Physical therapy blog with useful information about physical therapy software, best practices for using technology, physical therapy billing, physical therapy industry events and news from WebPT.
PT blog with with up to date information on how to make the most of your PT management system. Shared comments from PTs are also available on our blog.
Today's post comes from Tom Ambury, PT and compliance officer at PT Compliance Group, and WebPT cofounder and COO Heidi Jannenga, PT, MPT, ATC/L.
One of the most frequently asked questions in the PT billing space is: "Our state practice act allows licensed PTAs to treat without direct onsite supervision. I understand that PTAs can’t bill under their own National Provider Identifier (NPI) and license, so how do I bill for my PTA’s services?"
The answer: Don’t confuse state licensure laws with billing rules.
Per Medicare rule: 42 C.F.R. §410.26(b)(1)-(7); and CMS Medicare Benefit Policy Manual, Pub. 100-4, Ch. 15, §60.1 - §60.5, in order to bill for outpatient services provided by a PTA in a non-institutional setting, the claim must meet the following conditions:
Today’s blog post comes WebPT President and CTO Brad Jannenga
Earlier this month, I packed my bags and headed off to Washington DC along with Courtney Klein Johnson and Chris Petroff, founders of social incubator and fellow Phoenix tech startup, SeedSpot. Why were we heading to our nation’s capitol? Aside from wanting to see the famed cherry blossoms bloom, we were invited to take part in Startup America’s Champions Take DC event. Packed with amazing dialogue, brilliant insights, and lots of awesome people, the experience was a lot of things—exciting, educational, inspirational—but most of all extremely humbling.
Here are my top four most awe-inspiring moments:
Last week I discussed the risks associated with Medicare non-compliance and shared some tips for protecting your practice. While drafting a compliance plan and conducting self-audits are definite must-dos, you may eventually find your clinic in a situation that requires absolute expertise. Yes, an in-house compliance officer is ideal, but many small to mid-size clinics simply cannot afford to staff someone full-time. Thus, you may want to consider a consultant. Of course, it’s crucial you’re selective. Here are four things to consider before hiring a Medicare compliance consultant.
Credentials
As is the case with hiring for any position, experience is key. When shopping around for a Medicare compliance consultant, make sure they have the necessary credentials to ensure trustworthiness and peace of mind.
One must-have credential? Compliance certification! The Certified in Healthcare Compliance (CHC) website breaks down their certification process and details the following benefits of certification:
Last weekend, WebPT rolled out a new addition to the WebPT Medicare Allowable Fee Schedule and Cap Alert System: the Medicare Allowable Cap Report. We are so excited for this new feature launch that we thought we might take a few lines of our blog to walk through the WebPT Fee Schedule and Cap Alert System basics. 
Today’s blog post comes from Ann Wendel, PT. Ann is the owner of PranaPT, a member of WebPT, and an active social media participant (@PranaPT). Thanks, Ann!
Grab a cup of coffee (or a stiff drink) because we’re going to talk about Medicare. Currently, there are two issues that we as physical therapists need to be aware of because they affect how we treat patients on a daily basis.
First, it is vital for all therapists to pay attention to what is going on in Congress regarding the Medicare Therapy Cap. On April 14, 2011, sponsor Rep. Jim Gerlach introduced H.R. 1546 (112th): Medicare Access to Rehabilitation Services Act of 2011. As summarized by the Library of Congress, H.R. 1546 amends title XVIII (Medicare) of the Social Security Act to repeal the cap on outpatient physical therapy, speech-language pathology, and occupational therapy services of the type furnished by a physician or as an incident to physicians' services. Unfortunately, as listed on the govtrack.us website, the bill died a quick death and Congress subsequently referred it to the Ways and Means Committee on the same day. And there the act lies, awaiting the committee chair’s decision as to whether it moves past the committee stage.
The members of the Ways and Means Committee are listed here. We need to contact these folks to ask them to support H.R. 1546 (112th): Medicare Access to Rehabilitation Services Act of 2011 to allow Medicare patients to receive the rehabilitative care they need to live a full and functional life. Here is their contact information:
Ways and Means Committee Office
1102 Longworth House Office Building
Washington D.C. 20515
P: 202-225-3625
F: 202-225-2610
During CSM 2013, I attended the two-part presentation on fraud and abuse in Medicare. While such stories of the “Rock Doc” in South Beach were very interesting (and shocking!), the presenters stressed that those sensational stories are not the norm. Typically, when Medicare audits rehab therapy practices, it’s primarily due to documentation and billing red flags rather than flat out fraud. Of course, red flags can arise due to negligence (i.e., what Medicare would label as “abuse”).
Whether born out of accident or carelessness, you absolutely cannot let non-compliance fly. Medicare means businesses, and they aren’t messing around with audits. Not to mention that you owe your patients the epitome of professionalism, organization, and safety. Let’s discuss.
What are the major red flags?
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.
Last month we focused our blog theme on achieving greatness because we are 100% dedicated to helping you be successful in therapy practice. If you attended CSM 2013, you may have noticed our booth also had the “achieve greatness” theme. If you didn’t attend CSM, no worries. Here is a photo:
So why are we dedicated to helping the rehab community be better in business? Why are we determined to help elevate the profession? Because we friggin’ love ya (happy Valentine’s Day!). But also because we’re passionate about rehab therapy and the impact you all make daily on your patients’ lives. That’s in our roots. Co-Founder Heidi Jannenga is a physical therapist, and she created WebPT because she wanted to make an EMR solution that truly worked for her industry.
With this lovefest in mind, we created the “I Love Physical Therapy Because...” whiteboards and hoisted them up at CSM 2013 for all attendees to write on. The response was tremendous. Practicing therapists, educators, students, and fellow exhibitors all wrote on our boards. Everyone was very eager to share the love—and have their photos snapped:
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.
Why WebPT?
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:
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.
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