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.

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.

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:

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.


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.

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.

Extension of Therapy Cap Exceptions Process

According to the Centers for Medicare & Medicaid Services (CMS), on March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, which extends the exceptions process for outpatient therapy caps (see Section 3103).  Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after January 1, 2010, through December 31, 2010.  

The therapy caps are determined on a calendar year basis, so all patients began a new cap year on January 1, 2010.  For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,860.  For occupational therapy services, the limit is $1,860.  Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.

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.

Four Steps to Improve Your Therapy Revenue Cycle

February 19, 2009 · Posted in Reimbursement · Comment 

This article is from IMPACT, January 2009, with permission of the Private Practice Section,
APTA.  For a downloadable .pdf version of the article, click here

Four Steps to Improve Your Revenue Cycle – Independent of Billing Systems or
Claims Clearinghouses

By Jim Hammer
The threat of a 10.6 percent Medicare payment reduction captured the attention of many
therapy practices this past summer. Ultimately, the payment reduction was voted down,
but the bill had an unanticipated impact on the industry. It prompted many practices to
evaluate how they could maximize existing revenue streams and better prepare for future
financial challenges.
One innovative approach recently implemented at many therapy practices focuses on
analyzing electronic remittance advice (ERA) to reduce denials and underpayments.
Using ERA data, as opposed to data posted in the billing system or culled from the
clearinghouse, gives therapists greater insight into denial rates, by payer, as a means of
recouping reimbursement. This wise approach allows therapy practices to:
1. Pinpoint reimbursement bottlenecks
2. Benchmark findings
3. Efficiently track and work denials to recoup revenue
4. Monitor payer contract adherence
Focusing on these four key components of the revenue cycle helps practices find missing
and overlooked reimbursements, while helping them with timely and efficient collection.
Most importantly, ERA data analysis allows practices to gain an understanding of why a
payer denied a claim so they can prevent future denials. The resulting analysis gives
power back to therapists for dealing with payers, and allows them to develop the best
possible processes to ensure the full reimbursement they are allowed with the lowest cost
of collections.
The power of Web-based applications makes this type of analysis possible, even for the
smallest of practices. Subscription-based services allow practices to upload their ERA
data to a Web application, where tools are available to analyze the data. By leveraging
Web-based applications, practices do not have to hassle with licensing, implementing and
maintaining software and hardware.
Pinpointing Reimbursement Bottlenecks
Optimizing the revenue cycle depends on identifying reimbursement bottlenecks, such as
tracking the average payment delay by payer, or documenting if above-average delays
tend to result when specific procedure codes are used in claims. Identifying bottlenecks
provides therapists, billing and collection staffers with valuable information as to where
they should focus their efforts and modify processes to reduce delays. From a manager’s
desktop, numerous probes into the practice’s data offer new ways to trend and measure
bottlenecks that impact the revenue cycle, such as tracking:
• Claim summaries by reason code and/or procedure
• Denial rates by procedure
• Days sales outstanding (DSO) by procedure
• Claims summary by reason code/procedure
• Average payment lag by procedure
• Aged claims
• Patient lag by procedure
Benchmarking Findings
Much of the value in pinpointing bottlenecks is that it allows practices to benchmark their
findings for comparisons against other peer organizations locally, regionally or
nationally. Leading Web-based analytical tools will provide benchmarking data as part of
the subscription service. Benchmarking reports allow practices to get answers to
questions, such as how long does it take a practice vs. peers to get paid for specific codes,
and how often does a payer deny claims for specific procedures?
Tracking and Working Denials to Recoup Revenue
Part of the challenge for today’s therapy practices is tracking denials, rather than letting
them slip through the cracks and lose reimbursement opportunities. Web-based solutions
are available to help, and can include decision-support tools to assist with reworking
claims for resubmission. Actual customer experience shows that the average time to
rework a claim is 45 minutes and typically costs about $73. Applications that can
expedite this process immediately reduce operational costs.
Monitor Payer Contract Adherence
Each practice loses $30,000 on average per year due to underpayments. Practices that can
systematically track payer compliance have an opportunity to substantially increase
reimbursement. To accomplish this, practices can load payer-specific fee schedules into
Web-based systems to monitor payer compliance by comparing reimbursement to
contracted amounts.
The capabilities of Web-based solutions tailored for therapy-based practices continue to
advance. The best thing is, with no new software, hardware, long-term maintenance
contracts, or lengthy implementation projects, therapists can quickly drive more cash to
their bottom lines with these new tools. And, unlike relying on billing systems, these
new-generation Web-based tools are looking at payer-generated remittance files –
analyzing data that never even makes it into the billing software.
In this day of cutting costs and maximizing productivity, it pays to look at simple, Web technologies
to augment investments, instead of creating more capital expenditures. It’s
anticipated that future generations of these solutions will even be able to provide
practices with tools to determine the expected profitability of specific procedures based
on patient diagnosis. These solutions provide practices with powerful tools to avoid lost
revenue opportunities and identify processes that can be modified to support long-term
Jim Hammer, Chief Operating Officer of Chart Links, can be reached at

Legislation to Repeal Therapy Caps Introduced by House and Senate

January 14, 2009 · Posted in Reimbursement · Comment 

According to the American Physical Therapy Association (APTA), physical therapy services for Medicare beneficiaries would no longer be limited by arbitrary financial caps under legislation introduced this month in the Senate and House of Representatives.

The Medicare Access to Rehabilitation Services Act (S 46/HR 43) introduced calls for the repeal of the Medicare therapy caps that limit coveraege of outpatient rehabilitation services to $1840 for physical therapy and speech language pathology combined and $1840 for occupational therapy services.

The therapy caps were originally adopted by Congress in the Balanced Budget Act of 1997. The caps reduce beneficiaries’ access to critical services by limiting their choice of providers by requiring them to pay 100% of the cost of care once they exceed the cap or ration their care to avoid exhausting their benefits. Since 1997, Congress has acted to prevent implementation of the caps by passing several moratoria and authorizing an exceptions process for rehabilitation services above the financial limitation based on diagnosis and clinician evaluation and judgment. An 18-month extension of the exceptions process was included in the Medicare Improvements for Patients and Providers Act (HR 6331), which passed July 15, 2008. The exceptions process is set to expire December 31, 2009.

The repeal of the therapy caps protects Medicare beneficiaries, ensuring they receive the rehabilitation services they need as they recover from serious injury or suffer from debilitating diseases.

Therapy Documentation Software Return On Investment

January 5, 2009 · Posted in Compliance, Documentation, Reimbursement, Scheduling, Workflow · Comment 

When it comes to automating therapy documentation, funding is one of the biggest challenges outpatient rehab facilities face.

If you’re struggling to make a compelling business case for electronic medical records to your hospital board of directors, consider all of the operational areas that will yield quantifiable results.  As you build your case, marry up metrics to timeframes as a part of your formula for return on investment.

Efficiency Improvements

When you automate therapy appointments, appointment reminders, referral management, authorization tracking, evaluations, plans of care, progress notes,  flow sheets, and more; information can be called up and acted on almost immediately.  List out and quantify all of the administrative task time this saves.  Consider improvements in communications alone as it relates to time spent on referrals, authorizations and appointment reminders.    The staff productivity gained allows for major improvements in therapist work flow which, over time, allows more patients to be seen in the same amount of time.

Cost Savings

One of the greatest cost savings brought by electronic therapy documentation is the elimination of transcription costs.  Because therapists enter clinical documentation directly into the system, traditional paper-based methods are greatly reduced, if not eliminated.  Determine your current cost per therapist or per page for transcription.  Estimate, conservatively, a reduction in transcription costs.  This will likely be one of the most significant contributors to your overall cost savings with an electronic therapy documentation system.  Don’t forget to consider other paper chart costs in the ROI equation:

  • supplies for creating and storing charts (from folders, stickers and dividers to cabinets)
  • labor expenses for managing chart pulls, filing and audits
  • copying expenses for documentation to attorneys, payers and physicians

Revenue Enhancements

Electronic therapy documentation opens new doors for driving revenue that should be considered as a part of return on investment.  Consider how much more compliant, complete and accurate documentation becomes when it has the checks and balances of automation.  Coding levels and claim errors correlate directly to documentation of the encounter.  When therapy documentation occurs electronically, therapists report greater confidence levels as it pertains to Correct Coding Initiative (CCI) Edits, Medicare time tracking (or the eight minute rule), authorization tracking, and other compliance issues that can help or inhibit proper reimbursement.  Consider improvements in billing accuracy as a part of your ROI analysis.

Quality Improvements

Some of the less tangible returns of electronic therapy documentation include quality.  In most cases, electronic documentation allows for quicker, more legible, better organized and more comprehensive patient documentation overall.  Across the outpatient rehab facility, automation standardizes clinical documentation, reducing inconsistencies in structure,  poor handwriting, and lag time in documentation and approvals.  Patient education sheets are readily accessible and up to date.  Plan of care reports are auto-generated from the evaluation, able to be monitored, electronically signed, and faxed from the desktop.  These and many other improvements in quality should be considered in ROI.


In an outpatient setting, electronic therapy documentation impacts both the therapist and staff productivity.  A good business case for return on investment should focus on

  • efficiency improvements
  • cost savings
  • revenue enhancements
  • quality improvements

If you need help putting together your Return on Investment business case for an electronic therapy documentation system, please contact us.

Chart Links at APTA PPS Booth #512

October 27, 2008 · Posted in Marketing, Reimbursement · Comment 

Chart Links will exhibit at the American Physical Therapy Association Private Practice Section 2008 Annual Conference and Exposition, Booth #512, in Orlando, FL on November 6-8, 2008. 

Please stop by to visit John Rea and learn about our web-based reimbursement tools and/or our therapy web design services for private practices. 

For a complete listing of tradeshows at which Chart Links will exhibit, please view our schedule.

Payers Getting the Best of Your Bottom Line?

October 12, 2008 · Posted in Reimbursement · Comment 

The threat of a 10.6 percent Medicare payment reduction captured the attention of many therapy practices this past summer. Ultimately, the payment reduction was voted down, but the bill had an unanticipated impact on the industry. It prompted many practices to evaluate how they could maximize existing revenue streams and better prepare for future financial challenges.

One innovative approach that has been implemented at therapy practices focuses on analyzing electronic remittance advice (ERA) to reduce denials and underpayments. Using ERA data as opposed to data posted in the billing system or culled from the clearinghouse gives therapists greater insight into denial rates, by payer, as a means of recouping reimbursement.

ERA data analysis allows practices to gain an understanding of why a payer denied a claim so they can prevent future denials. The resulting analysis gives power back to therapists for dealing with payers, and allows them to develop the best possible processes to ensure the full reimbursement they are allowed with the lowest cost of collections.

Therapy Reimbursement Tool to Offer Benchmark Data for Rehabilitation

September 1, 2008 · Posted in Reimbursement · Comment 

Chart Links will soon offer reimbursement tools and benchmark data to physical therapy, occupational therapy, speech-language pathology and audiology practices. 

Payer claims data will be aggregated and analyzed from a Web-based suite of management reports and workflow tools that the therapist will use alongside any existing practice management or billing system. 

By allowing therapists to identify and reduce denials and underpayments from electronic remittance advice, the solution will help to make therapy practices more profitable.  It will also allow them to compare reimbursement data against regional and national averages.

Get more information about this Web-based tool for therapy reimbursement that will help manage denials and underpayments.

Read the press release about our partnership to provide these physical therapy reimbursement tools.