• CMS Can See Clearly Now, Releases PQRS Strategic Vision Image

    articleMay 21, 2015

    CMS Can See Clearly Now, Releases PQRS Strategic Vision

    All month long, we’ve talked about the healthcare industry’s rapid evolution from the fee-for-service Stone Age to the pay-for-performance Enlightenment Period. Yes, payment reform is upon us , but don’t take our word for it—take it straight from America's largest payer of healthcare services: The Centers for Medicare and Medicaid Services (CMS). In an effort to “contribute to improved healthcare quality across the nation, ” CMS recently published the Physician Quality Reporting Programs Strategic Vision , detailing …

  • To ACO or Not to ACO: The Efficacy Question Image

    articleMay 20, 2015

    To ACO or Not to ACO: The Efficacy Question

    Yesterday, I told you about accountable care organizations (ACO) and how they might affect your physical therapy practice . Just one of several alternative payment models , the ACO approach seems to foster better and more expedient care, lower costs, and greater emphasis on physical therapists’ role as care coordinators. But CMS has experienced high dropout rates with its Pioneer program, and Medicare has already gone through three iterations of its ACO model, including the recent release …

  • What PTs Need to Know About ACOs Image

    articleMay 19, 2015

    What PTs Need to Know About ACOs

    As a physical therapist, you’re likely well-versed in the acronyms that drive your documentation practices: HIPAA , CPT , CMS , PQRS , FLR , and FML (just kidding). But there’s one more to watch for: ACO. By now, you’ve probably heard this one being bandied about in discussions about healthcare reform and alternative payment models, but you might not be super familiar with what it means. So, here you go: In response to the Affordable Care …

  • America’s Next Top Payment Model: The Move to Pay-for-Quality Image

    articleMay 11, 2015

    America’s Next Top Payment Model: The Move to Pay-for-Quality

    Your mission, should you choose to accept it, is to provide higher-quality care at a lower cost. With the healthcare industry’s fast-moving transition to value-based —rather than service-based—payment systems, that’s the challenge many providers are facing. And while that mission may very well seem impossible, the truth is that rehab therapists and their peers in other medical fields don’t really have much of a choice as to whether they’ll accept it. The winds of change are already …

  • Past, Present, and Possibility: The Progression of Pay-for-Performance Image

    articleMay 7, 2015

    Past, Present, and Possibility: The Progression of Pay-for-Performance

    For decades, healthcare leaders have searched for a way to balance the interests of providers, patients, and payers. The pay-for-performance paradigm has emerged as a front-runner in the race to drive down healthcare costs while simultaneously raising the quality of care and increasing patient satisfaction. But what, exactly, does this buzz term mean? Defining Pay-for-Performance As this Health Affairs article explains, the pay-for-performance umbrella encompasses any “initiatives aimed at improving the quality, efficiency, and overall value of …

  • Evidence-Based Payment: Why Data is the Key to Pay-for-Performance Success Image

    articleMay 5, 2015

    Evidence-Based Payment: Why Data is the Key to Pay-for-Performance Success

    If I challenged you to find a rehab therapist who didn’t believe in the power of evidence, you’d be searching for a while—forever, hopefully. After all, PTs, OTs, and SLPs are steadfastly dedicated to evidence-based clinical practice, because they know it gives their patients the best possible chances for success. On the business side of therapy practice, however, the application of evidence—a.k.a. data—is something many rehab therapists have yet to fully embrace. Payers, on the other hand, …

  • Mad Maximizing Reimbursements: Revenue Road Image

    articleApr 23, 2015

    Mad Maximizing Reimbursements: Revenue Road

    We might not live in a post-apocalyptic world like the characters in the latest Mad Max film , but it certainly feels familiar in the world of physical therapy, where private practices fight to survive against ever-shrinking profit margins and federal legislation that threatens to erode bottom lines. Our weapon of choice in this furious battle? Increased efficiency. Here’s the strategy: Technology Processing Paper claims process in six to eight weeks, while electronic claims process in about …

  • Senate Repeals SGR in Landslide Vote Image

    articleApr 15, 2015

    Senate Repeals SGR in Landslide Vote

    Well, folks, the fix is in—the fix for the sustainable growth rate (SGR), that is. In a 92 to 8 vote, the Senate approved the SGR repeal bill, called HR2. In addition to an SGR repeal, the bill also officially extends the therapy cap exceptions process until December 31, 2017. This result is better than no therapy cap exceptions process at all; however, it’s disappointing to know that we came so close to achieving a full repeal …

  • Brace Yourself: Decreased Payments Might be Coming Image

    articleApr 14, 2015

    Brace Yourself: Decreased Payments Might be Coming

    As we warned at the end of last month , the times they are a-changin’. You’re likely well aware of the legislation that could do away with the Sustainable Growth Rate (SGR)—and extend the therapy cap for another two years. We had hoped to have better news for you at this point, but we’re still hanging tight while the Senate sings their own off-key version of Wilson Phillips’ “Hold On.” It’s April 14, 2015. That means the …

  • The Claim Game: How to Manage Overpayment Image

    articleApr 9, 2015

    The Claim Game: How to Manage Overpayment

    If you’ve recently discovered that a patient or insurance company overpaid you for services rendered, you might be tempted to consider it “free money.” It’s like you’re playing Medicare Monopoly, and you just pulled a Community Chest card that reads: “Insurance error in your favor. Collect claim overpayment.” However, overpayments give you an inflated appraisal of your total revenue and might even encourage embezzlement —both of which can wreak havoc on your balance sheet. Worse yet, if …

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