The Affordable Care Act was created in order to help uninsured or underinsured people with regard to their health care insurance.
Nitin Chhoda discusses how the act is evolving from time to time and making the coverage adjacent to the healthcare that the average people need. However, health insurance has become more and more expensive.
The Affordable Care Act was designed to extend coverage to those who had none, right inequities in coverage and lower healthcare practice management costs across the board, along with improving the quality of care for all Americans.
Some of those goals are beginning to be realized, but the cost of healthcare and insurance continues to increase with no abatement in sight.
The ranks of the uninsured will continue to swell as workers lose their employer-based healthcare insurance through job loss and outsourcing.
Healthcare Insurance are Expensive
The Affordable Care Act penalizes employers that don’t offer a healthcare and insurance option to employees, but the fines are far less than the cost of providing healthcare policies.
A growing number of business owners are choosing to pay a penalty that’s a fraction of what a single healthcare insurance policy would cost. The current state of healthcare reform establishes a system where costs for healthcare insurance continue to increase and benefits decrease.
The Affordable Care Act, created to extend healthcare and insurance to the majority of citizens, still leaves millions of individuals uninsured. It further penalizes individuals for their financial inability to purchase insurance, as well as those who have “high-end” policies.
Taxes on high end insurance programs beginning in 2018 encourages people to select less costly healthcare and insuranceplans where they shoulder more of the financial burden with higher premiums, co-pays and deductibles.
To avoid penalties and skyrocketing costs, individuals will choose the most inexpensive policies available and delay seeking medical attention when they can’t afford out-of-pocket expenses.
Part of the provisions in The Affordable Care Act provides programs to encourage clinicians to eliminate waste, improve care and safety for patients, and reduce expensive testing and procedures.
The “less is more” mentality brings the quality of care into question as healthcare and insurance providers attempt to meet the demand of millions of new patients flooding into the system.
The Effect
Therapists and other healthcare and insurance providers are being backed into a corner with the untenable position of sacrificing allotted time with patients in a system where clients have extensive waits for appointments.
Clinicians could be forced to pick and choose patients based on their insurance coverage or ability to self-pay, simply to keep their clinics solvent and continue to practice their profession.
In an effort by insurance companies to reduce their costs, homeopathic solutions could easily become the treatments of choice. Healthcare providers face increasing pressure by insurance companies to eschew a wide variety of tests and provide more extensive documentation to justify their decisions.
Therapists are effectively being second-guessed by those in organizations that have little or no medical experience, and no idea of the practicalities of a physical therapy clinic.
The Affordable Care Act provides for an array of essential services that new healthcare and insurance policies must provide, but consumers will ultimately pay the price for that coverage through increased out-of-pocket expenses.
Physical therapists will feel the effects through reduced reimbursements, a potential loss of patients, and increased collection costs.
The Future
In a perfect world, access to affordable healthcare would be available to all, insurance companies would forego record-breaking profits in favor of the common good, and clinicians would be free to treat patients as their profession calls them to do.
The future of affordable healthcare and insurance, benefits without penalties, and accessible treatment for all is in jeopardy. As currently written, all avenues lead back to many of the same problems that the Affordable Care Act was created to fix.
Most patients tend to embrace new technology. Technology helps the practice and improves the patients’ overall experience with the clinic.
Nitin Chhoda discusses the benefits of technology to automate and simplify patient follow up. This reduces the burden on the front desk staff and allows them to focus their efforts elsewhere, so they can do more to help market the practice.
The 21st century client is an individual that seeks instant gratification in everything from the food they eat to the videos they view, and that holds true for patients and their healthcare needs.
Clients want treatments from healthcare practice management to begin almost immediately, they appreciate convenience and they don’t like to wait.
Therapists can significantly improve the patient experience with technology and an EMR is the ticket to achieving that goal.
Physical therapy EMR
The patient portal contained in a physical therapy EMR is the primary way clients will interact and communicate with their therapist for many of their needs. The patient experience begins when they contact the clinic for an appointment, which can be scheduled online with an integrated EMR.
Healthcare histories and an array of pre-visit forms can be offered online that patients can complete, save and update as needed. There’s no need for clients to worry about printing out paperwork to bring with them to the office.
Forms are password protected and accessible any time for patient convenience. Clients can view their test results via their own account and request medication refills.
Information Beforehand
Collecting healthcare information beforehand provides clinicians with the opportunity to familiarize themselves with the patient’s history prior to their visit, eliminating long and tedious waits in the office.
Some healthcare providers routinely keep patients waiting for an hour or more past the time of their scheduled appointment.
Nothing motivates clients to change healthcare providers quicker than long waits at the office. Clinics can glean a variety of information through patient portals. The most important of those is insurance information that allows practice owners to determine the client’s insurance coverage and co-pays.
Problems can be identified and clarified prior to the office visit, allowing treatment to begin without delay. People in pain want relief and a client’s insurance coverage can significantly impact their course of treatment. A variety of payment options can also be offered online.
Integrated EMR
The modern patient is active, busy and on the go. They utilize a wide array of communication techniques, from email to Skype. An integrated EMR provides the means for therapists to contact patients via email, phone, and voice and text messaging.
It’s convenient for clients and therapists, and can be used for patient reminders, to gather additional information and send payment reminders.
With a web-based EMR, patient healthcare records are stored securely and can be accessed by multiple providers as the need arises. Therapists are no longer at the mercy of an antiquated system of paper records that can take weeks to arrive and require numerous requests from each individual provider.
The patient’s entire record is available immediately, providing access to essential information about everything from past procedures to allergies.
Modern patients demand convenience and flexibility from their healthcare providers, and an integrated EMR provides that in a variety of arenas, from scheduling appointments to paying their bills. EMRs provide the means for clinicians to manage patient healthcare for better outcomes and facilitate treatments that begin sooner.
EMR technology improves the patient experience and offers increased efficiency, productivity and enhanced reimbursements for therapists.
Nitin Chhoda explains the definition of malpractice and negligence and its implications for a private practice. He also shares tips to avoid malpractice and negligence lawsuits.
A lawsuit alleging either will cost the practice in terms of financial payouts, increased insurance costs and lost patients.
A lawsuit can even lead to the closure of a clinic. To avoid malpractice and negligence lawsuits, therapists must first understand exactly what the terms malpractice and negligence mean.
Malpractice results if a healthcare professional provides treatment that falls below commonly accepted standards and results in injury, death or direct damage to the patient.
Failure to provide appropriate treatment is also fodder for a malpractice suit and can include mental and emotional damage.
Negligence
A therapist would be considered negligent if they failed to provide care that’s considered reasonable for the circumstances, or if they missed or overlooked information that led to a worsening of the client’s condition.
To avoid potential malpractice and negligence lawsuits, it’s imperative that healthcare professionals take sufficient time to collect as much medical information as possible on their patients utilizing all available resources.
An EMR is one tool therapists are using to protect themselves.
An EMR can be accessed by multiple providers and is updated instantly for the most current information possible on all aspects of the patient’s medical history. Being fully informed is the first step to avoiding malpractice and negligence suits.
Therapists must be vigilant to head off potential problems before they occur. While some litigation is legitimate, clinicians must also be aware that there are unscrupulous individuals with one goal in mind – score a huge payday.
Steps
There are steps therapists can take to protect themselves and their practice from a damaging malpractice and negligence lawsuit.
Maintain complete and precise documentation. It can make the difference between winning and losing a malpractice suit.
Double-check all available information. This is especially true if the client’s condition hasn’t been assessed or is unclear.
Advise patients of all their options, risks and potential outcomes and have clients sign documentation to that effect.
Always have a second party present if the client is required to display sensitive body parts for examination and ensure documentation clearly shows the assistant was present.
Take extra time if needed to explain medications, why they’re being prescribed and possible side effects.
Ensure patients understand the difference between the facts of their care and any opinions that may be stated.
Never leave a reported problem or complaint unresolved, and always conduct follow-ups.
Seek consultations or provide referrals if indicated.
Don’t rush through exams. It’s imperative that therapists fully understand the client’s complaint, treatments that have been tried, and the results of that care to provide patients with the level of care needed.
Cultivate a good patient-therapist relationship.
Some healthcare providers never encounter the devastating effects of a malpractice and negligence suit. Those clinicians are constantly aware of the potential dangers and take appropriate precautions.
There will always be patients who are willing to sue for any imagined problem and the high cost of malpractice insurance is a clear indicator of the trend. Clinicians must practice defensive therapy and take steps to avoid problems before they have a change to arise.
Improving the four key areas of scheduling, billing, documentation and marketing allow a private practice to grow in a progressive manner.
This is now possible with the help of electronic medical records systems. Nitin Chhoda shares the advantages of an end-to-end integrated system for your private practice.
An EMR represents a major change in the practice management workflow and the way business is conducted.
It will integrate freely into every facet and department, offering clinicians a more productive and efficient means of managing their practice and patient care.
EMR as a Tool
An EMR offers business and marketing tools to easily track and monitor a wide range of variables that used to take hours or days to assemble.
Scheduling, documentation, billing and marketing are the four key areas in any healthcare practice management and EMRs facilitate the process, allowing therapists to expand their clientele and obtain quicker returns on reimbursements.
Documentation is available in precise detail and from multiple providers for a more accurate picture of the patient’s condition. EMRs offer advanced tools for marketing, allowing practitioners to develop, execute and monitor advertising efforts and their success.
A Complete Solution
A completely integrated practice management solution provides a multi-pronged approach to scheduling. An EMR allows therapists to schedule patient appointments complete with the date, time and client information, rather than a simple notation that includes a name and date.
Other events can be scheduled in the calendar, including meetings, times when other providers are unavailable, and personal appointments, along with vacations and sick days. Calendars can be set up for each provider within the clinic.
A scheduler provides therapists with multiple resources to coordinate services with other healthcare professionals in multiple locations. Patients of practice management can be scheduled for x-rays, surgeries, lab tests and a wide variety of ancillary services. A web-based EMR allows therapists to view a real-time calendar from anywhere in the world where an Internet connection is available.
The Old Way
Few patients have just one healthcare provider. Under a paper system, therapists often had to wait days or even weeks for medical records to make their way to the clinic, leading to delays in treatment. EMRs can be accessed by multiple providers and instantly updated when information is entered for the most current and up-to-date medical history available.
Medical professionals don’t have to rely on their client’s memory to recall tests that were administered, medications they’re taking or surgeries they’ve had. Integrated documentation allows practice management clinicians to create custom forms that reflect the clinic’s special needs, import provider notes, prescribe medications and refills, and make referrals when needed.
A physical therapy practice runs on its reimbursements. Integrated billing and coding virtually eliminates errors, the need for clarifications and rejection rates.
It includes complete diagnosis and CPT codes, and claims are submitted electronically so information reaches insurance companies and clearinghouses in record time, while maintaining HIPPA requirements for privacy and security.
Supporting Material
A variety of supporting practice management material can be attached to expedite the reimbursement process.
Marketing is an essential part of operating a successful physical therapy clinic and an EMR provides tools that allow practice owners to develop strategies that target specific demographic groups.
Practice management owners can monitor the success of those campaigns and ascertain where referrals are originating to create more advantageous alliances.
Integrating scheduling, documentation, billing and marketing under a single system streamlines all facets within a practice management for increased efficiency, better patient care and timely reimbursements. EMRs provide clinicians with the high-tech tools they need to succeed in a highly competitive field without sacrificing the well-being of clients or the clinic.
One of the areas that will be most impacted by the switch to ICD-10 will be the billing department. The ability of billing and coding staff to keep up with the increased coding requirements will have a direct impact on the continued flow of revenues to practices. Staff will need sufficient training in the new codes and even then, it may be necessary to engage additional personnel to address back logs.
After the deadline, any claims that aren’t submitted using ICD-10 will automatically be denied. Coding and billing staff will need the highest level of training available. People learn by doing and whenever possible, it’s a good idea to start using dual coding.
Practitioners that have their billing done by a professional agency will need to consult with the company to ensure the firm is prepared and revenues won’t be disrupted. Part of biller/coder readiness is ensuring that they and the software used is compliant with the strict HIPAA standards governing the electronic transmission of patient data.
Billers and coders may also need a refresher course in anatomy and physiology. The increased specificity of ICD-10 will require more in-depth coding. Billers/coders will find themselves using more specific terms than they’re normally accustomed. Next to the clinician, billers/coders are the most important link in the revenue chain. They must be ready for the transition or revenues will falter.,
Some interruption in the revenue flow will be inevitable. By its very composition, the new alpha-numeric coding system requires billers/coders to switch between a numeric pad and a keyboard, which will result in a slowing of coding claims. Super bills may no longer be a feasible option, requiring billers and coders to learn new forms and formats.
There are bound to be claims that are rejected in error due to the new coding. Claims will require resubmission and coders/billers will find themselves investing a significant amount of time communicating with clearinghouses and payers to determine why claims were denied. No matter how well trained the biller/coder is, those type of instances will slow down the submission and collection management process.
Errors in documentation and rejected claims will result in many patients receiving bills they don’t deserve. While it doesn’t directly affect billers/coders, it will have an impact on practices. Clinicians will see an increase in calls from panicked patients, requiring time and a cool head to explain and sooth clients.
Clinicians must adhere to coding guidelines if billers are to submit accurate claims. Practitioners can’t code for a suspected or probable diagnosis; items that would appear in notes must now be coded; coding should be done at the highest level possible; and a focus should be on medical necessity.
Clinicians and billers/coders have always had a partnership in terms of revenues and that relationship will be even more important as ICD-10 goes into effect. The billing department should be encouraged to seek verification and understanding of any item for which they’re unsure and clinicians should make time for this.
No one can hide from ICD-10. How each team member responds to its challenges will define the ultimate success of the practice and revenue flow.
Patients can be struck by numerous objects leading to pain, disability, physical therapy, and perhaps embarrassment, if the new ICD-10 codes an accurate indicator. Some of the codes seem nonsensical or unlikely. The fact that the codes exist amply demonstrate that these incidences have occurred – and multiple times in some cases.
There’s an extensive array of items that can be thrown, tossed and dropped that will cause injury. Most will lead to a visit to the ER or the physical therapist. Clinicians will definitely want to be ready for patients who have been hit by rowdy wildlife, from dive bombing macaws (W61.12XA) to head butting cows (W55.22XA) who may object to being milked.
If Grandma gets hit by a reindeer, code it as a V06.00xA, but for individuals who get thrown from a sleigh pulled by reindeer, that’s a code V80.929A. People interacting with churlish chickens with a propensity for throwing themselves at bipeds will code as a W6a.32XA. The codes make no differentiation between rubber chickens and real chickens, but there are codes for multiple encounters.
Land animals aren’t the exclusive cause of injuries. For the luckless patients who experience injury at the fins of water-dwelling creatures, it may feel like a script for a disaster movie. Clinicians will find coding options for clients with first and subsequent encounters with outraged orcas (W56.22xA), those who have been exposed to turtles (W59.29) and not-so-playful dolphins (W56.02XA).
Some individuals are just unable to multi-task while doing even the simplest things. Distracted talking and texting has led to multiple mishaps that practitioners will be coding for and may lead to some strange encounters with payers. There’s a code for people running into a lamppost (subsequent encounter, W22.02XD) and when walking the family canine (W54.1XXA).
Mankind is adept at conceiving new ways of having fun and doing it in the most dangerous venues possible. Bungee jumping (Y93.34), parasailing (Y93.19) and even playing a percussion instrument (Y93.32) or Y93.J4 for lips stuck to an instrument, can lead to unwanted conclusions. A friendly game of ultimate Frisbee (Y93.74) is cited as the reason for pulled muscles, broken bones and even whiplash.
Even fun with imaginary and inanimate creatures can be hazardous. Individuals who sustain an injury by running through a snowman, (thereby committing snowman homicide or possibly a hit and run) will code as Y02.8xxA. For those who are confused about where to put the carrot during a snowman build and insert it in their own ear, use code T16.2xxA. On the dark side, those bitten by a vampire (superficial bite of other specified part of neck, initial encounter), that’s a code S10.87xA.
When hair causes constriction (initial encounter) clinicians will turn to code W49.01XA and E928.4 for an external hair constriction. For a non-scarring hair loss, there’s code L65.9. There’s no telling when a bad hair day will result in serious injury.
Even the very air is fraught with potential danger. For clients who discover they have an air leak, use code J93.82. Patients may be injured through falling spacecraft (V95.49XA). When clients displace their balloon, code it as a T82.523S, but for victims of a falling alligator, that’s code W5803XA.
ICD-10 codes reflect real incidents and complaints, but the ways in which they’re worded often make them fodder for fun. The primary points clinicians need to remember is that they need to code to the highest level possible and as accurately as possible – even if it results in long conversations with payers who have disbelieving minds. Perhaps they could code for a therapeutic massage.
The Affordable Care Act was designed to extend coverage to those who had none, right inequities in coverage and lower healthcare practice management costs across the board, along with improving the quality of care for all Americans.
Therapists are effectively being second-guessed by those in organizations that have little or no medical experience, and no idea of the practicalities of a physical therapy clinic.
One of the areas that will be most impacted by the switch to 
Errors in documentation and rejected claims will result in many patients receiving bills they don’t deserve. While it doesn’t directly affect billers/coders, it will have an impact on practices. Clinicians will see an increase in calls from panicked patients, requiring time and a cool head to explain and sooth clients.
Patients can be struck by numerous objects leading to pain, disability, physical therapy, and perhaps embarrassment, if the new
Even fun with imaginary and inanimate creatures can be hazardous. Individuals who sustain an injury by running through a snowman, (thereby committing snowman homicide or possibly a hit and run) will code as Y02.8xxA. For those who are confused about where to put the carrot during a snowman build and insert it in their own ear, use code T16.2xxA. On the dark side, those bitten by a vampire (superficial bite of other specified part of neck, initial encounter), that’s a code S10.87xA.
