Rusty mechanical equipment. Creaky carnival rides. Wobbly chairs. People are naturally skeptical of things that are dilapidated, rundown, or slipshod—and with good reason. After all, that which is ramshackle usually isn’t reliable.
Now, imagine it’s the physical therapy software you use everyday to run your rehab therapy practice that’s gone derelict. Take PTOS EMR, for example, because if you didn’t know, this therapy office software is going out of business, and it has ceased all updates and maintenance care. Essentially, it’s neglected—and thus, unreliable.
You may be thinking, “Well, my dying physical therapy practice management software works fine enough. I can endure it until it shutters entirely. Who cares if it doesn’t update?” Well, mi amigo, you should care—big time—especially as the rehab therapy industry stares down a barrage of regulatory changes. Consider the following examples:
ICD-10 Code Updates
New ICD-10 codes went into effect in October 2016—several months after PTOS announced its impending closure. So, we’re betting PTOS doesn’t have those new codes in its system. Furthermore, the CDC deleted some codes and updated the code descriptions of others. So, not only are PTOS users unable to access new codes, but they also could be using invalid codes or misusing revised ones—and that spells denials.
End of the ICD-10 Grace Period
“When ICD-10 first went into effect on October 1, 2015, Medicare implemented a one-year ‘grace period’ that culminated with dates of service falling on or after September 30, 2016,” Erica McDermott writes in this blog post. During the grace period, CMS would accept a diagnosis code from the correct family of codes, even if it wasn’t the most specific code available. But, those days are done: no more grace period—which means providers now must code to the highest level of specificity. And while that responsibility ultimately lands on the provider, it sure helps to have a documentation software with built-in specificity checks. For example, WebPT alerts you when a more specific ICD-10 code is available. Most rehab therapy systems doesn’t provide that kind of functionality, so it’s highly unlikely that a software that’s about to go out of business (like PTOS) is going to add ICD-10 alerts now. During the grace period, people might have been fine overlooking that technical shortcoming, but now that CMS is cracking down, therapists can’t afford to settle for any documentation solution that doesn’t help them ensure coding accuracy.
New CPT Codes
Beginning in January 2017, eight new PT and OT codes will replace the 97001, 97002, 97003, and 97004 evaluation codes. Therapists are required to select the code that best represents the complexity of the patient’s evaluation. Thus, a degree of clinical judgement comes into play. But that expertise is pointless—as are your hopes of getting paid—if the new CPT codes aren’t even available within your documentation and billing system. If your rehab therapy software vendor is no longer maintaining its product (ahem, PTOS), then you won’t have access to these codes come January—and unless you want to risk claim rejections or denials, you must use the new codes for all evaluative notes for all carriers starting in the new year.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will go into effect January 1, 2017. Medicare will then reimburse based on the quality of care eligible providers deliver per its Quality Payment Program, which replaces the Sustainable Growth Rate (SGR) formula for physician reimbursement. MACRA’s primary program—the Merit-based Incentive Payment System (MIPS)—specifically focuses on quality data reporting. According to this article, MIPS replaces the Value-Based Payment Modifier (VM) program—which allowed for differential Medicare payments based on the quality and cost of care provided—as well as PQRS.
Rehab therapists can voluntarily participate in MIPS during the first two years of the program, which means they can practice reporting before it becomes mandatory for them in 2019. While PTOS won’t even make it through all of 2017, the soon-to-be-implemented MIPS program is a perfect example of why rehab therapists should always use reliable, accurate, and up-to-date software. For example, WebPT is already planning for MACRA and MIPS now—long before therapist participation is mandatory. That’s because we want to ensure our Members are ready for the change well in advance.
So, if you’re currently using an unreliable rehab therapy software—either because it’s going out of business like PTOS, or because you sense trouble on the horizon (think constant downtime, no recent updates, or absent support)—then it’s time to shop around and find a system you can truly depend on. After all, few things are as sure as regulatory change. It can be tough to predict precisely what CMS, the CDC, HHS, and the government’s many other acronymic agencies will throw at rehab therapists, but no provider should have to face it alone. Make sure your software is built—and maintained—to last, unlike that rickety Tilt-a-Whirl.