Many
orthopaedic groups are under the incorrect assumption that their physical and
occupational therapists cannot accept referrals from outside physicians or that
there is a limit on the percentage of patients that can come from outside
referrals.
Your
physical and occupational therapists can accept outside referrals, including
referrals of Medicare patients. However, to accept outside Medicare referrals,
your therapists need to be enrolled with Medicare (in the same manner as your
physicians), their receipts reassigned to the group, and you should be billing
under Medicare’s therapist in private practice (TPP) rules (which are expressly
permitted for therapists employed by physician groups). Most orthopaedic groups
are already billing Medicare for therapy under the TPP rules, rather than the alternative
“incident to” rules. You cannot accept outside referrals of Medicare patients
if you are billing under the incident to rules because incident to patients must
be under the care of one of your physicians.
In
addition, the percentage of therapy patients that can come from outside
referrals is not limited. In the past, most orthopaedic groups have not been
able to attract a significant number of outside therapy referrals. However, as orthopaedic
groups have expanded their therapy practice at main and multiple satellite
offices and private therapy practices have shrunk or disappeared, outside
referrals have increased and are more commonly becoming a significant source of
therapy patients.
Increasing
therapy referrals is key to maintaining and even growing PT/OT profitability.
This is especially the case given that the average number of visits per patient
has been steadily trending downward as deductibles and co-pays have increased
and payers have adopted more stringent authorization requirements. For example, if your average visits per
patient decreases from 10 to 9 (which is not unusual), you will need to
increase the number of new patients by 11% to avoid a decrease in total visits.
If your average visits per patient is decreasing and you are not offsetting
this decrease by an increase in referrals from your physicians or outside
physicians, the decrease in your total PT/OT visits will almost undoubtedly
result in a substantial decrease in profitability.
Visit us at www.pt-management.com
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