shannon.

“Definitely. It’s not personal, it’s not about me complaining at them or the front office staff not being on their game. It’s just the space between where we are now with our documentation and the level of specificity where we need to be.”

“Nobody can argue with that.”

“I hope nobody will want to. We’re a great team when we’re all rowing the same direction. I think that seeing where we fall short and knowing what we’re aiming at will help us get together again.”

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Mike nodded. “For a while, it kind of seemed like everybody was blaming everybody else.”

“Or at least expecting to be blamed,” Shannon agreed. “I don’t know quite how we got to that point, but I think we’re going to be able to get past it.”

Mike heard a rustle from a bedroom as one of the kids turned over in her sleep. He leaned his head against his wife’s and she leaned back, and they sat together in the quiet, feeling satisfied.

Can the right technology solution get Shannon’s team back together?

Want to know how to prepare your practice for ICD-10 coding?

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Kathleen Casbarro, CPC

Practice Makes Perfect | ICD-10

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Waiting for the Deadline Can Pose Numerous Problems

How can Shannon keep on track when ICD-10 transition seems to be a moving target?

I’ll be putting both the ICD-9 codes and the ICD-10 codes on my forms,” the home health equipment supplier said through the phone at Shannon’s ear, “and I’ll be expecting to know your plans for the transition beginning in August.”

“August?!” Shannon was startled back to attention. She had been getting distracted by raised voices in the hallway. The supplier she referred clients to for mobility equipment had been talking about ICD-10 codes, the new insurance codes required as of October 1st. Where was August coming from?

And what was that noise in the hall?

“I have to get started in August,” the voice in her ear explained patiently, “because my major payer is Medicare and Medicaid. I need time for my transition.”

“Well, I need time too–” Shannon began, but her supplier cut her off.

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“It sometimes seems as though all of you think this is going to happen by osmosis,” he said. “I value your referrals and I certainly want to keep working with you, but I work with too many referrers and payers to take a wait and see approach. I’ll be checking back with you in the first week of August to coordinate plans.”

“I think October is the deadline–” Shannon tried again.

“October it is, and it’s not going to change.” The supplier was beginning to sound testy. “I know a lot of people think there’ll be a delay, but the Centers for Medicare and Medicaid Services have said very clearly that they won’t budge. So I have to be ready on October 1, and I can’t wait till October to start getting ready.”

Shannon stammered a response and ended the call. The noise was still coming from the hallway. She took a deep breath and headed out to deal with it.

“I just don’t see why we have to start doing this now,” Tana was saying to the office manager. There were a few other clinicians standing with her and a couple more office staff watching from a few feet away. Occasional curious looks came from patients as they passed.

“What’s the problem?” Shannon asked, trying to sound upbeat.

“I know we have to change our documentation,” said Tana, “but I thought it wasn’t till October.”

“If we wait till October to start,” said Shannon, “we won’t be in the habit by then and we’ll make mistakes. We have to specify which side of the body and give a lot more detail than we’re used to, so that the new billing codes can be chosen correctly. There are so many new codes that it’ll be a lot more complicated than it is now.”

“So, because we have to take extra time and trouble in October, we have to start right away?” Tana scowled. “That doesn’t make sense. We don’t have lots of free time.”

One of the other clinicians nodded. “I can see the benefits of the new system,” he said, “but it’s totally going to slow us down. Why do that before we have to?”

“Yeah,” Tana agreed. “We’re not children. We don’t need to practice.”

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Shannon knew they weren’t children, but she was fairly sure they needed to practice. Especially if she was going to have to be able to work out the details of the transition in August so she could be sure of a steady supply of home health equipment for her patients.

What’s more, she was feeling wary about the Us versus Them attitude that seemed to be developing between the office staff and the clinicians.

“We’re all in this together and we all need to help each other. We all have to make changes and we know how hard that is. Let’s cooperate, okay?”

Tana rolled her eyes and the knot of workers broke up as everyone walked silently away leaving Shannon alone in the hallway.

Great, Shannon thought, now it can be them against me. She headed back to her office. Clearly, the calendar would have to be updated.

How can Shannon keep on track when the ICD-10 transition seems to be a moving target?

Want to know how to prepare your practice for ICD-10 coding?

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Kathleen Casbarro, CPC

Piecing It Together

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ICD-10 changeover doesn’t present a pretty picture

How can Shannon solve the puzzle of improving clinical documentation?

Shannon leaned back in her chair, gazing out the window with a dreamy look in her eyes. Her husband, Mike, watched her with a smile. They’d been married for years and their life often seemed to be centered around work and kids, but he still enjoyed looking at her.

“I like physical problems,” Shannon mused.

That brought Mike back to earth with a thump he figured must be almost audible. “What are you talking about?”

“Problems with people’s bodies aren’t always easy to fix,” Shannon admitted, “but they’re easier to deal with than emotional ones.”

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“I’m guessing we’re talking about Tana.” Mike said.

“Yep,” said Shannon. “Mike, I don’t get it. She seems to think I’m out to get her with the changes in documentation for the ICD-10 code changeover. We’re all having to make the same changes. The codes require us to be a lot more specific. But Tana acts like I’m persecuting her.”

“The other clinicians aren’t responding that way?”

“Not yet, but I’m worried about it. That kind of bad feeling can spread fast.”

“Some people find change stressful,” Mike said. “I see it at the restaurant. Asking for changes can feel like criticism, too. Like, if there was nothing wrong, you wouldn’t ask for the changes.”

“In this case, if we don’t provide the kind of documentation we’re supposed to, we’re likely to end up with errors in the code or with inadequate clinical documentation.”

“I’m going to assume that that is something like being found storing cooked and raw meat together,” Mike joked.

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“Just like that. We could be audited, we could be out of compliance, and it could be even harder to get paid.”

“None of those things sound good.” The sound of a crash came from the other room. Mike sighed. “I guess I’m going to have to find out what broke.”

“No,” said Shannon, “let me go. I think I need all the practice I can get.”

Mike took his wife’s hand. “We can go together. You’ll have to get your clinicians on the same page alone, but I can certainly help you pick up whatever mess is waiting for us in there.”

How can Shannon solve the puzzle of improving clinical documentation?

Want to know how to prepare your practice for ICD-10 coding?

watch the workflow webinar recodring now