Modifier 59 – The X File-ing Codes

Modifier 59 The Truth Is Out There

Area 59 Modifier 59 – the ‘X’ file-ing codes

Recent The X File-ing Codes rumblings from the US Centers for Medicare and Medicaid Services (CMS) has suggested that Modifier 59 time might be up.  Meaning more headaches when putting together your claim and more rules to learn about.


So what exactly did CMS change and when is it in effect?


Retroactively effective from the very first day of 2015, Change Request (CR) 8863 was implemented, it details the phasing out of Modifier 59 in instances where services rendered were separate and distinct from the service it’s billed with.  CMS are proposing four new HCPCS modifiers, (XE, XP, XS, XU), these will bypass CCI edit rules by indicating either a practitioner, a distinct encounter, an anatomical structure, or even an unusual service.


Now, while these are already in effect they are not mandatory, in fact in the same statement CMS stated that what was accepted as correct usage of Modifier 59 prior to the change will still be considered correct usage for 2015….but for how long???


While CMS has not announced an official phasing out date or timetable for mod 59 (so theoretically it may not be for a while) however, it is in your best interest to start acclimating yourself to the new modifiers now as CMS have already issued guidelines on their use and already accepting their submission!


CMS in their generosity are offering a wealth of knowledge and guidance on correct usage of the new modifiers.  Make sure to be prepared, take them up on their offer, collect the data, do a little studying and avoid the inevitable headache and confusion!

Physical Therapy Practice Management EMR

Physical Therapy Practice Management

New patients are hard to find and even harder to retain. The hardest part, however, is expecting them to refer friends and family to your clinic. For this to happen you need to spend more time with them.  It is estimated that a typical therapist spends 30% of his or her time on non-clinical activities: documenting, billing and staff management. This wastage should stop. And now. This time, if spent on patients would result in the multiplier effect – where one patients brings in many.

This needs an EMR that is more than a set of features, it has to encompass Physical Therapy Practice Management. Every line of code in an EMR should fold and fuse into the bigger picture – which is your PT Practice business.  Document Management for instance isn’t merely about templates. It is about auto-reminders that improve compliance, management tools to monitor your clinic, and features that save time such as integrated faxing. EMR vendors have to understand that documentation is the lifeblood of a clinic. It has to be clear, concise and compliant.

Billing, of course is the elephant in the room. Over 60% of billing errors happen because information does not flow automatically from documentation into billing modules of the Physical Therapy Practice Management EMR. To enter it right once is difficult enough, but to enter it twice is simply uncalled for. At PT PRACTICE PRO information from documentation flows directly into billing.  Your Physical Therapy Practice Management EMR billing should allow you the flexibility to bill daily, weekly, or by Insurance Company.  Many EMR’s are rigid here. They lack the inbuilt intelligence that lets you handle bills YOUR way.

Many PT Practice owners seldom realize the importance of reports. There are over 150 different tasks that can be itemized as reports. Once captured as data, these reports can be deduced as action items that can infuse intelligence into your clinic’s workflow. As a PT Practice product specialist I cannot stress the importance of this enough. Big leaps in profitability happen when small course corrections are made in day-to-day activities. Ask your EMR vendor to list reports that you can view and have them mapped to your workflow.

Making 206 bones work in harmony is enough study and practice for a lifetime. However today’s therapy practitioners have to contend with a medley of compliance rules that CMS seems to enjoy churning out. Unfortunately, many EMR developers aren’t up to speed- they look at compliance as a report card. But, we all know that ticking boxes is passé. Lack of compliance tells on your top-line. 2% penalty if you aren’t PQRS compliant, unbilled time if your clinic isn’t 8-minute rule compliant. Get on with a fully functional Physical Therapy Practice Management EMR.

Physical Therapy HIPAA Compliant EMR

Physical Therapy HIPAA Compliant EMR

How to properly store, protect and dispose of Patients records has always been a never-ending, difficult task for all medical offices. That’s why you need a Physical Therapy HIPAA Compliant EMR.

As we look to become completely paperless and therefore reduce the dangers of protecting records and disposing of them, we still face challenges as to how to balance this transition.  The challenge gets exasperated when trying to find a solution that is cost-effective and time-effective!

As we have learned from the past, cutting corners when storing and disposing of records is eventually going to get you in hot water with HIPAA.  So why not move your PT Practice completely paperless using a Physical Therapy HIPAA Compliant EMR that will not only Boost HIPAA compliance but helping the world and saving one tree at a time during this process.

PT Practice PRO is the ultimate Physical Therapy HIPAA Compliant EMR software system that offers integrated clinical fax solutions, making office to office patient paperwork transfers almost completely paperless.  Eliminating your need to print paperwork and above all no more standing over the fax machine willing it to work faster!  Perhaps we will miss the nostalgic trill of the fax machine but it is a sacrifice worth making when your EMR prevents you from having to spend all day filing!

When a Physical Therapy HIPAA Compliant EMR is implemented, the fright of CMS review, OIG review and audits don’t seem so frightful. At PT Practice Pro, we’ve Got Your Back. We understand the needs of our clients, it doesn’t matter if you are a private practice, franchise or corporate company, we all feel the same adversities brought on my regulations and we are committed to be there for all Physical Therapy members.

Please subscribe to our blog so we can bring you the most up-to-date news about the never ending challenges, changes and rules and regulations within Physical Therapy Industry.

The Impact of ICD-10 Physical Therapy


ICD-10 Physical Therapy

ICD-10 is fast approaching, are you ready? And there is nothing we can do to stop the impact of ICD-10 Physical Therapy.

  • ICD-10 is in full effect

The start date for ICD-10 is set for October 1, 2015 which means from then on, all ICD-9 codes will become obsolete.

  • This change is mandatory

ICD-9 currently has almost13,000 codes, with ICD-10 this database will substantially increase to approximately 68,000 codes! This switch is inevitable so it is recommended that you educate yourself as much as possible and familiarize yourself with reading this new code set. The current ICD-9 is over 30 years old so we should expect that the new classification might also be around for 30 years

  • The difference between ICD-9 and ICD-10 Physical Therapy

ICD-9 consists of three to five characters with a decimal point whereas ICD-10 will consist of three and up to seven characters in an alpha-numeric combination. This allows for a more specific diagnosis and can even include a description of how the injury resulted.

  • ICD-10 CM or ICD10 PCS? Which version are you using?

When you hear talk of ICD-10, most people are referring to ICD-10 CM. This is the code set used to diagnosis coding and is used for all outpatient healthcare settings. ICD-10 PCS or ICD-10 Physical Therapy will be used in hospital inpatient settings for procedural coding.

  • ICD-10 Physical Therapy Cross walking

There are many tools to assist you with the transition process from ICD-9 to ICD-10, as we all know. This revision from 9th to 10th can feel frightful, however, there are many websites out there to help you gain knowledge to make you feel more comfortable as we get closer to the October 1st DEADLINE.

we hope that you’ve found our ICD-10 Physical Therapy blog informative. For more current, up-to-date news and tips, please keep following or subscribe to our STAY IN THE KNOW BLOG specific to all rehab specialist topics.

Maximize Physical Therapy Marketing

Maximize Physical Therapy Marketing

The ultimate guide to Maximize Physical Therapy Marketing with your EMR.

Traditionally providing good treatment and having the right location was enough to run a successful Physical Therapy clinic and attract new business. Unfortunately like everything else in life, it is a lot more complicated than that now, any practice goal should be to maximize physical therapy marketing.

We can no longer rely on word of mouth or the work speaking for itself to attract new clients, so we go back to the source, making connections with Physicians trying to gain referrals. While this has always been an additional source of revenue for clinics, it has now become an absolute must and in many cases is the main source of new business for practices! Which is all fair and well, however this in itself becomes quite an arduous task, between balancing your work and keeping the Physician happy so they will send you a continuous stream of new business!

Most therapists true calling isn’t to sell and schmooze, while some have these skills, the ability to treat and provide comfort is a Therapists true, natural ability. This is why many Therapists struggle to find the right balance or make a significant impact on their practices client base which makes it that much more important to maximize physical therapy marketing efforts.

On top of that, Physicians, like the weather can change quite suddenly! They place new demands, make new connections or move on, leaving your business with a gaping wound where once was a stream of new business. Leaving you with the problem of trying to market your brand, but you have a mountain of paperwork and patients to treat, who has time to drive around trying to open new avenues of referrals?!!

Larger and modern clinics have cracked the code, in this battle you need a weapon and, that is a person dedicated to maximize physical therapy marketing your business! Yet, that alone is not enough, because unless this person has an eidetic memory, they will need a system or preferably a software in place that will allow them (and you!) to effectively track the referrals and the success rate of marketing techniques.

Providing excellent service is no longer enough and making local connections is not enough, in this day and age, it is absolutely essential to have a marketing representative dedicating to selling your brand and above all to equip them with the right tools. Don’t sink, swim! It may be time to start interviewing and researching for the right software and Maximize Physical Therapy Marketing!

Physical Therapy Referral Management

Physical Therapy Referral Management

2 Keys to Enhanced Physical Therapy REFERRAL MANAGEMENT with an integrated EMR!

Enhance Provider Referrals by using a SMART referral management system. Is this possible, do you really need a new system? Absolutely! Being able to identify each and every referral by Doctor, Doctor Specialty, clinic and how they found you can make a world of difference, having this information will make you a referral management guru!

After all, Therapists love to treat and would rather not spend precious time having to do referral research, this is why having a Physical Therapy referral management system is so important. If you are able to use your EMR system to combine this data for you, then why not?!

How is your Provider Communication?

We all know that a huge part of healthcare is contingent on providers talking with other providers on an efficient and timely basis. Are you on board with an EMR system that can produce clean and organized reports that cover all of the data that your Doctor wants to know? Well if you are not, you’ll definitely need one. Time is of the essence, providing straight forward Documentation will accelerate your communication process between Therapist and Physician.

Physical Therapy Referral Management Mapping

This will be your road map for when it comes time for referral marketing. If you’ve been able to cover the two points above, then you are set to go. Now you know who your patients are, which Doctor referred them, their specialty type, where their clinic is located, etc. In addition, you have an EMR system that can provide precise documentation giving physicians a clearer understanding of the patient cases, progress of treatment which will give them an advantage when it comes to providing more comprehensive care.

We hope that our readers implement some type of Physical Therapy Referral Management system. We look forward to your comments.

Remember to keeping checking our blog posts, we are committed to providing the latest news, tips and innovations to our Physical Therapy community.

PQRS Physical Therapy

PQRS Physical Therapy What you need to know about PQRS and the effect on Physical Therapy

What does CMS mean to you and your practice?

For those involved in the healthcare industry, we all know that CMS stands for the Centers for Medicare and Medicaid Services.

How does CMS affect your patient care?

In case you didn’t know, CMS is THE LARGEST PAYER in the nation. It doesn’t matter if your patient’s benefits fall under part A, part B, Part C, Part D or all of the above. All providers are subject to regulations set by laws. These regulations have been around and will continue to stick around.

It seems that the big regulation topics right now are FLR and PQRS Physical Therapy. These regulations are set in place to keep rehabilitation specialist compliant within the rules of “medical necessity.” Out of all providers, PT’s, OT’s and Speech Pathologists are the most affected by these rules.

PQRS Physical Therapy in your EMR

Bottom line, Non-compliance is NOT an option. So, how can we ease the burdens of these PQRS and Physical Therapy requirements?

  • Get with an EMR that automatically flags you when PQRS is required
  • Design a solid workflow that you can implement into your EMR software
  • Get your staff educated on the 4 W’s – Who, What, When and Why

WHO – Any patient has benefits under CMS

WHAT – According to APTA, to participate in PQRS and Physical Therapy, you must report on a minimum of 3 measures for 50% of all Medicare patients seen during the reporting period

WHEN – These reports are required on specific intervals, please CLICK HERE to learn more about PQRS Physical Therapy.

WHY – All providers must stay compliant and within regulations. Without satisfying these requirements, you won’t be eligible for re-imbursement, continued patient care and even worse a lag in your continuity of care

Physical Therapy Referrals

Physical Therapy Referrals

Do you want to increase Physical Therapy Referrals for Your Practice?

Sales and Marketing in the Physical Therapy Industry can be a real pain, it’s a lot of work and very time consuming! In this day and age, we seem to have less and less time available, time is money and what we need is a little more of both.

Just think and ask yourself, what if I could track all of physical therapy referrals and convert them into new patients, my physical therapy referrals source activity, my sales/marketing rep activity and my overall productivity at a glance. And that’s not even the best part, WHAT IF… I could have all of this available at home, at the office, on the go and even better, ALL AT YOUR FINGERTIPS.

I mean that’s the way of the world now, right? So you should be asking yourself, if I could have this and if it’s available, would I want it? Um, heck yeah!!

Well some systems think they have something that can help you but can they?

PT PRACTICE PRO has spent tons of time and energy investing in a new software feature that has the ability to combine all of these metrics to do your work for you. Who has the time to sit around pulling report after report, wasting precious time examining data and crunching numbers for one specific entity of your practice.

So, if you are a Practice owner, Clinic director, sales/marketing representative or fit in any of these roles, then you’ll definitely want to check out the new Referrals Management feature. This feature will be able to track your best referrals sources, all your marketing activity, calculate your referral rate, where your patients are coming from and so much more.

So, stop waiting and contact us today, our clients will testify that these Physical Therapy referral management tools have QUANTIFIED their REFERRALS. We’ll be more than happy to provide a demonstration of how this can work for your practice!

EMR Medicare Compliance


EMR Medicare Compliance

Keeping Compliant

If anything, it is back to the basics. You begin by addressing the elephant in the room – documentation. That’s where it all begins. And if you aren’t careful enough, that’s where it will, sadly, end too for your practice! Nothing is more important that keeping your EMR Medicare Compliance.

Schedule and safe guard your documentation like a bank. Clockwork precision, nothing less. Totally chaotic, barely legible paperwork delights third-party auditors, not PT practitioners. Try PT Practice Pro’s documentation module. Experience maximum organization with minimum fuss, by which we mean our in-house product specialist putting your people through the paces by as many webinars as it takes.

With PT Practice Pro EMR Medicare Compliance Isn’t All That Complicated

Many an EMR software gets data capture and documentation right during a patient’s first visit. But when it comes to carrying over relevant data to subsequent visits they crater off and leave practice owners stranded on unfamiliar and lonely IT roads. Not PT Practice Pro. Thanks to inbuilt workflows that alert practitioners, we thread and weave a patient’s history well. No detail is assumed unimportant.  The result: our notes, actually your notes, are both clear and compact. As is your billing and compliance adherence.

Cloud-based Information Capture Keeps You Informed

PQRS, ICD-10, 8-minute rules or what have you – regulators change rules out of the blue. PT Practice Pro’s cloud-based EMR Medicare Compliance updates them equally fast.  Unlike vendors with web-enabled we don’t let you fall behind the curve.  As with all federal or state legislation for that matter, the workable essence is lost in a mountain of legalese.  We extract just the stuff you need to keep the ball in play. We’ll keep you posted on the happenings through blogs, newsletters and webinars.  Should you still need an in-person assistance our product support team is a mere phone call away, right here in The US. Log in your ticket and a product specialist will ensure a working response to your problem.