Medicare PT/OT Claims

As we get closer to the end of the year, more of your Medicare patients are likely to be close to or above the $3,700 annual cap that triggers a mandatory manual medical review of each claim above the cap. (This $3,700 cap covers about 40 visits.)

The mandatory review will require you to provide an extensive amount of documentation.  Also, because the review will likely be done by a nurse with little therapy expertise and involve patients who have been seen for 40+ therapy visits during 2014, the likelihood of denial is very high.

Therefore, we recommend a close review of the chart for any patient who is above or likely to go above the $3,700 cap because, for all practical purposes, your likelihood of being paid for visits above this cap is very low.

Email cedgar@pt-management.com for more information 

Using Outpatient Physical Therapy Benchmarks to Measure and Improve Productivity, Profits

PHOENIX, Ariz. –- Data collected from more than 500,000 patient visits to physical therapy clinics provide real-world clinical benchmarks that can help physician practices optimize their PT practices.

PT Management Support Systems, a leader in managing PT/OT programs for physician groups and other healthcare providers, offers its findings in the October issue of AAOS Now, the monthly publication of the American Academy of Orthopaedic Surgeons.

“Benchmarks can help an orthopaedic practice determine whether its PT program is operating at an optimal level, what functions need improvement, and how to make those improvements,’’ says Cary B. Edgar, PTMS President and author of “Benchmarking PT Programs: Use benchmarking to measure and improve productivity.”

PTMS analyzed data from more about 500,000 visits to PT clinics owned and operated by orthopaedic groups from January 2013 through June 2014. This data included procedures per work hour; visits per day; payments per visit; costs per visit; and other PT-specific metrics.

The data point the way to better practices by highlighting various clinical and administrative inefficiencies. Among other findings, the data show that therapists often under code; scheduling practices do not accommodate as many patients as possible; therapists may be spending too much time on non-billable activities; patients often self-discharge because they do not see the value of therapy; and authorization, billing, and claims denial follow-up procedures are lax.

“Orthopaedic practices can strengthen their ancillary PT practices by applying the findings of these data,” Edgar says. “Inefficiencies can typically be easily addressed with clinical and administrative changes that often improve the quality of care and patient satisfaction.”

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Cary B. Edgar is the President of PT Management Support Systems LLC, a company that helps orthopaedic groups and other healthcare organizations develop and manage their physical, occupational, and hand therapy programs. He can be reached at cedgar@pt-management.com.

To access Edgar’s article on benchmarking, go to http://www.aaos.org/news/aaosnow/oct14/managing6.asp.
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Press contact information:

Diana Kem
PT Management Support Systems
480-206-6240
dkem@pt-management.com

Optimizing the Quality and Profitability of Physical Therapy Services Using Data-Driven Management

PTMS head Cary Edgar to address Texas Orthopaedic Association and Texas Association of Orthopaedic Executives on using data to manage physical and occupational therapy

PHOENIX, Ariz. – September 2014 – Cary Edgar, president of PT Management Support Systems (PTMS), a leader in setting up and managing physical and occupational therapy programs for healthcare organizations, will speak at the 2014 annual conference of the Texas Orthopedic Administrators Society on October 10 regarding the use of data to optimize both the quality and profitability of ancillary physical and occupational therapy.

Edgar will share key PT/OT benchmarks and address why a provider or practice may not be achieving them.  He will also discuss how to use data, such as average procedures per visit, to determine whether therapists are treating patients for an appropriate period of time and whether they are capturing all appropriate charges.  Edgar will talk about payment trends, such as how higher co-pays and deductibles are affecting average visits per patient and overall PT/OT profitability.

 “PT/OT margins can shrink very rapidly, and therefore, proactive management of provider and support staff productivity and overall efficiency based on real-time data is an absolute necessity,” Edgar says.

About PT Management Support Systems

As the nation’s leader in the setup and management of ancillary PT/OT services, PTMS leverages its financial, operational and regulatory expertise to help healthcare organizations, including physician practices and hospitals, generate a substantial ROI. PTMS offers real-time benchmarking, productivity tracking and reporting through its web-based TherapyWorks solution. 

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Press contact information

Diana Kem

PT Management Support Systems

480-206-6240

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