The ICD-10 Documentation Analysis

Physical Therapy Marketing to Patients Before, During, and After Visits

by Nitin Chhoda PT, DPT | Sep 10, 2017 | Physical Therapy Documentation, Physical Therapy Management, Physical Therapy Marketing

Marketing your physical therapy business doesn’t rely on producing creative brochures alone. It also depends on how you treat your patients before, during and after each visit. Nitin Chhoda shows how treating your patients can make or break your practice.

Most healthcare practice managers think of physical therapy marketing as something they buy. You can hire a physical therapy marketing professional to handle your advertising and published materials.

You can also ask them to research competitors and find ways to incorporate successful competitive messages into your marketing plan.

But physical therapy marketing is also something your practice does whenever anyone has contact with a patient. The overall impression that patients have of the entire practice is what will determine whether or not they’ll come back.

Referrals: Professional and Personal

You probably have a pretty good idea of how important professional referrals are to your practice. If you work with a few other, complementary practices, you probably have a consistent stream of referred patients.

But there are other physical therapy marketing referrals that happen all the time, and you may or may not even realize how much of a difference they are making.

Personal referrals from current patients to potential patients are very powerful physical therapy marketing plan. In fact, it is worthwhile to think about the potential patients when making decisions about how to run the practice.

Patients Feedback Are Important

What do you want your patients to say about the care they receive when they come to your practice? As an example, on a Facebook feed a friend wrote about her dentist. She said they take very good care of her, have a very comfortable waiting area and even some other perks.

She looks forward to going to her dentist. If all 800 friends of hers saw that post, a percentage of them will actually take action and check out that dentist. How many people do you know that say they look forward to going to the dentist’s office?

It’s the same thing when it comes to your physical therapy practice. Having a great physical therapy marketing should always consider the word-of-mouth referrals.

You want this kind of referral to be a physical therapy marketing tool that works for you. It can just as easily work against you, with people complaining about long waiting times, rushed appointments, and disorganized offices. Making a good impression is marketing at its most basic.

Post-Visit Physical Therapy Marketing

Another critical part of your physical therapy marketing plan will be the follow-up after appointments. Take every opportunity to learn from your patients by asking for feedback in a few different ways.

Have a comments box in the waiting room, communicate via email when scheduling future appointments, and periodically send a card to ask patients how they feel about their experiences in your practice.

Continue to Care for Your Patients Even After the Visit

Your patients should feel that they are cared for, that their clinician is not just doing their job, but is someone they can rely on to communicate with them and educate them about ways they can stay healthy. Rather than treating a visit to your practice as a burden or because there’s something wrong, a visit should be a simple check-up to make sure things are going okay.

The best physical therapy marketing you do will be to frame the work you do in a positive light, communicate messages that inform patients about how your practice wants them to feel good, and ensuring that the experience is always refreshingly honest, open, and relaxed.

Physical Therapy Marketing: Establishing Income Goals in Your Practice

by Nitin Chhoda PT, DPT | Dec 26, 2016 | Physical Therapy Management, Physical Therapy Marketing

Every business should have an income goal and physical therapy practices and medical practices are no exception. Nitin Chhoda explains how to establish income goals for your practice and set the stage for a profitable business.

Financial planning is a key element for any business owner, but it can be more difficult for physical therapists who deal with fluctuating patient numbers.

Those without a solid plan for physical therapy marketing can soon find themselves adrift in an economy where their services are undervalued and their standard of living is at risk.

It’s important to realize that in the beginning, the anticipated income that’s set in a financial action plan aren’t nearly as important as actually creating the plan to attain the goal.

Develop a Good Strategy

Developing a strategy to clarify direction and determine income not only helps eliminate unwelcome surprises, it also provides physical therapy marketing practice owners with a double dose of reality.

Implementing an electronic medical record system other office systems that automate low-dollar activities provide significant savings and present a good place to start.

A six-figure income isn’t beyond the realm of possibility, but it may not be attainable with the current state of the practice. By setting a dollar figure, therapists will have a clear physical therapy marketing plan of what they want to accomplish with their practice, the steps that need to be taken to reach their goals, and help them differentiate between valid opportunities and unproductive distractions.

Gather Financial Records From the Past Years

A good place to begin is by gathering financial records for the past three or four years and set aside an entire day to be incommunicado. Clear the calendar, turn off the phone and email, and shut down social media connections.

For a physical therapy marketing task of this importance, it’s essential to eliminate outside distractions.

Therapists will need to break down each year’s income into specific categories, leaving nothing out.

It’s helpful to use a spreadsheet for the exercise that encompasses income from all avenues, including teaching, speaking engagements, consulting services and product sales.

Leave a column for notes to record personal insights about the numbers. With the assistance of a spreadsheet, it will soon become apparent to therapists where their most profitable activities and biggest moneymakers for each month are generated.

Track Physical Therapy Marketing Trends

Therapists can track physical therapy marketing trends for various times of the year and use those to plan and organize high-dollar events to coincide with points of low income. It will quickly become clear if the anticipated income goals are achievable and if not, what must be done to boost revenues.

Physical therapy marketing and management requires practice owners to be ruthless in pursuit of a profitably operated clinic. Income levels fluctuate and they’re affected by a wide array of variables.

Physical therapy marketing campaigns, new referral sources, and the addition of services will all combine to affect the flow of patient traffic. Slow months can be augmented with special promotions and the upcoming year can be planned around a comprehensive plan of action.

Have a Definite Plan of Action

Physical therapy marketing is a critical element of profitable practices, and the most highly successful therapists have a definite plan of action to achieve their financial goals and those for their clinic.

Practice owners want the best possible treatments and outcomes for their patients, but they also need to make a living.

Therapists can easily define their efforts for future financial security by closely analyzing every aspect of their business. For those who prefer a more physical therapy marketing in-depth approach, therapists can reverse engineer their current operating system for enhanced income opportunities and patient care.

Physical Therapy Marketing: Identifying and Allocating Expenses in Your Practice

by Nitin Chhoda PT, DPT | Dec 19, 2016 | Physical Therapy Management, Physical Therapy Marketing

To maximize your income, you need effective marketing methods and proper allocation of the the expenses in your practice. In this article, Nitin Chhoda shares different ways to identify and calculate the expenses in your practice.

Assembling a team of reliable advisors and consultants is an excellent beginning to effective physical therapy marketing and management, but what therapists won’t learn in any medical school is practical information on money management and how to allocate expenses.

Operating a physical therapy business requires anticipating future trends, successful marketing endeavors, determining the cost of providing services, and planning ahead for foreseeable and unexpected expenses.

Effective Physical Therapy Marketing Is Important

Physical therapy marketing is the key to increasing the number of patients needed to meet income goals and finance the practice.

The most successful clinic owners utilize automated systems that can be customized to take advantage of traditional and mobile marketing opportunities that includes Clinical Contact, Therapy Newsletter, along with electronic medical record (EMR) systems.

Assets, acquisitions and depreciation are all terms with which therapists will quickly become acquainted. To remain profitable, therapists must determine the value of their time and services, even their physical therapy marketing strategies and what their clinic requires in terms of monthly funding to stay in business and implement capital projects.

Record All Your Expenses

All expenses must be accounted for, from labor and electric to equipment and office supplies. Direct costs related to a specific service, such as in physical therapy marketing, product or equipment procurement are obvious.

Clinic owners that want to add new equipment can shop around for the best products that fit within their budget and will work to pay for themselves in the shortest amount of time.

Determine Rates of Depreciation

Practice owners will also need to determine rates of depreciation and how assets will affect the value of the clinic.

Indirect costs are more difficult to quantify, can fluctuate monthly, and include items such as office supplies, cafeteria/break room costs or even cleaning supplies if the task isn’t contracted to an outside agency.

Start Allocating Your Expenses

Physical therapy marketing strategies that consume phone services, electric usage, and heating and cooling costs are all expenses that can vary widely and for which funds must be allocated.

No matter what method is utilized whether physical therapy marketing is included or not, the objective is to spread the expense across the patient base as equally as possible, to do so consistently and to have a physical therapy marketing plan in place that addresses the overall financial health of the clinic over time.

Some therapists choose to allocate costs based on individual departments or the employees within those divisions. Expenses can be allocated on the square footage of the practice or the number of labor hours expended.

Another way of allocating expenses can be implemented by establishing percentages for each department based on its contribution to the practice’s overall gross profit.

When a department is the only one that benefits, that department shoulders the entire expense.

If the expense, like physical therapy marketing expense, is shared by two or more departments, each bears a portion of the cost.

Physical Therapy Marketing: Understanding and Choosing the Best Payers For Your Practice

by Nitin Chhoda PT, DPT | Dec 11, 2016 | Physical Therapy Management, Physical Therapy Marketing

Contracting with payers can be like playing with landmines. Discover strategies to contract with the best payers and understand different types of payers, so you can negotiate increased pay rates.

marketing physical therapy Physical therapists quickly discover that not all payers reimburse at the same rate, forcing clinic owners to make tough decisions.

In the new economy, that can effectively eliminate a significant number of potential patients and works to defeat the purpose of the Affordable Care Act.

It also presents a moral and ethical quandary for physical therapy marketing and management.

Having Sufficient Income Is Very Important

Therapists provide essential treatments and services to relieve pain, restore mobility and enhance quality of life. They must also generate sufficient income to operate the practice and make a living, which can be difficult to achieve when insurers are reducing coverage, limiting visits and capping payments.

To provide access to the greatest number of patients, it’s essential for therapists not only to have effective physical therapy marketing, but also to identify and contract with insurers that maintain the best reimbursements.

Different Methods of Payments

A preferred provider network (PPO) may look attractive, but therapists can find that those offering such contracts pay a set fee that often falls far short of the actual cost of treatment. Clauses and exceptions may require the therapist to accept the PPO reimbursement as total payment.

A wealth of these types of situations will prove financially detrimental to the physical therapy marketing practice.

A fee-for-service (FFS) agreement is a similar arrangement. The advantage is that therapists can provide coding for billing purposes that explains each service, including physical therapy marketing and management, in detail. Some insurers offer per-visit payments that deliver a flat reimbursement rate each time the client is treated.

Per-visit payments resemble an FFS, but insurers often use this lump sum payment method as a means of capping the total amount paid per visit. An increasingly popular reimbursement program is the per-payment method, a bundled solution that provides payment for all services connected with a single incident/injury, while Medicare and Medicaid impose per-year payment caps on business and physical therapy marketing services.

More Methods of Payments Discussed

Capitation is a bundled payment method in which therapists receive a lump sum amount each month.

An insurer pays the therapist for each of their covered members that the physical therapy marketing practice owner treats.

This method pays well if the client requires minimal services, but it’s financially destructive for the therapist when patients needs multiple or complicated treatments.

Not as common, but equally detrimental to the financial health of a physical therapy marketing practice is the multiple procedure payment, also known as a cascade payment.

This model reimburses at 100 percent for the patient’s initial visit, but reduces payments by a set percentage for each visit thereafter. It’s becoming more popular within Workers’ Compensation programs.

Self-pay programs require payment from the patient at the time services are rendered, either in cash or via credit card. The method allows for increased cash flow and eliminates the submission of bills to insurers.

The disadvantage of the system is that many patients may not have the financial resources to pay for services, eliminating a significant number of individuals from the pool of patients.

Make Sure to Have a Balance Income

Each therapist must balance their desire to bring relief to their patients with the need to be paid adequately for their services.

Part of superior physical therapy marketing and management includes a careful examination of all contracts and a thorough understanding of how each mode of payment will affect the bottom line of the practice.

The ICD-10 Documentation Analysis

by Nitin Chhoda PT, DPT | Aug 26, 2015 | ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Management, Physical Therapy Marketing, Physical Therapy Software

The new documentation requirements for ICD-10 have a focus on the specifics. Payers want as many in-depth details as possible for each claim so they can decide if they’ll make the reimbursement or if the financial responsibility can be shifted elsewhere. Clinical documentation is a critical element for clinician reimbursement.

The American Academy of Professional Coders (AAPC) estimates that only 37 percent of current clinician documentation provides enough detail to meet the stringent reporting requirements of ICD-10. Documentation will require more detailed information on topics that include the what, when, where and why of injuries, diseases and conditions.

Typical information about the client’s height, weight and vital signs will remain, but the details of an injury and surrounding circumstances are much more specific. In the previous example of the woman who suffered shoulder pain and headaches after an accident on a cruise ship, the following information will be required under ICD-10 coding.

All external causes that led up to or contributed to the injury;
The exact location of the injury on the patient’s body;
The patient’s actions and activities at the time of the injury and after;
Injury codes require a character extender to identify the type of encounter and if the patient sought medical attention;
Data will be required to identify where the client sought medical treatment, any tests that were conducted and referrals that were made;
The patient’s location when the injury took place or when the symptoms appeared is essential and ICD-10 provides data that narrows the location to a specific room, environment or mode of public transportation, including cruise ships;

Applied specificity is required for any number of accidents and injuries to document the immediate symptoms experienced by the patient at the time of the incident, as well as ongoing symptoms, severity and frequency;
Clinicians must indicate any methods the patient has used for pain relief or to alleviate the problem, from over the counter medications to hot and cold therapies;
Documentation must identify if the pain or symptoms from the injury are chronic or acute;
Any related complications encountered;
The result of hands-on examination and any tests ordered;
A detailed account of the treatment plan, including the symptoms that will be addressed and how.

Complete and detailed documentation is essential for reimbursements and Medicare requires clinicians to maintain records on all of a patient’s health and medical history both past and present. A number of variables must be documented that were not required under ICD-9 code sets.

Clinicians will need to exercise caution to ensure each item is thoroughly documented with the corresponding code. The new documentation requirements have a focus on the immediate complaint and no suspected diagnosis must enter the equation, only what can be clearly determined from the available information.

Why ICD-10 Will Result in an Increase in Documentation Time

by Nitin Chhoda PT, DPT | Aug 24, 2015 | ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Marketing, Physical Therapy Software

More codes, greater specificity and increased reporting regulations, combined with coding rules and categorization changes, are all leading to significant increases in documentation time when ICD-10 is fully implemented. It’s estimated that clinicians will experience a 15 percent increase in their documentation time and that’s a conservative number.

Many ICD-10 codes are very similar except for one or two differences, while other codes are only differentiated by which side of the body the problem affects. Searching with a GEM may turn up no results or thousands. Even practitioners who have acquired ICD-10 training and use a computer assisted search tool will face challenges when locating the exact code that’s needed.

Productivity is expected to drop by up to 10 percent due to physician queries from billers/coders. The potential for denials and the need for additional management of claims will affect revenue flows. Very real problems will arise with clinician queries using keywords. The following example outlines a potential patient complaint and the results of a keyword search.

Subjective:
Mrs. Johnson was on vacation aboard a cruise ship and was walking in the gift shop when a vase fell on her right shoulder. She has had pain in the right shoulder since then. At the time that this injury occurred, she did not consult with a healthcare provider; she thought it would just go away on its own. After a few days, the pain seemed to get worse, and she started noticing more trouble reaching up and to the side. Also, ever since the incident, she has been suffering from chronic headaches. The patient complains of severe pain across the insertion of the supraspinatus. Traditional over the counter medications do not relieve the headache or the shoulder pain. Past medical history is unremarkable. She followed up with her primary care physician, who referred her to physical therapy. Patient indicates that no diagnostic tests (i.e – X-rays, MRI) were done so far.

Objective:
The patient weighs 220 lbs. and is 5 feet 4 inches tall. Her blood pressure is 128/86, pulse rate is 72 and respiratory rate is 16. She has full strength in all muscle groups in the upper extremity with the exception of the right middle deltoids, which are 3+ and right supraspinatus, which is 2+. All deep tendon reflexes in the upper extremity are normal. Range of motion is normal in the upper extremity with the exception of right shoulder external rotation (to 25 deg), abduction (to 130 deg) and flexion (to 135 deg). All of these ranges exhibited pain at end range.

Special tests: Right shoulder (+) Neers, (+) Hawkins-Kennedy, (+) IR lag sign with pain.
Cervical range is restricted to 50% for flexion, extension and side-bend. Tenderness and hypertonicity noted at suboccipital area (right>left).

Assessment:
Exam findings are consistent with rotator cuff strain in the right shoulder. Pain, range of motion restrictions, and weakness in right shoulder, with chronic headaches.

Plan:
Physical therapy 3 times a week for 4 weeks for treatment of right shoulder pain, with range restrictions and weakness, with symptoms consistent with rotator cuff involvement. Treatment to also address chronic headaches and neck range restrictions, with therapeutic exercises, therapeutic activities, postural exercises, patient education, joint mobilizations/soft tissue mobilizations, home exercise, and modalities as indicted.

A clinician that searches for the keywords cruise ship will find 233 results in two classification sets and a further search for falling object and right shoulder pain each has 500 references in three classification sets. A more specific search for rotator cuff returns 109 results in four classifications. Results increase with a key word search for physical therapy returning more than 500 results across seven classification sets.

Searching by specific codes will display results for multiple categories ranging from nuclear medicine and obstetrics to mental health, substance abuse and poisoning. The typical practice won’t experience many of the situations described in the new ICD-10 coding, but they must still wade through a morass of potential codes to arrive at the desired data.

Navigating the ICD-10 code set will affect every individual within the practice and clinics can’t rely on GEMs and crosswalks indefinitely. Implementation requires that all staff members receive education and clinicians obtain coding training in their specialty. It will help reduce documentation times and the instances of claim denials under the new codes and documentation rules.