PT Supervision Requirements in an Outpatient Hospital Department

November 19, 2009 · Posted in Reimbursement · Comment 

According to the American Physical Therapy Association (APTA), in the 2010 Outpatient Prospective Payment System (OPPS) Final Rule, issued October 30, the Centers for Medicare and Medicaid Services (CMS) confirms that physical therapy services delivered in an outpatient hospital department do not require the direct supervision of a physician.

The OPPS is the method of payment for most services delivered in an outpatient hospital department. However, physical therapy services are considered a separate benefit covered under the Medicare physician fee schedule through the Part B benefit. Therefore, they do not fall under the therapeutic services category that requires direct physician supervision under the OPPS.

New Payment Model for Anthem Blue Cross OTs in California

November 17, 2009 · Posted in Industry News, occupational therapy, Reimbursement · Comment 

As reported by the Occupational Therapy Association of California (OTAC), occupational therapy practitioners within Anthem Blue Cross’ network of providers were recently notified of a planned change in Anthem Blue Cross’ payment methodology for the reimbursement of occupational therapy services in California.

This new payment model changes the current payment system to one where providers will be paid $75 per visit regardless of the treatment(s) provided or the intensity of those treatment(s).

As this change in reimbursement could prove to be financially detrimental to occupational therapy practice, the OTAC is encouraging all of its members to be a part of their grassroots advocacy effort to ensure cost-effective and quality occupational therapy services for Anthem Blue Cross clients.  They have posted sample letters to use to educate executives at Anthem Blue Cross on the high value of occupational therapy services in promoting health and disability and to voice opposition to the $75 flat rate.

Spartanburg Eliminates Transcription Costs, Improves Clinician Productivity and Documentation Consistency Using Chart Links

Spartanburg Regional Rehabilitation Services is a division of Spartanburg Regional Healthcare System, which is based in South Carolina and was named one of the nation’s “Most Wired” hospitals in 2007 by Hospital & Health Networks magazine. Spartanburg Regional Rehabilitation Services focuses on physical therapy, occupational therapy and speech-language pathology, and includes 68 clinicians and 10 support staff across eight locations.

At the time that Spartanburg Regional Rehabilitation Services began evaluating electronic charting solutions, the organization’s use of paperbased patient charts required advanced planning to ensure that the chart was available at the location where the patient was visiting. In addition, Spartanburg maintained the majority of its paper-based charts older than one year at an off-site storage location. As a result, the office often had to retrieve records from offsite storage before patient visits.

“One of the many disadvantages of using paper-based documentation was that the therapists had to complete a billing sheet with every patient encounter, which was time consuming, and on some occasions, was not completed in a timely manner,” said Kelly Sheppard-Fowler, Practice Manager at Spartanburg Regional Rehabilitation Services. ” Another challenge with our manual processes was the lack of electronic scheduling, which makes it all too easy to encounter scheduling errors when coordinating across different sites.”

“The other solutions evaluated didn’t have the rehabilitation-specific functionality that we needed, such as specialized reports and templates, as well as a way to link clinical documentation with scheduled appointments,” Sheppard-Fowler said. “Most importantly, the solutions didn’t track insurance authorizations for patient visits, or notify the therapists when additional visit authorization was needed for the patient. Chart Links had all of these capabilities, plus much more.”

Spartanburg went live on Chart Links electronic documentation in August 2006 following a six-month implementation that included the creation of an interface to the organization’s McKesson Star billing system. “The implementation of Chart Links was successful due to the extensive planning and knowledge of the Chart Links staff. It was very helpful that the implementation staff included a therapist from Chart Links that could relate with our clinical staff,” Sheppard-Fowler said.

Users quickly adopted the solution because it mirrored the organization’s workflow. “Illegibility problems were immediately eliminated and the accuracy and thoroughness of our documentation improved drastically,” Sheppard-Fowler said.

Using Chart Links, Spartanburg clinicians no longer have to fill out billing sheets for each patient, since the system automatically completes the task. Edits within the system check that charges are compliant with private insurance and Medicare requirements, and that any charging errors are routed into a queue for review. To further prevent errors, the interface with the McKesson Star system allows Chart Links to confirm that patient information is consistent between the two systems. Additionally, Chart Links alerts therapists if Medicare modifiers are missing, and the system tracks patient visits that count toward insurance authorizations, automatically notifying clinicians when additional visits will require reauthorization. Chart Links also allows the clinical staff to fax plans of care directly out of the system to referring physicians, and has a tracking system to ensure compliance.

Since using Chart Links, reimbursement has increased due to more accurate documentation and the ability to track insurance authorizations that help avoid lost charges. Chart Links’ edit capabilities that catch errors before claim submissions have enabled Spartanburg to decrease its error rates significantly, which has reduced accounts receivable days.

In addition, Spartanburg eliminated its $10,000 per month transcription costs since all documentation is now electronic. “Chart Links helped make our documentation consistent across all our sites, and it’s easy to access a patient chart from any of our locations,” Sheppard-Fowler said.

Spartanburg implemented the Chart Links electronic scheduling module one year after going live with electronic documentation. “Initially, we utilized the hospital’s centralized department/software to handle our scheduling needs but the existing system did not accommodate our different sites, clinicians and specialties. As a result we encountered extensive scheduling errors. Most of these errors were eliminated once we began using the Chart Links scheduling system,” Sheppard-Fowler said.

Another benefit of using Chart Links is the system’s ability to help track clinician productivity. “Although we haven’t changed our productivity expectations, we have noticed that more clinicians are meeting their productivity goals,” Sheppard-Fowler said. “Prior to Chart Links, clinicians would simply turn in productivity reports to their manager, who would only contact clinicians if they were not meeting their goals. Now, clinicians actively monitor their productivity using Chart Links, which promotes accountability and self-motivation toward obtaining productivity goals.”