The Impact of HITECH on EHR Implementation

Software Advice, a trusted resource for buyers of software, recently published findings from a three-year study following the changing demand drivers among prospective buyers of eclectronic health record (EHR) software.

The study captured data over two sample periods: Q1 2010 (shortly after the HITECH Act was signed into law) and Q1 2013. In both sample periods, the reasons providers expressed interest in purchasing EHR software broadly fell into the following categories:

• Replacing paper records;
• Replacing existing EHR software;
• Opening a new practice;
• Replacing other software that wasn’t specifically designed for medical records; or
• Some combination of the above.

For both sample periods, replacing paper records was the most-mentioned reason for EHR purchases. However, the percentage of practices replacing paper records fell significantly from 2010 to 2013, while the percentage of respondents replacing existing software grew by almost 50 percent.

These findings seem to validate a hypothesis that the HITECH Act spurred some practices to adopt EHRs too hastily. For providers, this highlights the importance of having a rigorous selection process in place before making a purchase.

Digging deeper into the data allows us to determine why practices are replacing existing EHRs.

Mentions of being “unhappy with current EHR” grew by 11 percent from 2010 to 2013. Additionally, concerns with cost rose significantly, from only one mention in 2010 to being mentioned by one out of every eight participants in 2013. Customer service concerns grew by nearly 50 percent.

Replacing Paper
The percentage of buyers replacing paper charts decreased from 64.9 percent in 2010 to 50.9 percent in 2013.

In both 2010 and 2013, the top reasons practices mentioned for switching from paper to electronic records had to do with the general benefits of a paperless environment – decreasing paperwork, improving efficiency, and becoming more organized. These motivations suggest practices are interested in more than just stimulus dollars; they also seem to recognize the inherent value of electronic records.

Among potential EHR buyers, we observed a decline in the proportion of practices transitioning from paper to electronic records, contrasted with an increase in the proportion of practices replacing existing software. What our data points don’t show, by virtue of only including buyers in the market for an EHR, are the many providers who are not replacing their EHR solutions – those who have successfully implemented electronic records with great benefit to their practices.

With EHR replacements on the rise, we conclude by emphasizing the need for practices to perform due diligence before making a purchase decision. Careful research can be awarded with a system that contributes to improved patient outcomes as well as increased financial health for practices.


David Fried originally contributed this report to Software Advice, where he currently covers medical practice management, the EMR industry, and political and regulatory issues affecting doctors. View the full report, including methodology and limiting factors, here: Four Years Later: The Impact of the HITECH Act on EHR Implementations.

Claims-Based Data Collection for Outpatient Therapy

CMS Releases Transmittal 2603

Last week, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 2603 regarding the claims-based data collection requirement for Medicare Part B outpatient therapy services.  Affecting claims for physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP), the mandate requires the reporting of 42 new nonpayable functional G-codes and seven new severity/ complexity modifiers.

These new codes and modifiers will be required on selected claims for all outpatient therapy services.  They will provide information about functional status at the outset of care, at specified points during treatment and at the conclusion of care.

Effective Dates 

Although this claims-based reporting will be effective for dates of service on and after January 1, 2013, CMS has enacted a testing period to give therapists time to ensure that systems work.  Claims without the G-codes and modifiers will be processed during a testing period from January 1, 2103 through June 30, 2013.  It is not until July 1, 2013 that claims might be rejected as a result of improper claims-based data reporting.

Chart Links to Release Software Solution

With CMS business requirements now released, Chart Links is developing a software solution that accommodates claims-based data collection.  The software will be released for testing prior to the deadline of July 1, 2013.

If you have any questions or concerns about this impending reporting requirement, please contact Chart Links, developers of rehabilitation software.

CMS Releases Transmittal 2457 Regarding Outpatient Therapy Cap

The Centers for Medicare & Medicaid Services (CMS), on April 27, 2012, released Transmittal 2457 (Change Request 7785).

This transmittal covers therapy cap manual review thresholds.  For calendar year 2012, there will be two therapy service thresholds of $3700 per year; one annual threshold each for

(1) occupational therapy services and

(2) physical therapy services and speech-language pathology services combined.

Services will accrue toward the thresholds beginning with dates of service on and after January 1, 2012 for services with and without the KX modifier.  Beginning with dates of service on or after October 1, 2012, contractors will apply the thresholds to claims exceeding it by suspending the claim for manual review.

Further, the National Provider Identifier (NPI) of the certifying provider identified for a therapy plan of care must be included on the therapy claim.

Also addressed in the transmittal is the temporary application of therapy caps to outpatient Part B therapy services furnished in outpatient hospitals other than Critical Access Hospitals on/after October 1, 2012 and on/before December 31, 2012.

To see the full transmittal, click here.

5010 Deadline Extended through June

The Centers for Medicare and Medicaid Services (CMS) announced an extension of enforcement discretion, through June 30, 2012, for any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.

The Question is “When?” for ICD-10

February 17, 2012 · Posted in Industry News, Reimbursement · Comment 

Health and Human Services (HHS) Secretary Kathleen G. Sebelius yesterday announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

If you’re a Director of Rehabilitation with questions about ICD-10, be sure to contact the Rehabilitation Specialists at Chart Links.

Study: Direct Access to Physical Therapists Associated with Lower Costs and Fewer Visits

January 10, 2012 · Posted in Health Reform, Industry News, physical therapy · Comment 

A study suggesting that “the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases” could have significant implications for the US health care system, says the American Physical Therapy Association (APTA).

The study, published last fall in the journal Health Services Research (HSR), reviewed 62,707 episodes of physical therapy using non-Medicare claims data from a Midwest insurer over a 5-year period. Patients who visited a physical therapist directly for outpatient care (27%) had fewer visits and lower overall costs on average than those who were referred by a physician, while maintaining continuity of care within the overall medical system and showing no difference in health care use in the 60 days after the physical therapy episode.

The study is noteworthy because services delivered by physical therapists account for “a significant portion” of outpatient care costs in the United States, according to the study, and some health insurance plans require a physician referral for reimbursement of these services. In addition, although 46 states and the District of Columbia now allow some form of direct access to physical therapists for treatment/intervention, some of them nonetheless impose restrictions if patients have not been referred by a physician.

“Physical therapists have long known that direct access to our services is safe and effective,” said APTA President R. Scott Ward, PT, PhD. “The elimination of referral requirements and other restrictions has been a priority of APTA for decades. This study provides further evidence that direct access to physical therapists could go a long way toward helping to make health care more affordable and accessible for all. We encourage researchers and insurers to continue to further investigate this important issue that could have a profound impact on patient care.”

“When patients choose direct access to a physical therapist, it does not mean the end of collaboration with their physician, nor does it diminish continuity of care,” added Thomas DiAngelis, PT, DPT, president of APTA’s Private Practice Section. “We believe the results of this study will support our efforts to work with legislators and physician groups to establish policies that reduce unnecessary regulations, improve access, and build models of delivery that best serve the patient and the health care system. Although this study focused on direct access, it is not about the provider. It is about the patient. It means better opportunities to provide the proper care to those who need it, when they need it.”

Led by Jane Pendergast, PhD, professor of biostatistics and director of the Center for Public Health Studies at the University of Iowa, the study retrospectively analyzed 5 years (2003-2007) of private health insurance claims data from a Midwest insurer on beneficiaries aged 18-64 in Iowa and South Dakota. A total of nearly 63,000 outpatient physical therapy episodes of care were analyzed – more than 45,000 were classified as physician-referred and more than 17,000 were classified as “self-referred” to physical therapists. Physical therapy episodes began with the initial physical therapist evaluation and ended on the last date of services before 60 days of no further visits. Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of physical therapy. Researchers found that self-referred patients had fewer physical therapy visits (86% of physician-referred) and lower allowable amounts ($0.87 for every $1.00 of physician-referred) during the episode of care, after adjusting for age, gender, diagnosis, illness severity, and calendar year. In addition, overall related health care use – or care related to the problem for which physical therapy was received, but not physical therapy treatment – was lower in the self-referred group after adjustment. Examples of this type of care might include physician services or diagnostic testing. Potential differences in functional status and outcomes of care were not addressed.

“Health care use did not increase in the self-referred group, nor was continuity of care hindered,” the researchers write. “The self-referred patients were still in contact with physicians during and after physical therapy. Concerns about patient safety, missed diagnoses, and continuity of care for individuals who self-refer may be overstated.”

According to Rick Gawenda, PT, president of APTA’s Section on Health Policy and Administration, the study should cause insurers and policymakers to rethink the physician gatekeeper concept when it comes to physical therapist services. “Evidence shows that, in the case of physical therapy, the physician gatekeeper model is doing exactly the opposite of what it was originally designed to do; it does not reduce ineffective and duplicate care nor reduce health care costs,” says Gawenda. “It’s time to end the physician referral requirement in every state, and it’s time for all payers to embrace direct access to physical therapists.”

Earlier research has supported direct access to physical therapists, but the new HSR study is the most comprehensive to date. A 1994 study analyzed 4 years of Blue Cross Blue Shield of Maryland claims data and found that total paid claims for physician referral episodes to physical therapists were 2.2 times higher than the paid claims for direct access episodes. In addition, physician referral episodes were 65% longer in duration than direct access episodes and generated 67% more physical therapy claims and 60% more office visits. The HSR study looked at a far more extensive number of episodes than the previous study, and also controlled for illness severity and other factors that could have affected the patients’ outcomes.

“In summary,” the researchers write, “our findings do not support the assertion that self-referral leads to overuse of care or discontinuity in care, based on a very large population of individuals in a common private health insurance plan with no requirement for PT [physical therapy] referral or prohibition on patient self-referral. We consistently found lower use in the self-referral group, after adjusting for key demographic variables, diagnosis group, and case mix. We also found that individuals in both groups were similarly engaged with the medical care system during their course of care and afterwards.”

The American Physical Therapy Association (APTA) represents more than 77,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area at

The Practice Practice Section (PPS) is the business section of APTA that fosters the growth, economic viability, and business success of physical therapist-owned practices to benefit the public.

The Section on Health Policy and Administration (HPA) is a specialty component of APTA. The mission of the HPA Section is to transform the culture of physical therapy through initiatives that enhance professionalism, leadership, management, and advocacy to foster excellence in autonomous practice for the benefit of members and society.

Coauthors of the study were Stephanie A. Kliethermes, MS, a doctoral candidate in biostatistics at the Center for Public Health Studies, University of Iowa; Janet K. Freburger, PT, PhD, research associate and fellow at the Sheps Center for Health Services Research and a scientist at the Institute on Aging at the University of North Carolina, Chapel Hill; and Pamela A. Duffy, PT, PhD, OCS, CPC, assistant professor, Public Health Program, at Des Moines University.

The study was funded by a grant from APTA and its sections on Private Practice and Health Policy and Administration.

1. Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research. Published ahead of print September 23, 2011. DOI: 10.1111/j.1475-6773.2011.01324.x

CMS Gets a Fresh New Look on its Website

December 7, 2011 · Posted in Industry News · Comment 

The Centers for Medicare & Medicaid Services (CMS) has expanded and enhanced its online presence by debuting a new look and feel for, and launching a brand-new site for the Medicaid program,  CMS says these changes come in response to what users have said they wanted to be able to do on the site. 

Here’s what you’ll find on the new CMS and Medicaid sites:

  • A significantly improved search engine that gets you to the information you’re looking for, fast.
  • More in-depth information about what CMS is doing to implement the Affordable Care Act and other new initiatives, and details about how you can apply for new programs.
  • Up-to-date, real-time updates that reflect important developments and initiatives happening with CMS programs.
  • Medicaid program information that’s readily available, easy to find, and easy to use.
  • Easy-to-access links to, which will continue to be the primary site for consumer information.

While CMS has moved content around to make it easier to find, you shouldn’t lose access to any of the current Medicare and Medicaid information you rely on now. They’re launching an archive version of each of the websites so that historic information can remain online without adding clutter to their primary sites.

Check it out at and

Scottsdale Healthcare Outpatient Therapy Services Implements Chart Links Rehabilitation Software

Electronic therapy documentation and scheduling software from Chart Links is now being used by more than 40 therapists in four locations at Scottsdale Healthcare, a community-based non-profit healthcare system in Scottsdale, Ariz.

Scottsdale Healthcare Outpatient Therapy Services is a leading provider of therapy related to orthopedics and sports medicine, balance and vestibular disorders, swallowing and voice disorders, pediatrics, geriatric disability, neurological disorders, work-related injuries and total joint replacement, as well as hand therapy, aquatic physical therapy and audiology evaluation. In 2010, approximately 5,300 evaluations and 42,000 visits were processed across four Scottsdale Healthcare locations.

“We chose Chart Links due to the flexibility of its clinical documentation design,” said Therapy Services Manager Melinda Richardson, PT, MA. “We see patients of all ages across a variety of rehabilitation disciplines, so we require a high level of specificity in our therapy documentation to individualize patient care. Our clinicians didn’t feel that the fixed templates offered by other products allowed for easy modifications based on patient need. With Chart Links, we got the flexible documentation we needed without sacrificing compliance with Medicare CCI edits, modifiers and time tracking.”

Chart Links software streamlines all of the daily tasks associated with a patient’s physical therapy, occupational therapy, speech language pathology, or audiology visits. The software manages adult and pediatric therapy treatment by automating evaluations, flow sheets, progress notes, patient education, clinical correspondence and plans of care. It also manages payer compliance, provider reimbursement, outcomes reporting, administrative functions, business intelligence and enterprise productivity.

“Electronic access to our patient records has made us much more efficient,” said Richardson. “Before Chart Links, we used transcription along with handwritten documentation and had a scheduling system that was separate from our billing system. We were constantly handling and hunting down paper charts, and were tracking and reporting information manually. The electronic integration of Chart Links into our existing systems makes for a more productive and seamless management of information from start to finish. We’ve eliminated our transcription costs and resources, and we document in less time. We’ve also cut out labor and paper intensive processes like chart management, faxing and manual charge entry.”

Chart Links is capable of interfacing in a Health Level 7 (HL7) format to inbound Admission/Discharge/Transfer (ADT) for patient registration data and to outbound billing systems. Interfaces also exist for inbound scheduling, outbound scheduling, outbound results, and customized ADT or billing, among others.

“Moving forward, we are poised for sharing information electronically across care settings, for example, with home health systems or accountable care organizations,” Richardson said. “It’s that kind of connectivity that will enable healthcare as a whole to deliver a higher quality of care with less administrative cost.”

About Chart Links, LLC
For more than 16 years, Chart Links has developed rehabilitation software that automates workflow for referrals, insurance authorizations, cross-discipline scheduling, documentation, charges, and more. Chart Links allows medical rehabilitation facilities to be more efficient and to provide a higher quality of care by delivering results in the areas of compliance, outcomes, analytics and revenue. For more information about Chart Links, visit

About Scottsdale Healthcare
Scottsdale Healthcare is the community-based, not-for-profit parent organization of the Scottsdale Healthcare Osborn Medical Center, Scottsdale Healthcare Shea Medical Center and Scottsdale Healthcare Thompson Peak Hospital, Virginia G. Piper Cancer Center at Scottsdale Healthcare, Scottsdale Healthcare Research Institute and Scottsdale Healthcare Foundation. Arizona’s first and only multihospital health system to earn Magnet recognition for its nursing care, Scottsdale Healthcare is a leader in medical innovation, talent and technology, founded in 1962 and based in Scottsdale, Ariz. For more information, visit For information on Scottsdale Healthcare Outpatient Therapy Services, visit

Physical Therapy Practice Found Guilty of Health Care Fraud and Sentenced to Jail

April 15, 2011 · Posted in Industry News, physical therapy, Reimbursement · Comment recently reported that a married couple, the owners and operators of Superior Physical Therapy in Sault Ste. Marie, MI, was sentenced to jail after being found guilty on charges of health care fraud.

Aaron Clark, the physical therapist at Superior Physical Therapy, admitted to felony health care fraud in a written plea agreement and will spend two years in federal prison with 3 years of supervised release. He has been ordered to pay $345,000 in restitution to Blue Cross Blue Shield of Michigan and Medicare.

Michelle Clark, the biller who admitted to a misdemeanor count of theft from a health care benefit program, will spend 90 days in prison with a year of supervised release. She will also pay $345,000 in restitution.

The two were sentenced in U.S. District Court in Grand Rapids, MI.

Medicare Strike Force Charges 111 Individuals, including some PTs and OTs

The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing.  As released by The United States Department of Justice, there were a number of physical and occupational therapists indicted (an indictment is merely a charge and defendants are presumed innocent until proven guilty).


The Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.   


The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, money laundering and aggravated identity theft.   The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment.  


According to court documents, the defendants charged participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided.   In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, health care company owners, executives and others charged in the indictments and complaints are accused of conspiring to submit a total of more than $225 million in fraudulent billing.


The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.


Since their inception in March 2007, Strike Force operations in nine districts have charged more than 990 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.


To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:

Senate to Look into Potential Medicare Contractor Conflicts

March 2, 2011 · Posted in Industry News, RAC · Comment 

Three Senate committee chairmen asked the Department of Health and Human Services Inspector General to look into potential conflicts of interest among private sector contractors that perform many of the payment, administration and oversight functions of Medicare.

The chairmen say that a recent survey of contractors conducted by their staffs to examine problems within the Medicare program identified several relationships between key Medicare contractors “that raise questions about possible conflicts of interest, or at the very least, might present the appearance of a conflict of interest.”

In some instances, the oversight contractor is a subsidiary of a company with a Medicare claims processing contract; in other instances, the claims contractor is a subsidiary of a parent company that also has a subsidiary with an oversight contract.

Congressional staffers said they have been reviewing the relationship of subsidiaries of WellPoint Inc., Hewlett Packard Co’s EDS Corp., and several other Medicare contractors hired by the government to monitor the bills healthcare providers send to Medicare, according to media reports.

[Extracted from: Fierce Healthcare]

Clinics Exempt from Red Flags Rule

December 21, 2010 · Posted in Industry News · Comment 

The President recently signed “red flags” legislation that makes doctors exempt from the anti-identity theft requirements and safeguards that banks and other creditors must follow.

This amendment to the Fair Credit Reporting Act is primarily a definition of the term “creditor.”  Confusion over the definition of “creditor” resulted in a Federal Trade Commission position that physician practices and other small professional service businesses would need to comply with the same regulation that calls for banks and creditors to have written procedures in place to prevent, identify and mitigate identity theft and to train staff to follow those plans.  With the new legislation and clarification, compliance is no longer necessary.

Revision to LCD for Outpatient Physical and Occupational Therapy (L26884)

In 2010, National Government Services received a request for reconsideration of the Outpatient Physical and Occupational Therapy local coverage determination (LCD) (L26884) to include International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) codes V57.1-V57.89 as correct coding. Review of the ICD-9-CM manual indicated that the request was technically correct, and therefore the requirement was included in the May 2010 draft revision to the LCD. Numerous comments were received from all National Government Services jurisdictions that such coding was redundant and created additional burden for providers.

The National Government Services medical directors and policy staff agreed with these comments, and sought further guidance from the Centers for Medicare & Medicaid Services (CMS) about whether these diagnosis codes needed to be included in the LCD. CMS has indicated that although the ICD-9-CM manual does include this recommendation, contractors did not have to include these diagnoses in the LCD.

Consequently, the LCD and supplemental instruction article (SIA) are revised, effective November 1, 2010, to delete coding instructions that required ICD-9-CM codes V57.1-V57.89 be included as the primary diagnosis on all therapy claims. Furthermore, National Government Services will not require these diagnosis codes as primary or subsequent codes. National Government Services does, however, note that such a recommendation does exist in the ICD-9-CM manual. If providers use these codes, they must also include the diagnosis code of the specific medical condition for which each therapy service was provided.

To see the document on the NGS website, click on, select your Business Type and your Region and click “Go.” On the Provider Specific Portal Home Page, under News and Publications, click on What’s New from the drop down menu.

Source: Gawenda Seminars & Consulting

Congress Letter to CMS Re Payment Cuts for Outpatient Physical Therapy Services

As reported in Physical Therapy Products, on August 9, Rep Earl Pomeroy (D-ND) sent a letter signed by 68 members of Congress to Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services (CMS). The letter expresses concern over CMS’s proposal to cut payment for outpatient physical therapy, occupational therapy, and speech-language pathology services in the CY 2011 physician fee schedule proposed rule.


The letter begins, “We write to you to express our concern over the significant cuts in payment for outpatient physical therapy, occupational therapy, and speech-language pathology services proposed by the Centers for Medicare and Medicaid Services (CMS) in the CY 2011 Physician Fee Schedule Proposed Rule.”

“The rehabilitation community strongly believes that a cut of 50 percent is unwarranted and is concerned that CMS’ proposed policy is based on a flawed assumption that there is duplication of services when rehabilitation services are billed. Therapy codes are unlike most other Current Procedural Terminology (CPT) codes in that the practice expense component for a typical visit is spread out among multiple codes since multiple services are typically provided to a patient during a visit,” says the letter.

The letter requests that a detailed explanation of the methodology CMS used to calculate the new rates be provided to Congress. Pomeroy also included a request that CMS work closely with stakeholders in the rehabilitation community toward the production of a final rule that will not adversely affect access to care, particularly in rural and other underserved areas.

“Given that this represents a significant cut to a group of services in the proposed Medicare Physician Fee Schedule and given the large number of Medicare beneficiaries who rely upon these therapies, we ask that CMS provide us with a detailed justification, including an explanation of the methodology used to calculate the new rates.”

2011 Proposed Physician Fee Schedule Rule Contains Proposed Pay Cuts for Outpatient Therapy Services

June 28, 2010 · Posted in Industry News, Reimbursement · Comment 

As reported by, the Centers for Medicare & Medicaid Services (CMS) issued the proposed physician fee schedule rule that would implement key provisions of the Patient Protection and Affordable Care Act of 2010 and update payment rates under the physician fee schedule for services furnished on or after January 1, 2011 (CY 2011).

If this rule becomes effective, physicians, physical therapists and other health care professionals would receive a 6.1% cut to their Medicare payments starting January 1, 2011 in addition to the 21.3% reduction that has been delayed several times already this year due to the flawed Sustainable Growth Rate (SGR) formula. This reduction was replaced with a 2.2% update until November 30, 2010, when the President signed the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010″ on Friday, June 25.

In addition to the projected reductions due to the SGR, CMS also proposes a multiple procedure payment reduction policy (MPPR) that would result in significant reductions in payment for outpatient therapy services. Specifically, CMS proposes to make full payment for the therapy service or unit with the highest practice expense value and payment of 50 percent of the practice expense component for the second and subsequent procedures or units of the service furnished during the same day for the same patient. The work and malpractice components of the therapy service payment would not be reduced. The proposed multiple procedure payment reduction policy would apply to both the services paid under the physician fee schedule (PFS) that are furnished in the office setting and those services paid at the PFS rates that are furnished by outpatient hospitals, home health agencies (Part B), skilled nursing facilities (Part B), comprehensive rehabilitation facilities, and other entities that are paid by Medicare for outpatient therapy services. It is estimated that if the multiple procedure payment reduction policy were implemented, payment for outpatient therapy services would be reduced by approximately 13% in addition to the projected SGR payment cut for CY 2011.

The APTA believes that CMS’s proposal to apply the multiple procedure payment reduction to outpatient therapy services is based on flawed presumptions and has no justification. The APTA states that it will aggressively work to stop implementation of the proposed MPPR policy and the SGR payment reductions.

Just “Wright” or Just Plain Wrong?!

May 11, 2010 · Posted in Industry News · Comment 

The President of the American Physical Therapy Association (APTA), R Scott Ward, PT, PhD, recently blogged about a movie that is getting both positive and negative attention in industry listservs.  

Just Wright,” in theaters May 14th, stars Queen Latifah as a physical therapist who — it appears from movie trailers — falls in love with and begins dating her NBA star patient.  As this premise goes against the physical therapy Code of Ethics, much dialogue among PTs has been generated about Hollywood’s depiction of the profession.  

The blog post covers what actions the APTA’s PR department has taken with the producers of the film to point out the eithical concern involving the plot.  It also discusses a study from the April issue of the Journal of Medical Ethics to point out that the PT profession is not alone when it comes to entertainment industry portrayals that are less than accurate.

We suggest that you read the blog, see reactions from your colleagues and get involved in the dialogue prior too and after the movie is released on May 14th.

May is Better Hearing and Speech Month

March 23, 2010 · Posted in audiology, Industry News, Speech Therapy · Comment 

The American Speech-Language-Hearing Association (ASHA) is promoting “Better Hearing and Speech” in the month of May.  This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing.

For resources to help your facility celebrate Better Hearing and Speech month, go to

House Passes Health Reform

March 22, 2010 · Posted in Industry News · Comment 

On March 21, 2010, the United States House of Representatives passed H.R. 3590, the Patient Protection and Affordable Care Act.  Also passed was H.R. 4872, the Health Care and Education Affordability Reconciliation Act, which contains additional refinements. Historically speaking, these two bills are perceived to be as important as the creation of the Medicare program.

Chart Links Participates in PT Products’ Software Roundtable

February 16, 2010 · Posted in Documentation, Industry News, physical therapy · Comment 

Jim Hammer, COO of Chart Links, was invited again this year to participate in a software roundtable interview with editor of  Physcal Therapy Products, Arati Murti.  Here are a few of the questions and answers that were exchanged in the January 2010 edition:

PT Products:  Budgets are tight in today’s economy; what are practice managers focused on in terms of software features/needs?

Jim Hammer:  They’re focused on what really counts-features that provide a tangible return on investment: Compliance in coding and charting that will reduce payor denials and audits; reduce lost charges and increase revenue opportunity; Denial and revenue cycle management that will increase cash flow; and Automation of manual workflow processes (like referral and plan of care management) to create operational efficiencies and reduce labor costs.

PT Products:  In what features/business areas can managers save money/time? (What software features can be used differently or combined?)

Jim Hammer:  By using software to reduce the phone calls and faxing associated with physician approval of therapist-generated plans of care, both time and money can be saved. At one of our hospital-affiliated outpatient centers, both therapists and physicians were documenting electronically. However, the authorization process between the two systems required manual intervention with printing, sorting, bundling, faxing, scanning, and data input. Chart Links created a real-time interface to eliminate the manual paper chase in the workflow. By eliminating backlogs of unauthorized paper plans of care, the client has delivered quicker continuity of care (time) and has reduced billing delays (money).

PT Products:  What’s the most challenging business “bottleneck” that you hear of from your customers, and how can software help avoid that situation?

Jim Hammer:  Plan of care authorization management is still a manually burdensome and paper-laden process in our industry. Time is lost making phone calls, printing, signing, faxing, and waiting for paper forms to be authorized. With a Health Level 7 (HL7) interface and workflow automation, this process can be transformed into the electronic age to avoid the unnecessary paper chase.

PT Products:  In terms of software needs in 2010, what are the important differences in concerns for hospitals/facilities versus private practices?

Jim Hammer:  Data exchange. Hospital-affiliated outpatient rehabilitation centers must focus on how they will connect to the hospital information system and to local area referring physicians via Health Level 7 (HL7) interfaces. Standards and definition around health information exchange will be critical in the coming year.

CMS & ONC Issue Regs Proposing Definition of Meaningful Use and Setting Standards for EHR

The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued on December 30, 2009 that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology.

An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology.  Both regulations are open to public comment.

The Recovery Act established programs to provide incentive payments to eligible professionals and eligible hospitals participating in Medicare and Medicaid that adopt and make “meaningful use” of certified EHR technology.  Incentive payments may begin as soon as October 2010 to eligible hospitals.  Incentive payments to other eligible providers may begin in January 2011.

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