WebPT Blog - medicare
Jun 5, 2013| by Brooke Andrus
If the rules of Advance Beneficiary Notices of Noncoverage (ABNs) make you a bit confused, you’re definitely not alone. In an effort to shed some light on the ins and outs of ABNs and to highlight some recent changes to ABN requirements, Medicare rolled out a new set of FAQs clarifying their use. Here’s some info to help bring you up to speed:
What is an ABN?
An ABN is a form practitioners use to notify a Medicare patient that Medicare might not cover the therapy services he or she is about to receive.
What is the purpose of an ABN?
ABNs allow beneficiaries (your patients) to make informed decisions about whether they would like to accept therapy services despite the possibility of having to pay for those services out-of-pocket. A signed ABN form serves as proof that a patient knew prior to accepting such services that he or she might have to pay out-of-pocket for them.
When should a therapist issue an ABN?
A therapist must issue an ABN in either of the following instances:
- Before providing items or services that the therapist believes or knows Medicare may not cover
- Before providing items or services that Medicare usually covers but may not consider medically reasonable and medically necessary for this particular patient in this particular case
In neither instance can a therapist issue an ABN after the fact (i.e., after Medicare denies a claim); therapists always must complete the form and have patients sign it prior to the time of service.
May 30, 2013| by Heidi Jannenga PT
Thank you, Chuck, for presenting such detailed information on the Multiple Procedure Payment Reduction (MPPR) changes. My biggest takeaway from Chuck’s post is that, now more than ever, clinic owners must focus on practice management and truly pay attention to their business. Understanding the metrics of your practice is crucial in this age of declining reimbursements and frequent regulatory changes. There are three crucial metrics that I think come into play when assessing MPPR’s impact on your clinic:
1. Clinic cost per visit: This is your cost of doing business. What does it cost you per patient visit to run your clinic (with all expenses divided by the number of patients you see per day)? If you then add in whatever profit margin you would like your practice to make, your total will equal the minimum revenue per patient visit that your practice can sustain. If you accept insurance payments that are less than this amount, you will essentially lose money on each visit or cut into your profit margin.
2. Net revenue per visit: This is the average dollar amount per patient visit that you receive in reimbursement from each insurance. The clinic average is the average dollar amount per patient visit that you receive across all of your insurances. Make sure that your net revenue per visit for each insurance that you accept is above the clinic cost per visit. Essentially, you want to bring in more money than you spend. Consider your average Medicare visit reimbursement with MPPR: is it higher than your cost per visit? If not, then you’ll need to make adjustments to bring your cost per visit down. If yes, then MPPR may have only minimal impact on your overall business (pending the next factor).
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).
May 21, 2013| by Chuck Felder, PT, DPT, SCS, MBA
Today’s blog post comes from Chuck Felder, PT, DPT, SCS, MBA. For follow-up questions, please email Chuck at CFelder@HCSconsulting.com.
In 2012, CMS began a process of reducing payment for therapy services based on multiple procedures performed during the same visit. This is termed the Multiple Procedure Payment Reduction (MPPR). Despite APTA’s and others best efforts to get this removed, CMS began a 20% reduction policy on the second and subsequent procedure each day. This is in effect for all therapy services provided on a single day. So, if the patient received OT on the same day as PT, CMS would pay the highest value procedure at 100% and reduce all subsequent procedures that day by 20% of the practice expense component. Overall, the average visit with around 3.7 units would have its payment reduced about 6%–7%. For the first quarter of 2013, CMS continued the 20% reduction policy. However, they’ve since switched to a 50% reduction.
May 13, 2013| by Erica Cohen
If you’ve been paying attention to our blog posts, our webinars, and functionallimitation.org for the past few weeks, you might think we here at WebPT have gone a little FLR-crazy. And you’d be right. You see, the latest CMS regulation—functional limitation reporting (FLR)—has some pretty severe consequences for noncompliance. Namely, if you don’t comply, you don’t get paid. I don’t know about you, but that seems like an awful lot of pressure. So, we’ve set out to give you all the information and tools you need (including a fully integrated functional limitation reporting solution available within WebPT after May 17) to become an FLR Master. This way, in addition to supreme bragging rights as a result of your mastery, you’ll also get paid. We think that’s kind of a big deal.
With that in mind, here’s a flowchart that walks you through FLR in theory. Essentially, this is everything you’ll need to consider if you’re doing FLR on your own. Holy steps, Batman!
Following this chart is a nifty FLR in WebPT SmartArt graphic. Notice the difference? You don’t have have to be an FLR Master to see that WebPT’s integrated functional limitation reporting solution (coming May 17) is going to make FLR easy peasy.
May 8, 2013| by Brooke Andrus
We believe in empowering the entire rehab community to achieve greatness in therapy practice. That’s why we created WebPT, an intuitive, web-based EMR solution exclusively for rehab therapists that offers comprehensive documentation, scheduling, practice management, and billing services.
Don’t let the name fool you; WebPT isn’t solely for physical therapists. Rather, it’s for the entire rehab therapy community, and we’ve custom tailored our EMR solution to suit the practice of occupational therapy. Here’s how:
WebPT contains a whole separate user profile for occupational therapists. As soon as you select an OT user type, WebPT automatically loads all of our OT-specific items into your clinic’s account.
In addition to OT billing codes and Medicare therapy cap-tracking, WebPT features tons of OT-related tests and tools—like our Activities of Daily Living (ADL) profile; our Disabilities of Arm, Shoulder, and Hand (DASH) test; our upper extremity functional test; our shoulder pain and disability index; plus a host of special tests geared toward hands and joints. And speaking of hands—OTs specializing in hand therapy (like Laura Berger of Maui Hand Therapy) absolutely love our detailed wrist/hand profile. They also love being able to document and bill for custom orthoses, casts, and splints right in WebPT.
Plus, every document you create in our system will have an occupational therapy label—and your clinic’s name and logo—right at the top of the page, so the source and content of your emailed and faxed documents is immediately clear to referring physicians and other recipients. And you can send out those documents directly from the WebPT system. Cool, huh?billing integration, cloud-based EMR, compliance, functional limitation reporting, hand therapy, medicare, Occupational Therapy, PQRS, reports
May 7, 2013| by Heidi Jannenga PT
There’s no denying that functional limitation reporting is a little more work to get the same (or less if you consider MPPR) reimbursement and that ignites fear among some in our industry. But you shouldn’t be fearful; you should be frustrated at our own inability to document to a standard that shows our clinical relevance and the amazing outcomes we achieve every day in clinics across the US. We haven’t effectively demonstrated evidence-based practice yet, nor have we properly articulated progress through functional gain. Medicare has been warning us that something like this was coming, and we never ponied up. Now, we have functional limitation reporting (FLR).
I believe we’re moving toward a pay-for-performance structure. FLR is the initial facilitation of that with Medicare patients, and it’s only a matter of time before other carriers follow suit. Essentially, resistance is futile. But why resist? That’s my point in this month’s founder letter: do not resist; do not be afraid; and do not let frustration get the best of you. Because FLR is actually good. How? This reporting affords us the opportunity to demonstrate our expertise and relevancy—and get paid for it. You are essentially already completing these things every day in your clinical practice—now you just have to document it. So get fired up. We need to prove ourselves, and prove ourselves we will. Let’s tell Medicare to bring it on!
With that said, FLR is not about crosswalking a score for an objective measure to a category of severity—in fact, doing so would defeat the purpose of FLR. In reality, FLR is about using your clinical expertise to determine limitation and severity. It’s about your clinical judgment. How many times do you give a patient a self-evaluative outcome measurement tool to complete and the results leave you wondering how he or she came to those conclusions? It’s clear that the patient has an entirely false sense of self, and you know it. FLR requires that you incorporate your clinical judgment to truly assess the severity of a patient’s functional limitation as well as his or her progress. Ultimately, you shouldn't rely solely on a patient’s’ potentially faulty self-assessment as you develop your plan of care. Instead, you should apply your expertise to provide better, more objective treatment.
I cannot stress it enough: you’re proving your worth and getting paid for it. So, stop getting bogged down on modifiers, codes, and progress notes. Really, once you “get it,” FLR becomes second nature in your documentation workflow. (Plus, this month WebPT will launch a fully-integrated FLR feature, so it’ll be super streamlined.) You’re simply telling the story in a way that validates your services.
With FLR, we finally have an outlet to prove that what we do clinically is relevant and deserves payment. We should all view these new requirements as an opportunity for us to finally demonstrate the value of our profession. We’re badasses; we know this. Now let’s show it.
Mar 29, 2013| by Stacey Abelman
Today’s blog comes from WebPT’s Billing Onboarding & Operations Manager Stacey Abelman. Thanks Stacey!
I wish I could tell you that today’s blog was going to be about how to make rehab therapy billing a breeze. But it’s not. There’s no magic answer, no simple solution, and certainly no easy-as-pie fix. Not to fear, though. There are things you can do—steps you can take—to make sure your billing processes are at their very best so you’ll increase your revenue and decrease your headaches. Here are ten:
1. Make a Plan
What’s your clinic’s one-year plan? How about your five-year? Oftentimes, the answer is purchase new equipment, open a second location, or bring on an additional provider. Regardless of your particular goal, though, the first step is always the same: start making a plan of how you’re going to achieve it. And I’m guessing that increasing cash revenue will fall somewhere on this plan. If so, it’s time to start looking at your billing department. Maybe, to meet your practice goal, you need to set some billing specific goals—like decreasing accounts receivable (A/R) greater than 90 days down to less than 10% or sending all claims to carriers in less than two business days. Regardless of your goals—billing-specific and overall clinic—put it on paper, communicate it to your team, and break it into manageable steps.
Mar 25, 2013| by Heidi Jannenga PT
Today's blog post comes from WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L.
Today, copays are the norm, and they’re only becoming more costly. To top it off, many insurance plans—especially those that individuals and small businesses purchase (including HSAs)—have very large deductibles that patients must meet before insurance will pay for anything. While it’s obvious that these increased copays and deductibles put a burden on patients, they also burden physical therapy practices. How? Many practices don’t have the procedures in place for effective fee collection from patients—especially not in person. Instead, many are willing to simply write off cash collections when the patient doesn’t pay. But with declining insurance reimbursements, successful over-the-counter collections are more important than ever
What are the implications of not collecting?
In an APTA Podcast, Nancy White says, “studies show that the chance of collecting from a patient drops almost 20% as soon as the patient leaves the office.” Anecdotally, I think its higher—especially after patient discharge. While some front offices may find it easier to simply mail a statement after the visit, there are usually hidden costs associated with this. In fact, according to Nancy White, there is data that indicates “it may cost between $5–$10 per patient to send and process each statement by mail.” Not to mention that when you mail statements rather than collect upfront, you’re decreasing your chances of receiving payment and there’s a self-made waiting period for any payments patients do send.billing, collections, commercial carriers, copays, deductibles, HIPAA, insurance, medicare, PT best practices
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.)