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.

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

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 Healthcare.gov, 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 CMS.gov and Medicaid.gov.

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/

Audiology 2011 will provide audiologists and speech-language pathologists with in-depth discussions on Audiologic Rehabilitation (AR) for Adults. The broad range of topics will include:

• audiovisual speech perception and how this can impact speech reading in older adults
• the social psychology of acquired hearing loss with implications for practice
• the value of including communication partners in the AR process
• rehabilitation for auditory processing difficulties among adults
• accommodating the needs of adults with hearing loss in the workplace
• auditory training
• the importance and evidence behind effective counseling
• evaluation of the evidence and cost-effectiveness supporting the inclusion of AR services
• subjective and objective measures of hearing aid outcomes

For more information and system requirements, go to Audiology 2011.

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/

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/

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.

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

To promote occupational therapy and membership to the American Occupational Therapy Association, the video was produced by Cheryl Crow, a student of the Samuel Merritt University Masters in OT Program.

Great job, Cheryl.  We appreciate your contribution to the profession.

“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.

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.

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.

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.

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

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]