Practice Experience Podcast: The Productivity and Compliance Conundrum

Productivity and compliance: the two most dreaded topics for any monthly staff meeting. Although we would all love to sweep them both under the rug, we can’t deny that these two subjects make up the backbone of a healthy private practice. Luckily, we know a few regulatory and compliance heavyweights in the rehab therapy industry who get giddy with the mention of productivity and compliance. 

John Wallace, PT, MS, Senior VP of Revenue Cycle Management and Member Value at WebPT, and Rick Gawenda, PT, President and CEO at Gawenda Seminars and Consulting sat down with Bre Krager, Senior Content Marketing Manager at WebPT for this episode of The Practice Experience Podcast.  The trio talked about the productivity and compliance conundrum rehab therapists are contending with and how it can be tackled by practice owners and managers today.

To stoke the flames of this regulatory fireside chat, John, Rick, and Bre discuss: 

• what types of challenges private practices face today,
• what rehab therapists are missing in documentation, and
• compliance requirements beyond just insurance payers.

Episode Highlights

On Headwinds from the Supply and Regulation Sides

John: There is a lot of pressure on practice owners and managers to have a positive bottom line in today's environment. Combine that with what's going on with staff therapists—increasing educational debt and inflation—and we're at an inflection point where your ability to make more money as a practice owner is hampered by the changes that are happening in payer rates and the increased amount of payer audits that are presently occurring.

On the Compliance Conundrum and Audits

Rick: I am seeing more targeted probe and educate (TPE) audits that are being done by CMS. Often you've got one therapist who is seeing the patient writing the note, and signing the note, but then the claim is going out under a different therapist's NPI number. What the auditor sees is that “John Wallace” wrote and signed the note, but the claim was submitted under “Rick Gawenda's” NPI number… One of the most common reasons the claim is filed with a different NPI number is that a new therapist has never been enrolled in Medicare, or if they’ve started the enrollment process, it hasn't been approved yet. So instead of holding the claims and receiving retroactive payment, they are being sent with the wrong NPI, and I think that's becoming a more prominent issue lately.

On Defensible Documentation

Rick: You need the right documentation to support the CPT code you're billing that day. We all do a great job of documenting either what the patient did in therapy or what they were given, but what we're not documenting is what we did for the patient that day.

John: That's certainly a big problem. As you said, therapists are doing a good job of documenting what they do, but not so much about why they're doing it. The therapists need to record the patient's specific information that goes along with those different treatments.

On Payer Contracts

Rick: In my consulting business, people come to me and ask, “Should I sign this contract?” Well, the first question I ask is, “What's your cost per visit?” Often, a clinic owner’s response is, “I don't know.” If you do not know what your cost per visit is, then it is impossible to know if signing a particular contract is a good idea. You need to know your cost per visit in case it is higher than what this contract offers you.

On Education and the Productivity and Compliance Conundrum

John: Clinic owners and managers have to look at the details behind how they generate their revenue per visit. They must educate their staff about revenue and things like the cost per visit and payer contracts. 

On Technology and Compliance

Bre: The technology exists to help augment your documentation, billing, and compliance requirements, but you have to leverage your clinical decision-making and documentation expertise to make sure that you are using all of the bells and whistles in that documentation and billing software appropriately.

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