Don’t Get Caught Unaware!

Don’t Get Caught Unaware!

Every new quarter brings excitement to those of us in private practice. We look forward to servicing our communities better than the last, have a little fun along the way, and most of all, expand our knowledge with continuous learning opportunities.

With each new turn of the season brings the opportunity to learn about changes that may affect CPT coding & reimbursement. Moving into the 2nd quarter, it is ideal to invest your time, and the time of your staff, in learning how the new changes in Medicare will affect outpatient therapy sets as the New Year holidays are finally past us. Many courses, web events and articles are being offered by multiple supplies, including the APTA and PPS, covering the principles of billing and coding for PT/OT sets, in addition as information on updates and explanation of changes from Medicare, including PQRS and Functional Coding.

With all of the continuous education and improvement opportunities obtainable to us, it is vital that therapy providers understand the responsibility they have to correctly document the sets that they performed. It is the therapists obligation to understand and recognize patient management skills, and how to correctly capture all the service time spent with patients. Medical necessity for PT/OT sets must be demonstrated in documentation and consequently, it is imperative that providers master the art of functional goal writing. Functional goals should be objective and assessable, in addition as specify a given time frame. Collaborating with the patient will assist in creating goals that are meaningful and specific to them. Realize that any good skill takes time to master and championing any skill is a journey, not a sprint. The more time you invest in continuously improving efficiency in functional goal writing, the more likely your practice will assistance from decreased denials, improved reimbursement and a provision of already greater management of the episode of patient care.

As administrators, we have the opportunity to assist providers in understanding coding and documentation, as this is now more important than ever with the recent Medicare changes. Due to the American Tax Payer Relief of 2012, Medicare is requiring outpatient therapists to report on the severity and complexity of the functional position (conditions, outcomes and expenditures) on all beneficiaries. Anew claims-based data collection requirement will also require providers to report functional G-codes and severity/complexity modifiers on claims.In addition, at each reporting interval, the therapist must report on the current position and projected goal position. This is required at several stages in a patients plan of care including the evaluation, re-evaluations, progress notes, graduation/release, when a reporting for a limitation has ended (in situations where the need for continued therapy remains) and at the time a second limitation within the same episode of care has begun to be reported on (APTA Website).

This system began on January 1, 2013, hosting a voluntary testing period from January 1, 2013 to June 30, 2013, offering clinics a time to ensure all systems are in place for documentation and billing. It is strongly suggested that you acquire the proper education on functional therapy documentation now and integrate it as soon as possible in your clinic. Beginning July 1, 2013, the system will become mandatory and Medicare will begin rejecting claims submitted without the required functional data reporting information for outpatient therapy sets provided on and after July 1, 2013. (CMS Website). Improper documentation will drastically harm your cash flow. consequently, it is important that you and your staff keep current on all coding, documentation and Medicare trends so you do not see such a drop.

Remember, it is basic for licensed therapy providers to ensure that they are current in understanding the rules and regulations governing the provision of outpatient physical therapy sets. As practice administrators, it is our role to assist our providers in remaining current and assist them in better understanding how to properly code and document sets. Proactive knowledge and understanding of these new requirements will be much better than reactive compliance and loss of revenue. Prepare your practice now for any changes and dont get caught unaware! Embrace these changes – the 2nd quarter should bring a renewed passion to take our staff, our practice and ourselves to a new horizon for the summer and fall of 2013.

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