By Daniel J. Morrill, PT, DPT
“Reform” implies that something problematic is being improved. Trouble is, reform in reality often isn’t quite so simple — especially when it further complicates an already tangled web of regulations.
The Affordable Care Act has proven to be a veritable labyrinth of regulations that have radically altered Medicare benefits for physical, speech and occupational therapy. The final updates for 2015 were released October 31, so now’s the time to educate yourself on all of the regulations’ intricacies. Rehabilitation professionals must stay on top of the rules to stay competitive — but compliance, for many, is coming at a price.
Under the Affordable Care Act, increasingly aggressive Medicare regulations have required therapists to complete more documentation in order to receive payment for claims. The regulations have also enacted more restrictions on coverage and Medicare caps that further complicate the process.
Therapists are frustrated with both the extensive labor and costs associated with compliance. Completing all the documentation takes time that they could be spending with patients. Profit margins have also shrunk from around 40 percent to as low as 15 percent because therapists don’t have time to see as many patients each day and receive decreased reimbursement for therapy services.
In a perfect world, patients see their therapist, receive treatment and Medicare pays the claim. Under the new regulations, however, auditors are more intensely scrutinizing claims before they’re paid. Medicare typically will pay the claim, however if an audit is done and it is ruled that the treatment did not meet requirements for medical necessity, then the clinic would have to reimburse Medicare. It’s not unusual for therapists and auditors to have differing opinions on what treatments were medically necessary. Usually the treatments were medically necessary, but documentation wasn’t completed precisely according to the law — and that’s enough to flag the treatment as problematic.
But the right technology takes the guesswork out of compliance by streamlining record keeping and automating reminders that ensure your office won’t fall behind with the feds.
Staying on Track
The new regulations require detailed documentation for significant amounts of data. Medicare caps coverage annually for physical and speech therapy at $1,940, with another $1,940 available for occupational therapy. These caps apply even if patients switch rehabilitation practices midway through treatment or suffer an additional injury, which can lead to a convoluted paper trail.
Patients need to get more involved with the paperwork than before, since they’re the most reasonable source for questions about the therapies they’ve received in the past year. Therapists must also do more due diligence to ensure patients understand the extent of their coverage. Once patients reach their caps, Medicare may make reasonable exceptions to extend coverage, but it’s no guarantee.
As a result, therapy offices must be proactive rather than reactive about tracking benefits and ensuring their patients are covered for the services they need. Practices must create a workflow that maximizes therapists’ time by developing systems that track follow ups, automate notes to doctors and send reminders so therapists don’t fall behind with all of the tasks. Using this process to regularly self audit ensures the office will be prepared in the event that an outside auditor comes in to review work and offer their recommendations on how to improve.
In a practice with a high Medicare population — between 30-40 percent of patients — the time devoted to tracking and documenting visits can quickly affect the bottom line if there isn’t a clear process in place.
Physical therapy software helps improve efficiency by allowing therapists to simplify organizational processes and customize a solution that works best for them. If the office does find itself audited down the road, the software will ensure that therapists can defend themselves with rock-solid documentation.
The right software solution will offer customizable evaluation templates so therapists can document their visits in mere moments. The notes automatically update after every visit to ensure they’re working with the most current information. Because these processes happen so effortlessly, therapists can spend more time working with patients and less time filling out paperwork.
Software can also help you manage claims processing by letting you search for patients in batches based on whatever criteria you desire — all patients, for example, that started their therapy this year at a different office before coming to your practice. Checks built into the system flag mistakes or missing information so you can fix problems before submitting claims, helping you avoid claim rejection and maintain a clean record book in the event of an audit.
The combination of Medicare and physical therapy is one of the most complex relationships in the medical field. There’s so much information to track and process to ensure your office gets paid — and that patients get full attention they deserve — that it’s increasingly necessary to need help with all the paperwork that goes on behind the scenes.
A physical therapy software solution will be that partner you can trust, streamlining administrative processes for your therapists so they can spend more time with patients — which is exactly where they belong.