WebPT Blog - CMS
May 23, 2013| by Erica Cohen
We all know that functional limitation reporting (FLR) means (a little) more work for (basically) the same reward. And that can be a hard pill to swallow for many therapists who are already stretched thin as a result of increasing caseloads and increasingly stringent documentation requirements. Even so, taking the easy road—the low road—and gaming the system—and thus, this profession—is not the answer. It never is. This—just like everything else you do for your patients, your practice, and your profession—is a matter of pride. So make your reporting something to be proud of—it’s a testament to who you are as an individual and as a therapist.
Over the last several months,we’ve come across more than a few concerning questions from the community regarding ways to get around functional limitation reporting. Today, we thought we’d address two of them: crosswalking scores from objective measurement tools to severity modifiers and misrepresenting patient progress.
To satisfy functional limitation reporting requirements, therapists must assign a severity modifier to their patient’s current (or discharge) status G-code as well as their projected goal status G-code. These severity modifiers communicate where a patient is currently in terms of functional limitation and where he or she should be after treatment (i.e., long term functional goal).
Mar 11, 2013| by Erica Cohen
Today's blogs post comes from WebPT Co-Founder and PT Heidi Jannenga, Marketing Manager Mike Manheimer, and Senior Writers Erica Cohen and Charlotte Bohnett.
Last month’s webinar on Medicare was our most highly attended webinar to date. And that’s really not surprising, because wherever Medicare goes, questions follow. But unfortunately, we couldn’t get to them all live. So we thought we’d put together a blog post will all the great questions you asked and our answers. That way, you can access it wherever, whenever you want. Ready to jump in? Here’s your Medicare Q&A.
(P.S. Are you a first timer to thiswebinar or looking for a refresher? Click here to rewatch the webinar.)
Mar 7, 2013| by Tom Ambury
Today's post comes from Tom Ambury, PT and compliance officer at PT Compliance Group. Thanks, Tom!
“Tom, how can you make a statement that the Medicare 8-minute rule is simple yet diabolically complicated?” I can make that statement because even though this rule has been in effect for years—and thus, people should have the hang of it—mistakes still happen. And when I talk to therapists about it, a lot of confusion still exists.
The 8-minute rule is how we determine what to bill to Medicare. To correctly calculate the charge, you must divide charges into two categories: time based (or “constant attendance”) modalities and procedures as well as supervised modalities and procedures. Constant attendance modalities and procedures include therapeutic exercise, manual therapy, neuromuscular reeducation, therapeutic activities, gait training, ultrasound, iontophoresis, and electrical stimulation attended. Supervised procedures and modalities would include physical therapy evaluation, physical therapy reevaluation, electrical stimulation unattended, and whirlpool.
What the 8-minute rule says—and how it got its name—is if you are performing only one constant attendance modality or procedure, you have to perform that modality or procedure for at least eight (8) minutes in order to bill that charge.
For example, I see a patient for the initial visit, and I perform my initial evaluation for 35 minutes with seven (7) minutes of therapeutic exercise. My charges are one unit of physical therapy evaluation. I cannot bill for therapeutic exercise because I performed that procedure for seven (7) minutes. So, by rule, I would need to perform therapeutic exercise for eight (8) minutes in order to bill it. Most therapists understand this, and your documentation system should prevent this type of error.
Where the diabolically complicated part comes in is when the therapist performs multiple constant attendance procedures or modalities and then must correctly calculate the charge. Complications arise because there’s a cumulative and distribution part of the rule.
When calculating the correct charges for multiple procedures and modalities, you must add the total constant attendance modalities and procedures together to get the “Direct Timed Minutes.” This number determines how many constant attendance units you can charge. At this point, you would determine how many supervised units to charge and determine the “Total Treatment Time.” To add to the diabolically complicatedness, there is also a rule to determine the correct distribution of charges. Let’s go through some examples:8-minute rule, billing, CMS, compliance, direct minutes, medicare, PT best practices, pt compliance group
Feb 18, 2013| by Erica Cohen
This blog post comes from WebPT writers Charlotte Bohnett and Erica Cohen.
Navigating the murky waters of Medicare can be as scary as finding yourself on a lifeboat in the middle of the ocean with a tiger on board—well, maybe not just as scary, especially if you have WebPT to help. We’re filling this month’s blogs with all sorts of valuable and applicable information on everything there is to know about 2013 Medicare. But what better way to get up to speed than with some frequently asked questions.
1.) What is the Therapy Cap?
Under the Balanced Budget Act (BBA) of 1997, Congress placed an annual cap on rehabilitation services through Medicare. That means that Medicare will only reimburse you as the rehabilitation therapist up to a certain dollar amount per patient regardless of services provided.
In 2013, CMS increased the therapy cap by $20 to $1,900 (from $1,880 in 2012) for physical therapy and speech therapy combined and $1,900 for occupational therapy. This year, the therapy cap applies to services furnished in private practice, physician offices, skilled nursing facilities (Part B), rehabilitation agencies (or ORFs), comprehensive outpatient rehabilitation facilities (CORFs), and outpatient hospital departments. Unless Congress passes legislation, the therapy cap will no longer apply to outpatient hospital settings beginning January 1, 2014.
Feb 12, 2013| by Charlotte Bohnett
What is PQRS?
Created by Center for Medicare and Medicaid Services (CMS), Physician Quality Reporting System (PQRS) mandates that physical therapists, occupational therapists, and qualified speech-language therapists meet the standards for satisfactory reporting. If you are not PQRS compliant in 2013, CMS will assess penalties of 1.5% of your Medicare payments as fines in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during the reporting period.
While it seems like a pain, PQRS is absolutely necessary. Save yourself the headaches—and fines—and let WebPT manage PQRS for you. We’re a Certified PQRS Registry, so with us, staying compliant is easy. Here are the benefits:
- Avoid a 1.5% reimbursement penalty in 2015
- Earn a 0.5% incentive payment
- Let WebPT manage PQRS for you with our registry-based reporting method
- Improve measure reporting efficiency through our EMR
- Ensure compliance
- Elevate your clinic’s standard of care while saving yourself time, money, and stress
Feb 11, 2013| by Erica Cohen
We’ve covered the ins and outs of G-codes as well as how it easy it will be to implement them successfully within WebPT—and why an integrated functional limitation reporting solution is the best solution. Today let’s go back to the G-code basics.
What’s a G-code?
Effective July 1, 2013, CMS will require therapists to complete functional limitation reporting through the use of new G-codes and corresponding severity modifiers for all eligible Medicare patients at the initial examination, at minimum every ten visit (or progress note), and at discharge in order to receive reimbursement.
Feb 7, 2013| by Erica Cohen
As many of you already know, CMS will begin mandating functional limitation reporting on July 1, 2013. In short, this means that if you do not successfully complete functional limitation reporting (in the form of G-codes and corresponding severity modifiers) for every eligible Medicare Part B patient you see beginning July 1, 2013, you will not receive reimbursement for your services. For those of you who treat a high percentage of Medicare patients, successfully completing this requirement may mean the difference between keeping your lights on or closing your doors. Sounds daunting, right? It's actually not. Sure, the repercussions for non-compliance are severe, but it's really not that hard to be compliant—especially if you choose the right reporting tool, like WebPT's fully integrated EMR + functional limitation reporting.
Still getting up to speed on functional limitation reporting? Watch our free functional limitation reporting webinar or download the slides here.
Feb 5, 2013| by Erica Cohen
Today's blog post comes from WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L.
By now, I’m sure you’ve heard about functional limitation reporting—also known as claims-based outcome reporting (CBOR) and G-code reporting. Regardless of what your clinic calls it, functional limitation reporting is coming quickly. In fact, as of July 1, 2013, CMS is making it mandatory. That means they won’t pay you for your services if you don’t properly report functional limitations via specific G-codes on the claim form for each eligible Medicare patient. Now, if you’re a WebPT Member, we got you covered. In mid-spring, we’re integrating functional limitation reporting (G-codes and corresponding severity modifiers) into your documentation workflow, which will make it a breeze to stay compliant—and thus, get paid.
Last month we covered functional limitation reporting basics in several blog posts, a webinar, and an article on Physiospot, but in the midst of all this—and especially at CSM 2013—I’ve realized that in addition to understanding functional limitation reporting inside and out, we need to understand its importance beyond getting paid. While overall the transition to functional limitation reporting is a good thing, it may actually fall short in terms of bringing our profession closer to achieving evidence-based practice on the whole. Why, you ask?
Functional limitation reporting will allow us to gain tremendous insight into our patients’ and our peers’ patients’ functional outcomes. Just think of what all that data could show based on treatment type and patient demographics, and that goes for us as individual providers and for us as an industry. This is our chance to prove unequivocally that rehab therapy works—and to see which techniques work best. We’re clearly moving towards a pay-for-performance reimbursement structure, and this is an ideal way to demonstrate our patients’ progress with our care. Additionally, this reporting requirement will make us better therapists by insisting that we treat function and not just objective measures.
Because this requirement is more heavily focused on the subjective—what the patient thinks and feels—questions remain as to whether it may actually weaken our evidenced-based practice efforts. As an industry, we’ve fully researched and vetted many functional outcome measurement tools as reliable and valid tests. However, they are still based on the subjective complaints of the patient vs. objective measures taken by the therapist. Ultimately, it appears Medicare’s stance is that what the patient thinks and feels is what really matters—which in my opinion is accurate. But it doesn’t appear that Medicare really cares what method or treatment procedures we use to achieve patient improvement—just do it and do it as quickly as possible. This does not promote nor advocate for true evidence-based practice. It’s just by any means necessary.
In the end, though, we can’t let Medicare’s apathetic vibe influence our behavior and practice. While we need to understand and acknowledge the opportunities, it shouldn’t be what we focus on. Let’s hone in on the good. During CSM 2013, in the Autonomy presentation, an attendee stood up and said: “Functional Limitation Reporting is good. It might be more paperwork [which with WebPT, it won’t], but it’ll prove our worth.” That’s the attitude I’m embracing, and I think we all should. We encourage our patients to think positive—no matter how difficult the process or how murky the waters ahead might be. We need to encourage ourselves to do the same.
Feb 4, 2013| by Erica Cohen
In January, WebPT released the Medicare Allowable Fee Schedule in preparation for the new Medicare Therapy Cap Alerts we’ll launch this month. In short, this new feature will allow you to reproduce your Allowable Fee Schedule within WebPT as published by Medicare. This fee schedule will inform a tracking tool and subsequent alerts so you can see how much of the therapy cap your patients have accrued using your services.
As a result of this launch, we’ve gotten quite a few questions about the Medicare Therapy Cap and the changes CMS made this year. Here, we’ll share some Q&A we adapted from the APTA’s Medicare Therapy Cap FAQs:
Jan 16, 2013| by Erica Cohen
The concept of a compliance program is new to many in private practice physical therapy. However, it’s a necessary aspect of any practice. Here are some common questions (and answers!) regarding a compliance program:
What is a compliance program?
A compliance program is a set of checks and balances to ensure that a physical therapy practice is meeting its established standards. Another way to look at it is that compliance is a quality program to ensure a clinic is following best practices.
Why do I need a compliance program? There are many reasons for having compliance program:
- In some states, it is the law.
- Some insurance providers now require physical therapy practices to demonstrate what they are doing for compliance as part of the credentialing/re-credentialing process.
- Physical therapy practices are coming under ever greater scrutiny through such things as:
- Claims-Based Functional Outcome Measures
- Onsite visits by insurance providers
- Increased number and type of physical therapy documentation audits by insurance providers
- In my opinion, the most important reason for having a compliance program is to be able to prove to anyone that we as practitioners are making a reasonable attempt to comply with all regulatory requirements and have established the necessary procedures and controls to do so.
Now, you may be thinking: “Those are some good reasons for some practices to establish a compliance program, but I’ve never had a problem before and I use a compliant documentation system. So, why would I need a compliance program?”