Physical Therapy Archives

EMR: The Changing Face of Healthcare Management

by Nitin Chhoda PT, DPT | Jul 23, 2013 | Physical Therapy

EMR facilitates office processes, expedites revenues and enhances the quality of client care. These are just some of the advantages why Nitin Chhoda wants physical therapists and private practice owners need to implement an electronic medical record system now.

Throughout the years as technology evolved, healthcare management has adapted to meet the changing capabilities of the system.

Before a new eave of technological advances, offices were forced to rely on paper medical records, handwritten, and susceptible to casualty or loss.

These boxes and file cabinets filled back rooms of physical therapists’ offices. If the documents remained safe in the office, they were still at risk of being read by an individual who could compromise the patient information.

Now a new era of medical records has arrived called electronic medical records (EMRs). It has streamlined every facet of the healthcare practice, no longer forcing offices to rely on paper records

New Flow of Communication
Physical therapist and other private practice offices used to rely on postal system and copier to transfer information to other practices. The ability to fax records helped speed up the process but it still took time. If a patient relocated for employment or family, the patient’s medical records had to be transferred as well, a cumbersome practice that could take weeks or months of sorting, copying, billing for copies, and mailing.

With EMR, records are stored in the “cloud” or a healthcare database from which a physician can easily access a new patient’s previous records. EMR also allow doctors and physical therapists to coordinate treatment of their mutual patients, and the information is updated immediately.

Cost-Saving Procedure
Paying an employee to keep medical records can cost a physical therapist or provider up to $15 per hour. With new EMR software, medical records are kept easier and faster, and readily accessible to any individual in the office with the touch of a button.

Improved Physical Therapy Documentation for Third Parties
In the days before advanced technology, retrieving physical therapy documentation was a tedious practice. Insurance agencies were forced to rely on photocopied records or faxed copies. This delay in processing slowed the entire system. Personal injury attorneys had to retrieve a signed HIPAA from a patient, individually contacting each medical provider for patient records for legal analysis.

Now with EMR, attorneys can simply fill out a request form, and have the information provided within a few a days.

Streamlined Billing Practice
In the pre-EMR days, physical therapist billing used to be a shaky process at best. Providers had to submit individually to each insurance agency, and wait for the results. Few patients had insurance and if treatment was covered by a government agency, the waiting time doubled.

Income was precarious due to the long response time. Now EMR system allows physical therapist and other providers to bill with a few clicks, and insurance agencies are instantly notified with invoices. Gone are the days of billing via mail for insurance and individuals, payment processing is now available online.

EMR opens a new way of communication and billing process for patients, insurance agencies, and third parties. In the evolving body of healthcare, EMR improves the treatment of patients with up-to-date information.

As more providers embrace technology, EMR is also available on tablets and mobile phones, for instant consultation.

Health Insurance and How It Relates to the Current Economic Outlook

by Nitin Chhoda PT, DPT | Jul 20, 2013 | Physical Therapy

The multi-tiered healthcare system in the U.S. is a slow and ponderous process, but one that’s essential for the financial stability of practices and to ease the pain and suffering of patients. Nitin Chhoda explains health insurance and its relations to our current economy.

Healthcare is a complicated and convoluted process in the U.S. that involves patients, practitioners, health insurance providers and a multitude of clearinghouses established specifically for processing, verifying and paying claims.

Due to the many facets of the industry, it can leave even insured patients with insufficient health insurance coverage or none when they need it most, while clinicians are buried in a mountain of paperwork and rejected claims.

Healthcare in the 21st Century

Healthcare was a reactive system focused on treating ailments and illnesses as they appeared. The beginning of the 21^st century saw a shift in the thinking of health insurance company executives toward preventative measures and ways for clients to avoid becoming ill or developing conditions such as diabetes and heart disease.

When the Affordable Health Care Act is fully implemented, millions of previously uninsured individuals will have access to a core group of services through health insurance policies obtained through their employment or management insurance exchange.

Health Providers

Health insurance providers are beginning to change their procedures by forcing patients to shoulder more of the cost burden and setting limitations on costs and treatments.

The result is that many clients that have health insurance are no better off than those without.

Due to these insurance practices, physical therapy management must develop and implement strategic plans to contract with the best paying providers and examine client health insurance coverage closely before beginning a treatment.

Decide Carefully

To remain solvent, clinicians will be required to make hard decisions about the patients they treat, the health insurance they accept and the providers with which they contract.

The technology embodied in an electronic medical record (EMR) system is a clinician’s best friend for verifying health insurance, providing enhanced documentation and submitting reimbursement claims.

Referral and Preauthorization: A Jump Start

by Nitin Chhoda PT, DPT | Jun 17, 2013 | Physical Therapy

An increasing number of healthcare insurance companies are requiring preauthorizations and referrals before they’ll pay for testing and treatments.

Even though the onus is typically on the patient to provide proof of either before seeking treatment, clinicians should take the lead to ensure the proper approvals were obtained.

In this informative article, Nitin Chhoda discusses the referral and preauthorization process to ensure reimbursements are approved.

Verify Coverage
It’s essential that clinics, especially physical therapy management, verify a patient’s healthcare insurance coverage before they arrive for their appointment. The referral information is essential for the payment and treatment process.

Payers are a law unto themselves, each with their own set of rules, regulations and parameters for reimbursements. Some won’t pay for anything that it has determined to be experimental or investigative, or will only pay for a less expensive or basic procedure. Others won’t reimburse for any procedure that doesn’t have a specific code.

Preauthorization Dictates Payment
Verifying the client’s insurance coverage, with or without referral, allows practitioners to locate potential problems with reimbursements or special protocols that must be followed. The data will also impact the treatment provided by the clinician.

For insurance carriers that require preauthorization, clinicians must receive an agreement from the payer for reimbursement before providing a proposed treatment or service. An authorization number will be provided that must be included on the claim for reimbursement.

The critical element for a preauthorization is the CPT code, which must be determined before the patient is seen and services rendered. The challenge is for practitioners to supply the correct code for the anticipated treatment, taking into account all possible options. Insurance carriers will only pay for the specific procedure that was preauthorized.

In emergency situations, it may not be possible to verify insurance coverage beforehand. It then becomes necessary to seek authorization or referral from the payer as soon as possible. When preauthorization is required and not obtained, clinicians may find that they won’t be reimbursed, even if the service was essential for saving a patient’s life.

Practitioners should be aware that many payers won’t issue authorizations after that fact.

The Rules of Referrals
Sometimes a client requires the services of a specialist or a second opinion, but their healthcare insurance demands a referral. It’s to the medical provider’s advantage to assist in the referral process and to ensure that the referral is clearly noted on the reimbursement claim. Once the referral has been approved, many clinicians assist by making the appointment with the specialist and notifying the patient.

The large majority of clients don’t have a clear understanding of what their medical insurance will cover or if there are any special requirements. When a referral isn’t obtained when one is required, the patient will be held accountable for the expense and will blame the referring physician.

It’s a situation that can cost the practitioner future revenues from the client and loss of potential patients in the future.

As more insurance carriers begin to require referrals and preauthorizations, it’s critical for any healthcare provider to obtain and verify a patient’s coverage prior to their appointment.

It will affect procedures and treatments provided. Obtaining the appropriate approvals ensures continuity of care for the client and that clinicians receive the reimbursements to which they’re entitled.

Medical Terms Talking the Talk and How to “Get” Them, Part 1

by Nitin Chhoda PT, DPT | May 22, 2013 | Physical Therapy

Nitin Chhoda shares how to use prefixes, suffixes and roots to determine the anatomy of medical terminology.

Thanks to a diversity of TV programs, some medical terms have found their way into common usage.

Most people know the meaning of IV and stat, but medical terms are notoriously difficult to spell and decode, making it essential that a medical billing and coding specialist has a working knowledge of the terminology used within the practice.

They can accomplish that by learning the three-part combinations that comprise medical terms.

Medical Terms Are a Combination of Prefixes, Suffixes and Root Words
Medical terminology is comprised of prefixes, root words and suffixes stemming from Greek and Latin. Prefixes appear at the beginning of words. The pre means before, as in preschool, but the prefix can also be used to designate a location, number or time.

The root portion of a medical term forms the central part of the word. An example would be the word premature, as in premature aging. Mature is the root word and the “pre” suffix is used to indicate an individual is demonstrating symptoms of aging that’s at odds with the subject’s chronological age.

Suffixes are used at the end of a word to change the meaning, as in hopeless. It means the absence of hope and reverses the entire meaning. It’s often used to describe a condition, disease, disorder or procedure.

Root words, prefixes and suffixes are combined to create medical terms. Broken down into its component parts, the term myocarditis translates into muscle heart inflammation – or inflammation of the heart. An idiosyncrasy of medical terminology is that the words can be somewhat out of order from what most people are used to seeing.

Prefixes of medical terms work independently of root words and specific prefixes will always refer to one thing. For example, the prefix endo will always refer to inner. It’s essential for billing and coding specialists to be familiar with common prefixes and suffixes used in medical professions.

It’s also helpful to know something of anatomy, as many terms refer to a specific area of the body.

A Tried and Tested Technique for Learning Medical Terms
The best way students in all branches of the medical profession have devised for learning medical terminology is to learn groups of three roots, prefixes and suffixes.

For those with a limited knowledge of anatomy, it helps to learn the root words of common body parts and then associating prefixes and suffixes with a specific part of the body.

Medical terminology sounds extremely complicated, but many people have heard and retained information about medical terms without even realizing it.

Some even use the terms, but without fully understanding how prefixes and suffixes reflect a diagnosis. Learning a few medical terms at a time is more effective than trying to memorize dozens all at once and suffer information overload. Those who approach the task by learning small groups will be surprised at how fluent they become in a very short time.

Physical Therapy Documentation: The Importance of Operational Analysis For Your Practice

by Nitin Chhoda PT, DPT | Dec 29, 2012 | Physical Therapy

Sometimes, more patients is not the answer, especially if the clinic is not sound from an operational and financial standpoint. To succeed as a practice, it’s important to work ‘smart’ and not just work ‘hard’, and enlisting your staff in your vision is a key component of the process.

In this article, Nitin Chhoda will teach how to improve your practice, operationally and financially by enlisting the help of your most valuable asset – your human capital.

Before you can step into the fray with staff and ask for a change of pace or even different physical therapy documentation procedures, a lot of operational analysis should be completed.

This involves reviewing reception staff efficiency as well as reception area capacity.

The physical therapists may be able to handle higher productivity, but without operational and financial analysis, you may be adding to the workload of other staff and decreasing productivity and efficiency in those realms.

Improving your bottom line should never get in the way of common sense when it comes to managing staff needs and expectations. Billing staff must also be evaluated and consulted about potential changes.

Managing Staff Correctly

If you want physical therapy documentation and billing staff to be able to bill more frequently, maximize claim acceptance, minimize errors, and collect payment more often and at a faster rate, overwhelming them with additional work will not get the job done. What will an increase in weighted procedures mean for coding and billing?

Every physical therapy documentation and management professional who is considering implementing a physical therapy documentation software solution has plenty to think about.

From the cost of the EMR to the implementation of policies and procedures that will actually make the practice more efficient, the job of transitioning a physical therapy practice over to electronic medical records is not simple.

The Staff Can Help

The truth is that physical therapy documentation and management is often quick to take on too much when the staff really can be helpful.

In terms of operational analysis, it will be the staff that bears the burden of operational changes. So it follows that the staff should be part of the process to make those changes logical, effective, and realistic.

Before implementing a new physical therapy documentation solution, the staff should be prepared sufficiently for their new responsibilities. Every staff member will need training to be able to use any new software.

But they will also need to know that the software is meant to make their jobs easier in the long run. The only way you can ensure that the EMR works in this way is to find out what the staff thinks will make their jobs easier.

Communicate Well With Your Staff

It may take a one-by-one approach to determine where your operations are sufficiently prepared and where changes need to be made.

The conversation you have with physical therapy documentation and billing staff will be very different from the way the reception staff feel about changing work modes.

Will the reception staff feel good about handing patients an iPad rather than a clipboard? If the task of filing and pulling files is taken out of the job, will they appreciate and use that extra time sufficiently? How many tablet computers do they need?

Even simple questions about the number of clipboards they have now and how often they use them all can give physical therapy documentation and management insights into how the day-to-day tasks in the practice can be better managed using physical therapy documentation software.

Operational analysis is the process of identifying just what you have and what you will need to make things work well with your new system.

Physical Therapy Documentation: Productivity Benchmarks in Your Documentation System

by Nitin Chhoda PT, DPT | Dec 25, 2012 | Physical Therapy

Nitin Chhoda discusses how setting benchmarks will allow your physical therapy documentation and practice to become more productive.

Keeping track of productivity benchmarks should be the priority of any physical therapy practice that wants to make the most of time management strategies.

Efficiency and productivity are not always easy to measure, but with a few benchmarks included in your physical therapy documentation system, you will be able to view reports on how everyone is measuring up to expectations and goals.

Benchmarks for Determining Optimal Operational Levels

One way that benchmarks in physical therapy documentation can serve to improve productivity is to measure the productivity of providers. This can be a difficult line to draw, especially without any basis for comparison.

An EMR reporting system can help determine what the average number of patients per day is, as well as patients per day per physical therapist. But even then, you are relying on numbers without much context.

Because physical therapy documentation is so closely aligned with billing, one way to measure productivity is to track weighted procedures per provider work hour or weighted procedures per visit.

Weighted procedures are used by billing staff to determine which CPT billing codes to use, and those codes give a specific financial value to each appointment.

Using these numbers, you can come up with a much more precise measurement of productivity. Rather than just focusing on visits per day, which may have varying values depending on the visit, you can focus on the amount of billable work that is being done each day or even each hour.

The challenge is to come up with a quick and realistic system physical therapy documentation for collecting the data and measuring them against your goals or expectations.

Visits Per Patient and Cancellation Rates

Another measure of the productivity of a physical therapy documentation practice will be in the success the practice has with each individual patient.

Do many of your patients “self-discharge” before completing their anticipated number of appointments?

How often do you have no-shows or last minute cancellations? Are patients being discharged early because you cannot schedule new patients?

The average physical therapy documentation series will last for 9 appointments, depending on many factors, including diagnosis and affordability for the patient. However, 9 visits is an appropriate benchmark for practice management to anticipate and aim for.

Payments Per Weighted Procedure and Per Visit

Payments per weighted procedure and per visit can be dramatically different depending on where your physical therapy documentation practice is located and the productivity of each visit.

These two numbers should be used together as benchmarks for success. Let’s say you have a goal of averaging $90 per visit. If one physical therapists only bills for three weighted procedures, but another bills for four, the amount per visit will be dramatically different for the two providers.

The physical therapy documentation payment per weighted procedure amount is critical to these calculations. If you know what you can bill for, you can design the treatment plan around weighted procedures that can be billed to the insurance companies you work with. Setting benchmarks will allow your physical therapy documentation and practice to use that information and become more productive.