Physical Therapy Documentation & Medical Billing INTOUCHEMR

The Four Ds of Negligence

by Nitin Chhoda PT, DPT | Apr 21, 2019 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Nitin Chhoda shares the four Ds of negligence in a private practice setting so that clinicians can prevent negligence from occurring in the business.

The medical profession is a rewarding one, but full of opportunities to inadvertently run afoul of rules and regulations. Most patients are sincere.

They simply want to get better or see an end to their pain, but there exists a pool of unscrupulous clients who are vigilant in their search for a reason to sue a medical provider for a breach in one of the four Ds of negligence.

The four Ds encompass duty, dereliction, direct cause and damage. The majority of healthcare practice management providers won’t experience the harm to their reputation, clientele and clinic that result from a lawsuit, but medical professionals should be aware that they can be held liable vicariously through the actions of their staff.

To avoid the four Ds of negligence, it’s essential that everyone is conversant in the proper procedures. To be guilty of negligence, a disgruntled patient must prove that the practitioner took action, or failed to, that was ultimately detrimental to the client.

Clinicians should be wary of patients that come into the office requesting specific medications, tests and treatments.

1. Where Duty Begins and Ends

The first of the four Ds refers to duty. Clinicians have a duty to their patients to provide the most accurate diagnosis and care, utilizing their extensive education and experience. Healthcare workers have a duty to inform patients of potential problems they observe upon examination in the clinical setting. They’re under no obligation to provide medical information about any condition they notice in connection with strangers and casual acquaintances, which is a part of negligence.

2. Dereliction of Duty

Dereliction is the second of the four Ds of negligence and refers to actions that a healthcare provider may fail to take. If a medical professional observes a skin condition that could be cancer but neglects to inform the client, it’s a breach of duty.

3. Making a Bad Situation Worse – the Direct Cause

Direct cause is the third element of the four Ds. In this type of negligence, the onus is on the client to prove that the healthcare provider knew about a potential risk, didn’t inform the patient, and the client was injured as a result.

4. Collecting Damages from Clinicians

Rounding out the four Ds of negligence is damages patients can collect in a lawsuit. Damages are the financial compensation clients can collect and includes lost wages, medical expenses and mental duress.

Vicarious and Collateral Liability

Practice owners can be held liable for staff members who make mistakes, don’t follow proper procedures or overstep the boundaries of their responsibilities.

That includes defamation of character, slander and making libelous statements. It also encompasses invasion of privacy, sharing records without informed consent, violating patient care standards, and malfeasance.

Medical practitioners must work within established laws and parameters when treating patients and ensure staff members are cognizant of what constitutes a breach of the four Ds of negligence.

Staff must be trained in potentially litigious situations for themselves, the practice and the consequences. Education, an understanding of procedures and identifying clients that may come equipped with a lawsuit mentality will help anyone in the medical profession avoid the four Ds.

Healthcare Insurance Simplified – the Patient’s Perspective of Health Coverage in the New Economy

by Nitin Chhoda PT, DPT | Apr 14, 2019 | Healthcare Practice Management, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Although healthcare insurance can be useful in the case of illness, many people do not understand their insurance coverage and limitations.

Nitin Chhoda shares the different perspective of healthcare insurance; from that patient’s point of view to the healthcare service provider.

Patients and therapists view healthcare insurance from an entirely different perspective.

For patients, it’s a way to defray costs when they require a wide range of services, from prescriptions and hospitalization to well patient check-ups and ongoing physical therapy treatments.

For therapists and healthcare practice management providers, healthcare insurance is the primary means of reimbursement for services.

Healthcare Insurance

Older clients, parents and those who have experienced the need for an extended hospital stay are well acquainted with the value of maintaining a comprehensive healthcare insurance policy. They may complain about the cost of premiums, copays and deductibles, but they know the benefits far outweigh the monetary sacrifices they may make to keep their coverage up to date.

Younger individuals tend to eschew healthcare coverage or purchase less than they need. For this demographic, accidents and healthcare emergencies are incidents that happen to “other” people.

The entire healthcare insurance industry is a mystery to most patients. They’re unsure of exactly what they’re paying for, the terms of their coverage and their financial responsibility.

Healthcare insurance is often far more expensive than they anticipate, may not cover a wide variety of treatments and procedures, and involve high deductibles that must be met before coverage is available.

A Patient’s Perspective

Millions of individuals across the nation live in constant fear of becoming ill, injured or incapacitated, even when they have insurance. When they do become ill, it may be difficult to find a healthcare insurance provider that accepts their brand of insurance.

Patients often delay treatment, spreading potentially dangerous diseases. When no other option exists, those same clients resort to emergency room treatment that contributes largely to the increasing cost of healthcare costs.

As it exists, the healthcare industry in the U.S. forces patients to make decisions that can radically influence their lives and future finances.

The Affordable Care Act provided coverage to millions who were uninsured or underinsured, but it also created a deficit of healthcare insurance providers in relation to the number of new patients coming into the system.

Those who don’t understand their coverage represent a major loss of income for therapists. When claims for non-covered expenses are rejected, patients must pay the bill and collecting those funds can be a costly endeavor.

The first steps in healthcare reform have been taken, but more must be accomplished. The future of healthcare insurance in the new economy will require patients to pay more for their healthcare coverage and shoulder more of the financial burden in terms of co-pays and deductibles.

Coverage and Limitations

Coverage caps and limitations could very well become the norm. For therapists, the result of such trends is a loss of income and a potential move toward more self-pay patients, a strategy that could effectively eliminate many from the healthcare system and cost practices in the long-term.

The experience and expertise of a good therapist can’t be understated and they deserve to be compensated for that acumen. Therapists are the chief advocates for their patients’ needs, but are often forced by healthcare insurance companies to accept far less for their services than the actual value or are second-guessed by insurance company officials.

It’s neither an efficient or cost effective system, and one that can potentially place patients in harm’s way while contributing to a system that makes it increasingly difficult for therapists to operate a financially sound practice.

Healthcare Insurance and Health Insurance – What Are They?

by Nitin Chhoda PT, DPT | Apr 7, 2019 | Healthcare Practice Management, Physical Therapy Billing, Physical Therapy Documentation

Nitin Chhoda explains the health care insurance, its providers, the Insurance coverages and the Affordable Care Act for patients.

He also discusses the importance of knowing the limitations of patients’ insurance so that patients and service providers know what to expect at the time of treatment.

Healthcare practice management costs that continue to rise and unforeseen medical emergencies are the two overriding reasons individuals buy healthcare insurance.

Essentially, patients purchase insurance against the risk of becoming ill or encountering a potentially expensive and unforeseen medical need.

Accidents and catastrophic medical emergencies happen in the blink of an eye. Healthcare insurance helps defray patient costs and insures healthcare providers receive payment for their services.

Insurance Provider

Patient healthcare insurance is most often provided through an individual’s employer. Business owners contract with insurance companies to provide an established range of healthcare services that can include hospitalization, vision and dental coverage, along with office visits, prescriptions and lab tests.

Available coverage varies widely, with employers shouldering a major portion of the costs while the individual is responsible for co-pays, deductibles and monthly premiums. Medicaid and Medicare represent another form of healthcare insurance. Medicare is administered through the federal government.

Medicaid is funded through federal and state governments and distributed at the discretion of each state. Medicare is accessible by retirees and the disabled. Medicaid typically covers low-income children and adults with no other available options.

Insurance Coverages

Dwindling funds and budgetary concerns have led to coverage limits in both Medicaid and Medicare, making it essential for therapists to verify a patient’s coverage before treatment.

There’s been a push by healthcare insurance providers and employers for patients to shoulder more of the monetary burden of their healthcare, giving rise to a wide variety of special clauses and exclusions in healthcare policies.

Cancer, long-term healthcare needs and disability claims are costly for insurance providers and many policies now require clients to purchase additional, specific coverage for certain conditions. The result of shifts in healthcare insurance policies and practices has resulted in a lack of sufficient coverage for much of the population.

Underinsured clients and those with no coverage present a major problem for therapists who must balance the desire to practice their profession and render aid to those in need, with operating a practice that remains solvent and profitable. The first line of collections when a patient receives treatment is the healthcare provider.

To ensure reimbursements are received in a timely manner, practitioners submit claims to the patient’s insurance provider.

Any amount not covered through the client’s healthcare plan is the responsibility of the patient. It’s essential for therapists to determine a client’s coverage before the time of treatment to ensure the patient receives necessary services and clinicians obtain the payment to which they’re entitled.

The Affordable Care Act

The Affordable Care Act extended medical coverage to millions of individuals who previously had no insurance, but significant limitations and gaps in available services still exist.

Clinicians must ensure they have current insurance information for every client they treat before the patient arrives at the office.

It’s an unfortunate reality, but the direction of current insurance company policies may force therapists to decline patients with limited or no coverage to ensure their practice isn’t at financial risk.

Insurance companies represent the first line of reimbursements for clinics, followed by state and government programs, and self-pay patients. Changing and evolving healthcare insurance will require practice owners to examine the state of their businesses and the patients they treat with an increasingly stringent set of criteria.

Physical Therapy Documentation: The Importance of Personalization in Your Physical Therapy EMR system

by Nitin Chhoda PT, DPT | Mar 31, 2019 | Physical Therapy Documentation, Physical Therapy Management

Personalization is critical when choosing the right physical therapy documentation or EMR for your practice.

Nitin Chhoda discusses the importance of personalization and customization in the physical therapy documentation process, and how it should affect your selection of a physical therapy EMR.

The best limbo dancers are extremely flexible and that same quality is essential in a physical therapy documentation system.

The majority of EMRs were developed and written with a specific user in mind, from hospitals and physicians to surgeons.

EMRs reflect the reasoning of the creator rather than the end user. It’s essential to select an EMR developed by or for a physical therapy practice to ensure the EMR doesn’t begin dictating how the clinic conducts business.

Selecting the Best Physical Therapy Documentation System

When selecting a physical therapy documentation system, the two key factors are flexibility and control. The system must offer the flexibility to meet the individual needs of the practice for the present and the future.

Therapists must be able to control every aspect of the physical therapy documentation process without interference from the EMR. Documentation software provides the means to achieve a more efficient and profitable practice.

It should never intrude on or force therapists to compromise on the way they operate their business.

Have an Effective EMR

Many EMRs look and sound good in theory, but ignore the practical concerns of the clinical environment. Physical therapy practices vary widely in the services offered, professional experience and work environment and an EMR must be able to adapt to the diverse needs of the individual practice.

A good physical therapy documentation system offers additional options as needed to grow with the practice.

An effective EMR integrates easily with existing office systems to expedite physical therapy documentation of patient records, enhance marketing endeavors, and provide patient portals for additional functionality. EMRs automate many of the time consuming tasks typically handled by staff members, freeing them to engage in pursuits that promote the clinic, acquire new patients, and increase the level of the practice’s customer care.

Customized Pattern

The ability to create customized templates, without restriction, that accurately reflects the services and treatment options of the individual practice is essential. Therapists should be able to create their own templates, without hiring a tech specialist to navigate the system.

Not all patients respond the same way to treatment, requiring therapists to be creative to achieve the best results for the client. Any EMR should include the ability to combine any number of physical therapy documentation services and bill accordingly.

Reimbursements

Physical therapy documentation, billing and coding options specifically designed for use by therapists help navigate the increasingly complex requirements for reimbursements.

The ability to submit claims electronically should be a function of physical therapy documentation software.

Reimbursements are received quicker and additional information and clarification can be accomplished almost immediately. EMRs also allow therapists to work with an extensive number of payers for the best reimbursements.

As more complex and innovative treatments are developed, physical therapy documentation must be able to change and evolve to meet the needs of practices.

Flexibility in all facets of EMR software is needed, from time stamps to avoid legal issues to the ability to create custom forms that reflect the special requirements associated with physical therapy clinics. Both web-based and server-based EMRs are available, but the key to successful implementation is always the ultimate flexibility of the selected software and its ability to facilitate clinic expansion and profitability.

Physical Therapy Marketing: Limiting Exposure to Bad Payers

by Nitin Chhoda PT, DPT | Mar 29, 2019 | Physical Therapy Documentation, Physical Therapy Management, Physical Therapy Marketing

Searching for the best insurance companies maybe hard to find, but it doesn’t mean that they do not exist. Nitin Chhoda exposes simple techniques on how to identify and contract with the best payers so that your practice will have continuous income.

Knowing the bad payers when it comes to your physical therapy practice is not as hard as you might think. Nitin Chhoda reveals ways you can recognize bad payers in order to avoid them, and spend more of your time caring for patients.

Every physical therapy marketing in a practice goes through the process of determining which are the best paying insurance companies. You may find that one of the best ways to learn about bad payers is by asking around.

Of course, you may not feel like going into the competitor’s office as part of the physical therapy marketing plan, but there are ways to get information that don’t involve any risk.

Call Around to Other Healthcare Service Providers

The best information will come from other physical therapy marketing services and practices. Some insurance companies may have better policies for certain types of medical care than others.

However, if you are unsure about contacting other physical therapy managers and owners, you can also talk to those healthcare providers that you already have a relationship with.

Are there other physical therapy marketing and management offices where you refer your patients to when they need a different kind of care? Do surgeons or specialists send their patients to you when they need physical therapy?

Get in touch with the people you know and ask them a few questions about their best payers and their worst. Most professionals will be happy to share the information.

Same State, Different City

Another way to get good information is to get in touch with other physical therapy marketing services of other practices that are in the same state as you, but in a different city or town. This may feel a bit awkward at first, but the benefits of learning about bad payers are well worth a little confusion.

Remember to talk to the other managers as your peers. Remind them that you’re all in the same boat and you think this kind of information should be shared so that you can all avoid insurance companies that are bad at paying their bills.

In fact, you may find that someone has started to compile a list already. There tend to be way more resources out there than you expect – it’s just a question of finding them.

It may be that a local physical therapy marketing business group has already identified some of the worst and best payers and they might be willing to share the list with you. You never know if you don’t try.

Start a List of Your Own

Of course as you go, you will learn which companies you prefer and which seem to always reject your claims.

Keep track of those companies, mostly for your own physical therapy marketing practice and so you can adjust who you contract with, but also because perhaps one day someone will call your office asking for advice.

Physical therapy marketing in a practice can benefit from working together, and in some cases a good deed will pay dividends. If a practice becomes overwhelmed with new patients, perhaps they will send some your way if you’ve done them a favor in the past.

Running a healthy and thriving physical therapy practice is a lot of work. There are some very important decisions to make, and they will keep coming. The more you can work with others and build relationships with those payers that are good, the better off your physical therapy marketing practice will be.

Medical EMR Can Simplify Healthcare

by Nitin Chhoda PT, DPT | Mar 10, 2019 | Electronic Medical Records, Physical Therapy Documentation

Medical EMR can simplify healthcare in many different ways. The best part is that it can streamline the whole physical therapy documentation process from start to finish without consuming too much time from the staff. Nitin Chhoda explains how this is all possible.

There are many ways that an integrated medical EMR system can help a practice to save money and become more efficient. But one benefit of EMRs that is often overlooked is the way a good system can simplify healthcare in general.

There are benefits to patients as well as clinicians that can help even the most confused patient to get the care they need at a better price, without costing the practice more money.

Billing Advantages

Healthcare providers already know how an integrated electronic medical record can make billing more accurate and efficient.

If everyone in the practice is using the same system, and all data are available through that system at any time, medical billing staff can pull the data they need and bill on a timely schedule.

Coding can also be easier, with a specific set of billable tasks and diagnoses, clinicians can provide medical EMR coding staff with the precise information they need to get the medical coding done more quickly and easily.

The billers can then take the information and file claims with the insurance companies and bill patients for their share of the cost. The improvement in efficiency that medical coding and billing departments are experiencing has been exciting for those practices that have implemented a medical EMR.

So how does this simplify healthcare and understanding the healthcare and insurance system in the United States? First of all, if the billing system requires specific information from patients, the billing department can implement procedures for determining what a patient will owe even before services are provided.

Patients Need Help

The fact is that the majority of patients who come into a medical practice do not quite understand how the healthcare system works in the U.S. They probably don’t know what their own deductible and co-pay will be, and it is likely that they will not expect a bill a few weeks or a month after their appointment.

So rather than taking the time to bill the insurance company, only to be rejected or denied based on a co-pay or deductible issue, the medical EMR billing staff can find out the details before billing.

Naturally, this can be done even without a medical EMR, but to set up a system would be more of a challenge than purchasing it as part of an integrated medical EMR.

In fact, because medical EMRs companies are set up to handle exactly this sort of adjustment to a biller’s workflow, the transition is made smooth and simple.

Improving Outcomes

Additionally, a medical EMR can help improve patient outcomes. It may sound funny to say that a computer program or software will have an effect on how well patients respond to treatment.

But the fact is that with a medical EMR, it is possible to track treatments and outcomes much more closely. Reports can be generated quickly. The results of certain treatments are better than others, and at the practice level it is possible to identify advantageous treatment decisions with a medical EMR.