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.

Conclusions
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.

Medicare Therapy Cap Forecast Report

Chart Links, the providers of rehabilitation workflow management software, is pleased to announce availability of the Medicare Cap Forecast Report.  The purpose of this report is to aid outpatient rehabilitation facilities in managing the CMS Medicare Part B Outpatient Therapy Cap and Exceptions Process.

The Medicare Cap Forecast Report allows Chart Links Rehabilitation Software users to generate a list of patients who may be nearing the therapy cap threshold.  The report displays amount and visit utilization for occupational therapy services as well as physical therapy and speech-language pathology services combined.

To learn about the Medicare Cap Forecast Report, please contact the Chart Links Helpdesk at (877) 701-9191.

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.

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 www.moveforwardpt.com.

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.

Reference
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

October is National Physical Therapy Month

October 5, 2011 · Posted in physical therapy · Comment 

National Physical Therapy Month (NPTM) is celebrated each October.

This is an opportunity for facilities to reach out to consumers and educate them about the unique benefits of treatment by a physical therapist:

  • Significant improvement in mobility to perform daily activities
  • Provision of alternatives to surgery
  • Management or elimination of pain without medication and its side effects

This year’s celebration is focused on sports injury prevention across the lifespan.

For more information, go to http://www.apta.org/NPTM/

APTA’s Defensible Documentation for Physical Therapy

August 25, 2011 · Posted in Documentation, physical therapy · Comment 

The Practice Department of the American Physical Therapy Association (APTA) has recently developed  a resource called “Defensive Documentation for Patient/Client Management.”  The tool was created in response to issues related to physical therapy documentation.  APTA members can access the documentation here.

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
http://www.chartlinks.com

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 shc.org. For information on Scottsdale Healthcare Outpatient Therapy Services, visit
http://www.shc.org/therapy/

Scottsdale Healthcare Outpatient Therapy Services Implements Chart Links Rehabilitation Software

Workflow management software enables more than 40 therapists in four locations to manage therapy documentation, scheduling, referrals, insurance authorizations, charges and more.

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
http://www.chartlinks.com

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 shc.org. For information on Scottsdale Healthcare Outpatient Therapy Services, visit
http://www.shc.org/therapy/

Therapy Web Design Services

As a physical therapist, occupational therapist or speech therapist providing care in today’s competitive environment, you want your therapy practice website to attract and retain patients and referral sources.

Quality therapy web design and effective optimization for search engines is critical for marketing your practice. These days, more patients turn to a Google internet search before turning to the yellow pages to find and research a local rehabilitation provider.

At Chart Links, we offer custom therapy web design to fit the needs of your practice. Select from package options to create your most important marketing tool — your website.

National Physical Therapy Month in October

July 26, 2011 · Posted in physical therapy · Comment 

It’s time to start planning for October’s National Physical Therapy Month (NPTM). This year’s focus is on sports injury prevention across the lifespan.  NPTM is an opportunity to reach out to consumers and educate them about the unique benefits of treatment by a physical therapist.  For more information, go to http://www.apta.org/NPTM/

National Rehabilitation Week to be Celebrated September 19-25, 2011

June 28, 2011 · Posted in occupational therapy, physical therapy, Speech Therapy · Comment 

The National Rehabilitation Awareness Foundation (NRAF) was established in 1996 by Allied Services, a not-for-profit healthcare system headquartered in Scranton, Pa. Allied, since 1976, served as sponsor of National Rehabilitation Week, a nationwide celebration to educate people about the benefits of rehabilitation and the capabilities of people with disabilities.

This year’s National Rehabilitation Week will be celebrated September 19-25, 2011.

The Foundation was created to extend the observance from a week-long event to a year ‘round awareness campaign. One of the Foundation’s main initiatives is to elevate the celebration to a greater level of prominence.

PT Day on Capitol Hill

June 16, 2011 · Posted in physical therapy · Comment 

Approximately 1,000 physical therapists, physical therapist assistants, and students of physical therapy rallied on Capitol Hill before meeting with their members of Congress as part of PT Day on Capitol Hill, June 9, 2011.

Watch the 7-minute video.

The rally included addresses from Sens Jon Tester (D-MT) and Roger Wicker (R-MS). Following the rally, participants went to prearranged meetings to seek support of the Medicare Access to Rehabilitation Services Act (HR 1546/S 829), legislation that would repeal the cap on outpatient rehabilitative services for Medicare beneficiaries, the Physical Therapist Student Loan Repayment Eligibility Act (HR 1426/S 975), and the Protecting Student Athletes from Concussions Act (HR 469).

Source:  American Physical Therapy Association website

“Exercise is Medicine” Month

May 12, 2011 · Posted in physical therapy · Comment 

May is Exercise is Medicine® Month. This is a time when all providers are called to assess and review every patient’s physical activity program at every visit.  It is a time for celebrating the health benefits of exercise and offering resources to get people moving.

“Everyone should start or renew an exercise program now as an investment in lifelong health,” said Robert E. Sallis, MD, FACSM, chair of Exercise is Medicine. “Every person, regardless of age or health, is responsible for his or her own physical activity. There are far more reasons to exercise than excuses not to.”

Exercise is Medicine partners include the American College of Nurse Practitioners, the American Academy of Physical Medicine and Rehabilitation, the American Medical Society for Sports Medicine, and organizations and universities from all parts of the world.

For the past four years, governors and mayors nationwide have signed on to proclaim May 2011 as Exercise is Medicine Month in their communities.

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

April 15, 2011 · Posted in Industry News, physical therapy, Reimbursement · Comment 

PTManagerBlog.com 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: www.stopmedicarefraud.gov.

Quotes from an OT User of Electronic Occupational Therapy Documentation

One of our Chart Links Rehabilitation Software users, Debbie Flaspohler, OTR, MOT, CLT and manager of occupational therapy at Margaret Mary Community Hospital in Batesville, Ind., was recently quoted in an article called “Meaningful Change,” written by Teresa Mcusic from TodayInOT.com.  Reveiw some of her quotes extracted below, or, read the full article.

Debbie Flaspohler, OTR, MOT, CLT, manager of occupational therapy, Margaret Mary Community Hospital in Batesville, Ind., says she was comfortable using her facility’s Chart Links LLC rehabilitation software within a few weeks. “It was an easy program to move around in,” she says. “And Chart Links did a good job of coming and doing orientation. A team came and spent about a week with us. Also, they have a help desk, so when we got stuck, we could call them.”

The legibility and standardization of electronic records are major benefits over hand-written paper charts, therapists say. The electronic documentation also is more concise, Flaspohler says. “It looks more professional,” she says. “These are a legal document used for reimbursement. Clarity and accuracy are really important.”

Such precision also helps with more consistency among healthcare team members, Flaspohler says. “It helps everybody document the way they are supposed to,” she says. “It’s not black and white — you can modify the way you want to — but it makes you fill out what you need to fill out.”

The systems also can be tailored to include information on interventions for patients with conditions the therapists don’t often encounter, Flaspohler says. “For diagnoses you normally don’t see, you can pull in components from the system for a segment on that,” she says.

For more information about Chart Links Rehabilitation software for occupational therapists, visit our website.

Physical Therapy Workflow Software and Documentation

March 15, 2011 · Posted in Documentation, physical therapy, Workflow · Comment 

Chart Links offers physical therapy documentation software designed to match the workflow of a physical rehabilitation facility.

In addition to administrative and financial features like patient registration, referral management, insurance authorization, cross-discipline scheduling, charges, reporting/analytics, and outcomes, Chart Links offers the following physical therapy-specific features.

  • PT Evaluations. Standard physical therapy documentation and evaluation forms library (i.e., cervical spine, shoulder, ankle). Contains numerous sections with the ability to customize into sets and forms.
  • PT Flow Sheets. Electronic management of daily flow sheets (i.e., shoulder therex, exercise) with ability to analyze progress over time. Ability to link flow sheets to progress notes.
  • Scheduling. Ability to schedule patient with PTA and PT in one easy-to-use feature.
  • Patient Arrival Notification. Using our physical therapy documentation software, PT may receive a page on his/her beeper to be notified when a patient has checked in at the front desk.
  • Wireless Access. Allows for un-tethered documentation (i.e., document in a wireless gym setting with hardware on a rolling cart, or, use a handheld wireless tablet PC).
  • PT Patient Education. Print-on-demand patient handouts (i.e., home programs, exercises). Instructional and educational materials are available for customization and distribution. Ability to scan-in existing sheets or create-your-own. Ability to interface to third-party electronic formats.
  • Authorizations. Monitor authorized visits for PT evaluation and follow-up visits.
  • Compliance. Support of compliance efforts with JCAHO, CARF, HIPAA and other rehabilitation professional standards. Helps ensure compliance with Medicare CCI edits, modifiers and time tracking while documenting.

For more information, visit Chart Links at www.chartlinks.com

Article About Chart Links Published in Rehab Management Magazine

An article summarizing how Chart Links Rehabilitation Software streamlined the clinical and financial operations of an outpatient rehab practice recently got published in the Jan/Feb 2011 Rehab Management magazine.  Read the full article below or link to it here.

—–

Implementing Solutions

by Andrea Marchi, PT, MBA, CSCS

EMR streamlines rehab practice’s clinical and financial operations.

Many therapists are considering the implementation of electronic medical record (EMR) solutions, but hesitate on making the purchase because they aren’t sure exactly how the technology will help their practice.

Our practice had the same concern initially, so we thoroughly evaluated the areas where an EMR could improve our business. It was quickly apparent that paper-based processes had a stranglehold on our practice. We suffered from many of the challenges other practices experience, such as: misplaced patient records; incomplete, untimely documentation impacting the billing process or regulatory compliance; productivity and financial performance data that was several months old by the time it was compiledWith the industry steadily moving toward widespread adoption of EMRs, we wanted to get ahead of the curve. Our facility, HealthPoint Rehab, which is affiliated with Southeast Hospital, handles about 33,600 patient visits annually out of two outpatient rehabilitation centers located in Cape Girardeau and Jackson, Mo.

There are numerous EMRs designed for physician practice specialties, but few that address the specific needs of rehab centers. We found a system designed to accommodate our team of 25 therapists engaged in physical, occupational, speech, and specialty therapies. Our system automates workflow for cross-discipline scheduling, referrals, insurance authorizations, clinical documentation, charges, and more. It includes Health Level 7 (HL7) interfaces to our hospital information system for effortless exchange of data. Most importantly, it supports our efforts to comply with professional standards while running an efficient business.

After a comprehensive system selection process, we implemented a software system in January 2009. The following information details how the technology has helped our organization over the past 2 years.

The biggest benefit we immediately noticed was the timely documentation of patient treatments. We have desktop computers installed within private exam rooms and laptop carts in our open gym spaces. Most of our therapists complete the treatment notes during the patient visit, while others finish after the visit.

In contrast, it took us much longer to get our initial evaluation paperwork to the physicians’ offices when we relied on dictation, transcription, and snail mail. We used to employ a full-time transcriptionist, but we have since eliminated the position and use the system’s faxing software to electronically fax our documentation to the physicians.

The structure of our daily notes within the software system has allowed our therapists to document procedures in a very clean and concise format. Another benefit is that our software system can ensure compliance with insurance regulations and therapy standards. During the documentation process, the system alerts therapists if they do not complete sections of the note that are necessary to comply with requirements from Medicare and The Joint Commission.

Using the EMR has helped us improve our billing process. Since charts are electronic and always available to the billing specialists when they need them, we complete our billing in a much more timely manner. We no longer waste time searching for the paper chart.

Unlike most EMRs, our rehab-specific solution has therapy-based billing capabilities built right into it. Correct coding initiative (CCI) edits built into the system help prevent errors that can result in returned claims or rejections from payors. The latest CCI edit table is automatically downloaded into the charge table, so we are always working from the most current version. Our system automatically reviews charges as they are being entered and alerts users if charges are improperly grouped or are missing modifiers. Using the system gives us the confidence that we are doing our billing correctly the first time, so we don’t have to worry about rebilling later in order to fix errors.

Further assisting our billing efforts is an interface that connects the system to the Meditech hospital information system at Southeast Missouri Hospital. The interface allows the systems to exchange information for billing and results, as well as admission, discharge, and transfer data. The result is a reduction in duplicate data entry.

TRACKING CAPABILITIES

The tracking capabilities of the EMR also help with compliance, especially when it comes to ensuring that physicians sign plans of care following initial patient evaluations. The system’s reporting capabilities enable therapists and front-office workers to easily view all plans of care that have not been signed by physicians, which helps accelerate follow-ups. And in cases where physician signatures have not been obtained, it tracks the number of times the plan of care was faxed by the system to a physician for signature. This tracking capability helps rehab clinics demonstrate their due diligence in trying to obtain signatures, which is Medicare compliant.

Prescriptions for therapy are also tracked. Upon receiving a physician’s prescription for therapy, it is entered into the system along with the number of visits that are prescribed or allowed by insurance. It also reports patients who have prescriptions that are about to expire, so the front-office can ensure we continue to treat patients with a current prescription.

A simple-to-use ad hoc analysis tool enables us to analyze practice trends, develop universal metrics, measure long-term changes, and gather operational decision-support data. Using the EMR’s analytics package, we have been able to analyze cancellation rates by patient type, determine our top referral sources by physician or physician group practice, track the number and type of CPT code charges, as well as proactively monitor staff productivity.

For example, by using the analytics module, we discovered that pediatric speech patients had the highest number of visit cancellations. Each cancellation negatively impacts our revenue and therapist productivity, so we developed new cancellation policies—applied to all patient types—to help curb the problem. By making patients aware of the new policy, we have been able to decrease our cancellation rate from 18% to 13%.

We also use the analytics module to track therapist productivity based on hours worked and units billed. In the past, we had one of our secretaries compile data to measure therapist productivity, but the process was cumbersome, and results were not available for 2 to 3 months after the time frame measured. Now, productivity is calculated weekly, so therapists can proactively monitor their productivity, which has been a wonderful management tool.

Another area we monitor with the analytics module is tracking referral sources. We can see exactly which physicians and physician clinics refer the most patients to us, which guides us in building relationships and growing our business.

The productivity of our front-office has been greatly improved by using the new system’s electronic scheduling capabilities. Now, scheduling is easy; as information can be clicked, dragged, copied, and pasted rather than entered manually. Also, scheduling multiple visits can be done all at once instead of creating individual appointments.

Front-office productivity is further enhanced by the system’s automated paging capabilities. Upon patient check-in, the system automatically sends an alphanumeric page to the corresponding therapist to let them know that the patient has arrived. Previously, the receptionist manually dialed the therapist’s numeric pager and during busy periods, it would be several minutes following the patient’s arrival before the secretary was able to send the page. In a business that bills based on time and units, a 3- to 5-minute delay can be the difference of billing an additional unit of service. In that regard, something as simple as automated paging may eventually lead to increases in revenue for us.

The EMR we selected has complemented our workflows and helped our practice improve productivity and documentation.

The most vital component to our successful EMR usage is that we selected a solution designed to operate in our business environment. The system’s rehab-specific capabilities allow our practice to automate the processes that matter most to our business. After using the solution for nearly 2 years, we can’t imagine doing our jobs without it.


Andrea Marchi, PT, MBA, CSCS, is the rehab manager at Southeast Missouri Hospital, HealthPoint Rehab, Cape Girardeau, Mo.

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