Hungry, Hungry HIPAA!

HIPAA hippo

HIPAA Health Insurance Portability and Accountability

With the recent announcement that the 21st Century Cure Bill had passed it first congressional hurdle has left many health-care providers scratching their heads, wondering is this a good thing??

The scope of the bill seems to be to advance the impact and success of medical innovation, the methodology would be to collect, compare and analyze patients protected health data supporting HIPAA compliance.

So the question is, how are they going to collect this data?  Are we expected to collect/send MORE data when treating, ask more questions?!?  How does the patient consent? And more importantly how do we stay compliant and protect our data??!

Well, according to the Bill the data would be used by researchers, they would have remote access to the PHI collected, from which point they can begin to analyze and compare data, hopefully leading to the discovery, development and delivery of new drugs and treatments.  Without patient consent.

Yes, you read that right, without patient consent, these proposals will effectively loosen HIPAA regulations in terms of storing PHI, however it would strengthen the level of responsibility for EHR vendors and Health IT systems.  In the same vein, within the Bill is a measure that provides for penalties for Healthcare entities that “inappropriately” block the sharing of information!

What seems to be the upside to this proposal then as a qualified experienced healthcare provider? The Bill would appear to provide payments to those who exchange or disclose PHI for research purposes, although the amount has not been specified nor have the submission parameters, leaving everybody unclear and unsure as to how to prepare for this change and staying HIPAA compliant.

With the huge fine given to Anchorage Community Health Services ($150,000!!!!) for HIPAA violations due to malware infections, the one thing that is certain.  Many will be weary and will not rush into any new changes without clarification.

Pay for Performance

Pay for Performance

Goodbye Fee for Service, Hello Pay for Performance! Most recently, Outcome reporting is becoming a more prevalent topic of interest within the Physical Therapy industry. More interestingly, did you know that the Physical Therapy profession has been fighting barriers with identifying the true value of rehabilitation for years? Which is a huge reason why PT’s have evolved from a certificate program to a Doctorate level medical professional. Bravo!

So what is Pay for Performance?

Recently stated in Health Affairs that Pay for Performance is a new payment systems that reward doctors and hospitals for improving the quality of care. Sounds fair enough right, however, this became grew to a current “issue” that leaves many with mixed notions.

So, what is the difference between Fee for Service Pay for Performance?

Fee for service is built on a model of service delivery, physicians charge separate fees for each service(s) provided to their patients. This is ideal as it allows the providers to receive maximal revenues. And as we all understand that in our industry, practice revenues is thee lifeline.

So although, the goal of Pay for Performance will certainly improve the standards of healthcare, it does affect the reimbursements for providers. For those in the Physical Therapy industry, it seems as if we have just gotten another curve ball thrown at us on top of all of the other regulations, rules and requirements already in place.

Please stay tuned to our blog as our next articles will be on how we can implement the Pay for Performance model, improve quality of care AND preserve maximum insurance reimbursements by utilizing OUTCOMES.

A PQRS a day keeps Medicare at Bay

PQRS Medicare and Physical Therapy

As well are all aware by now, this whole PQRS thing is going to be around for a long time, so the sooner we get used to it, the better.  And besides, even if Medicare does do away with it we all know there will be something similar nor far behind it!

PQRS or the Physician quality reporting system requires professionals who bill Medicare under part B to report data, finding and notes to ensure payment and above all to avoid the adjustment penalization that occurs with non-participation or unsatisfactorily.  This is currently set at an annual deduction of 1.5% on claims but has been now been raised to 2% and that will take effect in 2017.

But there is not just punishments there is rewards too, with CMS paying out more than $380 million in incentive payments through PQRS and Electronic-Prescribing Incentive Program.

So how are we Physical Therapists faring?

Well for the most part not bad, but not great either with almost 40% of health care providers seeing their Medicare reimbursements cut by 1.5% for the whole of 2015 as they did not meet the guidelines.

But the big news is that Physical Therapists have done the side proud and actually beat the national average by more than 10 points!

How about other health-care providers?  It would seem that Physicians for the most part have no interest in taking part and do not seem overly concerned with the threat of a 1.5% reductions in reimbursements due to not reporting PQRS.  65% of eligible physicians did not take part claiming the whole process is too confusing and too time-consuming!

However of these 65% physicians it is estimated that the vast majority will treat less than 100 Medicare patients a day so that could also be a big factor, either way nice job therapists, take a bow and your incentive you’ve earned it!

MMR Manual Medical Review

MMR Manual Medical Review

M.M.R. – K.O or OK??

Just when you thought you knew it all, CMS comes along with a brand new rule change!  New modifier or even a new code we can all live with and adjust to, but now you are telling me that we are going to change the whole MMR Manual Medical Review process?  Well that is not playing by the rules!  Unless, (Whisper it) the new changes makes things easier?!

Actually it turns out that may be the case!  CMS are proposing a new post-payment review procedure that entails more of a logical stepped approach for the RACS (Recovery Audit Contractors).

The new procedures will allow the RACS to issue up to 5 individual ADRS (Additional Documentation Request’s) starting with a document request for the first claim that took the patient over their annual MMR Manual Medical Review limit.  As always there has to be a 45 day gap between each ADR, however with each subsequent ADR the RAC can request more documents. The RAC will have the ability to request up to 10% on the second request, 25% on third, up to 50% on the fourth and 100% of documentation by the fifth request.

This seems like a more logical and organized method, allowing for easier resolution of MMR Manual Medical Review and a shorter review period.  However before we get too excited, this new procedure does not yet apply to claims made in 2015, as yet only applies to outpatient therapy facilities and has still be completely finalized.

We had a feeling that this might have been too good to be true, but we are confident that this method will prove more successful and become standard procedure.

Stop Therapy Cap

Stop Therapy Cap

In Today’s News – Good times. Bad times…

The vote is in and the future will never be the same again, or something like that! We need to Stop the Therapy Cap

The long awaited vote on Medicare’s policies, specifically the SGR (sustainable growth rate) and Outpatient therapy cap is in, the vote was due almost 2 weeks ago but was pushed back due to a Spring break for the senate.

The SGR has been a bone of contention for many treatment providers, it set a physician’s payment rate based upon the quantity of treatment they provide, more worrying though was the proposed rate for 2015, a reduction of payment rates by almost 21%!!

So as you can imagine it was with absolutely no sadness that we wave goodbye to the SGR plan and say hello the new payment system that is proposing an annual raise of 0.05% in Medicare reimbursement rates for the next 5 years!  Furthermore, this payment plan will base the physician’s payment rate based upon the quality of care they provide instead of the quantity.

Which leaves the dreaded Therapy Cap, for almost 18 years it has been a thorn in the side of Therapists, creating a barrier to administrating care for those trying to aide their elderly patient into having a more comfortable existence.

We have all cursed the cap at some point as it has a knack of getting in the way when you starting to make some significant progress but it would seem that this battle has been lost and unlike the SGR, the cap will stand.

However this will not stop those determined to right this wrong, there are several groups who have been actively campaigning since its introduction to scrap it and this latest set-back will certainly not be the final word!

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!