10 Billing Reports that Make or Break your Practice

10 Billing Reports that Make or Break your Practice

10 Billing Reports that Make or Break your Practice

10 Billing ReportsCash flow is the engine of any practice and it should be easy for clinicians to obtain reports on any aspect of their practice in a simple, streamlined and efficient manner that doesn’t require contacting the billing department.

Those reports are the metrics by which a practitioner can determine profitability and the health of his/her clinic.

The most important aspect for clinicians is that billers to do their part in the most efficient manner possible. They may be familiar with particular medical billing software and only choose to use certain programs. That preference doesn’t matter, as long as the software is capable of generating the 10 billing reports needed to track and monitor different practice metrics.

The aging report, which shows a summary of all accounts receivable (known as AR) is the primary tool for assessing and analyzing high level practice profitability across multiple metrics. The AR is typically viewed as a way to identify late or non-paying patients, but the right EMR software can provide in-depth data in an extensive variety of areas that affect the viability of a clinic.

Payer Payment Patterns

It doesn’t take long after a clinician opens a practice to discover that all payers don’t reimburse at the same level and those payment rates can change over time, necessitating periodic reviews. Payer reports are essential for a clinic to determine which insurance companies and clearinghouses reimburse at the highest levels and those who are slow to pay / pay less than others.

  • Medicare now pays approximately 80 percent of private health insurers 80%
  • Medicaid pays at an average rate of 56 percent. 56%

Medicare and other payers determine the rate at which practitioners are reimbursed according to the resource-based relative value scale (RBRVS). Part of the 1989 Omnibus Budget Reconciliation Act, this was created to address disparities in the payment system and a large number of private insurance payers reimburse practitioners at rates that are lower than Medicare.

It’s a particularly troubling problem for clinicians as Medicare and Medicaid has reduced reimbursements after passage of the Affordable Healthcare Act, and this may change further with the new administration.

Practitioners don’t want to deny care, but many are weighing the pros and cons of accepting Medicare, Medicaid and payments by certain payers. The ability to generate a corresponding report provides clinicians with the essential reimbursement rates by payer, allowing them to work with companies with the highest payments.

Provider

It always pays to examine the competition and the right EMR billing medical software can provide clinicians with an overview of what other providers are charging for the same services. It’s essential for practitioners to evaluate their fee schedules to make reimbursements a priority, but be wary of radical increases or setting fees at $200 if others in the area are only charging $75.

Many practice owners mistakenly believe that setting their fees at the level allowed by payers will ensure payment. They feel that payers will only reimburse at a set level and are happy if they receive that amount. Fees should be established at a higher rate than what providers pay. The difference will be paid by secondary insurers or the patient.

Patient

Every practice encounters patients that are habitually late on paying their balance or don’t pay until threatened with a collection agency. The ability to generate sophisticated reports to identify those patients is a critical step in increasing revenues. Patient reports can show those who are slow or delinquent on co-pays and outstanding balances.

One solution is not to schedule more appointments for the patient until they’ve paid their bill in full. Clinicians aren’t bill collectors and EMR reports provide a way to identify the most desirable patients and those that readily pay their portion of medical costs.

Referring Physician Reports

Referrals are an essential part of operating a practice, but some referral sources are more valuable than others. One of the 10 billing reports practitioners need is a comprehensive view of referring physicians. An EMR report should provide clinicians with information on which physicians are providing the greatest number of referrals of patients with the highest paying insurance companies.

Provider Productivity

In practices with multiple providers, there are always individuals who treat more patients and consistently provide higher paying services to individuals. With sophisticated EMR software, practice owners can determine which providers are making the most money for the practice.

Location Analysis

Practices with multiple locations often have widely varying revenues that can be related directly back to where patients are originating. Reports provide practice owners with patient demographics to ascertain variables that include location. Business owners can focus marketing efforts on areas that are being underserved and populations most likely to require their services.

ICD-10 Codes Reimbursements

ICD-10 codesICD-10 codes can be used to more precisely document each diagnosis for increased revenues. A comprehensive EMR provides key data about which ICD-10 codes make the most money for the practice. Clinic owners can use that data for marketing to patients most in need of services that can be justified through the ICD codes and an EMR should be able to link ICD-10 codes with CPT codes. Reports will reflect which diagnosis codes generate the most income.

CPT Code Analysis

CPT codes can be exhibited through reports to show which services achieve the highest level of compensation. It’s valuable information that provides insights for marketing. CPT codes can be used effectively with multiple ICD-10 codes to more accurately reflect the full extent of the services provided. The data can be especially important for treating patients with chronic conditions, providing value-based care, and marketing to specified populations.

Co-pays and Outstanding Balances

As patients become responsible for a greater financial portion of their healthcare, clinics must make every effort to collect co-pays at the time of the patient’s appointment and achieve a quick turnaround on their balances. Clinicians should have software that can generate reports on patients who pay their co-pays, those with outstanding balances of long duration, and those who are chronically late paying their bills.

Productivity By Day, Week and Hour

The ideal for any practice is a steady stream of patients each day without cancellations or blank appointments. The clinic’s EMR should have the functionality to produce a report that identifies the most productive times of the day, the times and days of the week that cancellations are most likely to occur, and even which individual within the practice is experiencing the highest level of unproductive down time.

Conclusion

Errors remain a common problem for many practices with NCCI edits for Medicare topping the list. Problems depriving clinics of revenues range from misspellings, erroneous entries and coding difficulties to improper use of modifiers, demographic data and incorrect referral and preauthorization information.

Sophisticated software such as In Touch EMR™ can be customizable and provides an integrated solution that can generate the 10 most critical reports required for a practice’s financial well-being. The reports are highly detailed, yet displayed in simple and easy to understand formats.

The software can check insurance eligibility online when appointments are made, post ERAs, and bill secondary insurance sources. The EMR scrubs claims before they’re submitted and provides automatic alerts if it detects a potential problem that would affect acceptance and reimbursement.

In Touch EMR™ reduces errors and has one of the highest levels of successful reimbursements in the field. It offers an integrated scheduling, documentation, billing and marketing software solution fully capable of generating the 10 types of reports that make or break a practice.

Need More Information about In Touch EMR? Contact Us

In Touch EMR is a fully integrated scheduling, documentation and billing software for physical therapy practices. It is a simple and user friendly web-based, ICD-10 and HIPAA compliant EMR, and it offers customizable templates for notes, the ability to attach files, electronic signatures, and the ability to track progress notes, treatment plans, and assessments.

Please click here for a brochure of In Touch EMR. (please right click and choose ‘save as’ to download the brochure).

Click here for answers to your most frequently asked questions about EMR selection and transition.

In Touch EMR has grown to over 1000 clients, our company / founders have been mentioned on CNN, Forbes, Huffington Post, Amazon, been featured as a Cleardata success story, received the prestigious ONC certification, 2015 and 2016 PQRS registry designation, integrated with Microsoft’s cutting edge patient portal technology and initiated groundbreaking healthcare partnerships with companies like Novartis. All of this is possible thanks to clients across the country, who have embraced In Touch EMR.

In Touch EMR is featured on our HIPAA compliant hosting partner (Cleardata) website along with other industry leaders such as the Cleveland clinic, Nexttech, Saint Mary’s regional medical center and UCLA health.

SIMPLE, TRANSPARENT PRICING MODEL

At In Touch EMR, we charge a flat fee per licensed clinician (no hidden fees or surprises) and it includes everything, unlimited claims and notes and infinite custom template creation. We are also a CMS recognized PQRS registry, we automate the reporting of PQRS and Functional Limitation G codes and provide automatic alerts for plan of care expirations, authorizations, progress note reminders and KX modifier alerts.

Clients also get a self-paced video training program on how to get up and running, custom documentation template builder, iPad app – one touch document import, Instant Intake iPad app, unlimited patient manager and patient portal.

Every license unlimited ongoing support (phone / email / live chat), billing software integration, unlimited appointments, unlimited documentation, unlimited document uploads and unlimited electronic faxing.

OFFICE OF THE NATIONAL COORDINATOR CERTIFIED ELECTRONIC HEALTH RECORD TECHNOLOGY

We are a premier vendor in the rehabilitation space, and on the prestigious, certified Health IT Product List, which is a division of the office of the National Coordinator for Health Information Technology, a division of the Department of Health and Human Services.

Very few vendors can make this claim, and they generally won’t bring this up (in some cases, out of ignorance) mostly because this is not a mandatory certification, it is optional and requires a significant investment of time and effort. This certification is a sign of our commitment to a HIPAA compliant, secure and stable EMR system for your clinic.

If you ever get audited, the fact that you are using ONC-certified EHR technology (CEHRT) will work in your favor. CMS looks favorably on the use of CEHRT since HHS is trying to encourage the adoption of CEHRT amongs providers nationwide as part of a long term push towards electronic documentation and interoperability between EMR systems. Your practice can state that it carefully vetted and selected “a rehabilitation-specific vendor that passed  all of the ONC HIT 2014 Edition EHR Certification criteria required to satisfy the Base EHR definition”

Since In Touch EMR has been very proactive at staying at the forefront of emerging guidelines for EMR vendors, you are assured higher quality, higher security and more compliance with CMS and other payer regulations.

For more information about the ONC, please visit:

http://www.healthit.gov/newsroom/about-onc

In Touch EMR is one of the only EMR vendors in the rehabilitation space to pass all the 2014 Edition EHR Certification criteria required to satisfy the Base EHR Definition as stated by the Office of the National Coordinator for Health Information Technology, as listed here: http://www.healthit.gov/sites/default/files/pdf/BaseEHR_8-18-12_Final.pdf

In Touch EMR is on the Certified Health IT Product List (CHPL) website.

http://www.healthit.gov/policy-researchers-implementers/certified-health-it-product-list-chpl

The product is listed here:

http://oncchpl.force.com/ehrcert?q=chpl

Search for In Touch EMR > CHPL Product Number: 150002R00

PRAISE FROM THOUSANDS OF SATISFIED CLINICS ACROSS THE UNITED STATES

“In Touch EMR has emerged as a comprehensive, customizable EMR solution for our growing organization. Support is always there when we need it, options to customize options to match our workflow are endless, clinicians find it simple and easy to use, front desk and billing love the integration between documentation and claims and compliance is built-in. This is exactly what we needed and it has boosted our efficiency. Couldn’t have asked for more. In Touch EMR is a leader in web-based EMR for our practice. Thank you!”

Julie Edelman PT, DPT – Avanti Therapy

“Moving to In Touch EMR was a process of adjustment, but it was worth it, for several reasons. Not only has the staff at In Touch EMR been proactive in adding new features and responding to support calls and streamlining our billing processes, they have been understanding, professional, polite and patient. The ability to create our own documentation templates, generate professional reports on demand and submit claims to billing with one click has allowed us to streamline our practice. The billing software is extremely versatile – I can review number of claims sent / on hold, payer breakdown, charges per visit and collections per visit. Our biller is able to pull up detailed reports, exactly the way we want. My front desk staff has the ability to track authorizations and create progress note alerts, physician prescription alerts and fax reports to physicians with the click of a button in In Touch EMR. My management is now exploring analytics to identify areas of growth and efficiency and expect to drive our practice further with analytic insights. Best of all, the transition for our entire staff was streamlined and consistent and help was readily available. I like that we are able to talk to someone whenever we need to. If you are looking for a powerful, reliable, and responsive team to help you implement EMR and billing software to grow your practice, look no further than the team at In Touch EMR. We support this therapist owned EMR company wholeheartedly.”

Matthew S. Fischer, MSPT – Fischer Physical Therapy

“In my 30+ years as a compliance auditor, author and instructor, I have yet to see an EMR and billing software as comprehensive as In Touch EMR. If you are looking for compliant ICD-10 documentation, and a ‘gold standard’ that can survive auditing, get In Touch EMR. A well defined workflow for the front desk, clinicians, billers and coders makes this a one-stop shop for quick, compliant documentation and flawless billing. I’m impressed with their HIPAA compliance, PHI protection and data breach prevention protocols. The front desk automation (certification alerts, patient portal, birthday reminders, e-newsletters) and clinician automation (progress note and reevaluation countdown, autotext technology, flowsheet templates, tasks and messages) are sufficient to set them apart. They didn’t stop there. The billing automation (claim cleanser, automatic transmission to billing, CCI edits – modifier 59 automation, autopost ERAs) and the administrator functions (access controls, audit logs, time tracking, productivity metrics) result in an incredible EMR and billing software combination for all clinicians. It’s a no brainer – forget the hype from other products and get In Touch EMR”

Cheryl House RMC, CHI  Compliance Auditor, Author, Coder and Instructor at Illinois Valley Community College

“I was looking for a Practice Management Software that combined both documentation and billing platform systems that work in unison. I had previously tried more complicated systems that made me exhausted at the end of the day. In Touch EMR and In Touch Biller Pro represent a united and unified package that helps the private practice clinician govern a practice. It’s easy to use, it is concise, and it has a plenty of analysis variables to study.”

Sammy K. Bonfim PT – Rehabilitation & Performance Center

All In Touch EMR customers get unlimited support via phone, email and live chat.

Click below to schedule a free demo with the experts at In Touch EMR, or call (800)-421-8442 to learn more.

Schedule a Demo of In Touch EMR Now

At In Touch EMR, we charge a flat fee per licensed clinician (no hidden fees or surprises) and it includes everything, unlimited claims and notes and infinite custom template creation. We are also a CMS recognized PQRS registry, we automate the reporting of PQRS and Functional Limitation G codes and provide automatic alerts for plan of care expirations, authorizations, progress note reminders and KX modifier alerts. Schedule a demo to see why practices across the country are switching to In Touch EMR.

CLICK HERE TO SCHEDULE NOW

10 Phrases to Trigger Referrals from Patients

10 Phrases to Trigger Referrals from Patients

10 Phrases to Trigger Referrals from Patients

10 phrasesPatients are busy and can easily forget about something unless they are reminded about it more than once.

Everyone has a certain attention span. It’s one of reasons that TV commercials are set to air on a specific schedule within the prime viewing time of their target market. The only way to get a patient’s attention and keep it is to use specific phrases, demonstrate value in advance and repetition of your message, so it finally gets through.

I’ve created an approach called the ‘Referral Rebounder Pathway’, a seven-point technique designed to build a relationship with existing patients. The objective is to keep the practitioner and their clinic in the forefront of the patient’s mind. The message is repeated, and the outcome is that anytime the patient or someone in their social group need services, they think of you.

Research has demonstrated that it requires several “touches” to convince patients to schedule an appointment, make a referral or take virtually any action. Seven was found to be the optimal number of contacts needed with a patient to obtain the desired results.

The fact is – Patients get busy and don’t always check their messages or emails in a timely manner, necessitating multiple contacts.

Value in advance

It is not enough to just tell patients what you have to offer.

They need to see it and experience it and feel it. This is known as value in advance and is accomplished by giving them something that immediately shows them the value and benefits the clinic offers.

Instead of giving patients your business card or brochure, do something for them.

Human psychology follows a fairly predictable pattern.

Individuals feel obligated to “return the favor” when something nice is done for them. For example, even before a patient makes an appointment, tell them something like the following. “Just for calling us, we’d like to send you a small token of our appreciation.” Make sure it speaks to the practitioner’s expertise and demonstrates the value to the patient.

For example, even before a patient makes an appointment, tell them something like “Just for calling us, we’d like to share a small token of our appreciation.”

If you share an ebook, or an educational booklet, or a printed newsletter, make sure it speaks to the clinician’s expertise and demonstrates the value of treatment to the patient.

The same principle holds true when working with physicians for referrals. Offer to treat a physician’s patient as quickly as possible. When they go back to the doctor, they’ll tell him/her how well the treatment worked and how quickly they were seen.

The Referral Rebounder Pathway requires consistency and patience, even if there is no sign of an ‘immediate return’.

Perseverance pays off and with the right intention, service and communication, clinicians can win over patients and physicians as referral sources.

Being able to communicate through multiple methods is the best way to build an ongoing relationship with patients to generate referrals. Some individuals prefer a phone call or email, while others prefer a text message.

Failure to communicate with patients after they’re discharged or have left the office is the number one mistake clinicians make.

Practitioners often don’t follow up with even a single call in the mistaken believe that their services are so valuable or so awe-inspiring that there’s no doubt that their patients will be talking about them for weeks. With the growing amount of competition, that kind of thinking is a luxury clinicians simply can’t afford.

In addition, the attention span of the human species is significantly lower than at any previous time. A study conducted by Microsoft Corp. and reported in Time® Magazine showed that an adult’s average attention span is eight seconds – shorter than that of a goldfish at nine seconds. Combined with increased competition, clinicians in private practice can no longer depend solely on their core services. You must create a foundation for referrals with value and repetition.

Winning through repetition

Repetition is one of the best-known techniques for getting someone to remember. Repetitive teaching is part of the learning process in school. Writers, journalists and public speakers are all well acquainted with the “rule of three.” For clinicians, it’s more like the “rule of 7.”

When reaching out to patients, the process may resemble the following.

Ignore

Ignore

Who are you again?

Ah! I remember you now

Thank you for thinking of me.

Hmm – my sister hurt her arm last week.

I told my sister about you and I need an appointment, too. I’m having trouble with my shoulder.

Angela K. Troyer, Ph.D. and the program director of Neuropsychology and Cognitive Health at Baycrest, noted in Psychology Today that spaced repetition is the best technique to facilitate recall.

Repeating something over and over without pausing is only slightly better than not repeating the information at all. It’s the primary reason that spaced repetition is so effective when contacting patients.

Once a patient’s pain has been alleviated or their condition disappears, they tend to forget about it (and us) and move on.

It’s up to the practitioner to provide a professional, consistent reminder of how much better they feel after treatment through simple and courteous follow-up communication. This is not just good customer service, it is sound business strategy.

To win through repetition, the outreach from the clinic must be done in a timely manner and clinics must have a method that enables contact with patients via text, voice mail, email and phone.

The communication doesn’t have to be elaborate and can contain any of the following 10 key phrases:

“Hope you are well. Just checking in.”

“If you have any problems, please give us a call.”

“Are you experiencing any current pain or movement difficulties?”

“We appreciate your referrals since we are a small company.”

“How to do feel since your visit?”

“Are the exercises helping?”

“Can I help you schedule your follow-up appointment?”

“Who is helping you out at home?”

“Do you have any questions?”

“Following up on my text/voice/email from yesterday. What can we do to serve you or your family members? We have a range of wellness services available to help you improve your quality of life.”

Tailor the message

The last thing a clinician wants is to be perceived as insincere.

Tailor the message to the individual, the media used and the needs of the patient. For example, a text message would be more effective than a phone call for younger patients, while many seniors prefer a phone call or even a letter. For the most beneficial results, clinicians can utilize

For the most beneficial results, clinicians must use hypertargeting and segmenting of their patient list.

Trigger phrases are designed to demonstrate empathy. Carolyn Thomas at MyHeartSisters.org, noted that in a Boston University study published in the journal Medical Teachers, empathy for other people begins to decline as students go further through medical school, even those who are naturally empathetic.

Clinicians must nurture and demonstrate more empathy to patients.

Move on from rejection

It’s inevitable that there will be patients and physicians who request that the clinic not contact them anymore. That doesn’t mean practitioners should become discouraged and stop all their efforts – quite the contrary.

If they ask to end the contact, abide by their wishes and move on. They typically wouldn’t have made a referral anyway. The objective with value and repetition is to identify and encourage patients who say “Thanks for thinking of me, nice of you! Oh, by the way, can I come in for xxxx?”

This is the intended outcome of the referral rebounder pathway.

Staff and technology

Referral Rebounder Pathway interactions with patients are critical.

Every clinic should have a staff member that dedicates at least a half hour each day to contacting patients. Another option is software that can be programmed with the clinic’s message and can be set to contact the appropriate patients at regular intervals. Software services like In Touch EMR automatically trigger reminders and integrate with over 500 applications including Therapy Newsletter to automate patient follow-up.

There are several technological options for small private practices that may not have the available staff to perform those duties. One of those is Therapy Newsletter that offers done-for-you email and printed newsletters, autoresponders for discharged patients and website integration. It also provides downloadable books for patients, “refer a friend” technology for patients, unlimited faxing to physicians, and email capture for those who visit the clinic’s site.

Conclusion

It requires an average of seven individual contacts with patients to stimulate a referral response. Maintaining contact is essential for building a foundation of trust with patients that will lead to willing referrals and the technology is available to foster the process that’s quick, easy and affordable.

Maintaining contact is essential for building a foundation of trust with patients that will lead to willing referrals. Technology is available to make this a quick, easy and affordable process.

For more information about Therapy Newsletter, please call 201-535-4475 or
to begin a 30-day trial for just $1, visit www.therapynewsletter.com.

Need More Information about In Touch EMR? Take a FREE 30 Day Trial, No Credit Card Required

In Touch EMR is a fully integrated scheduling, documentation and billing software for physical therapy practices. It is a simple and user friendly web-based, ICD-10 and HIPAA compliant EMR, and it offers customizable templates for notes, the ability to attach files, electronic signatures, and the ability to track progress notes, treatment plans, and assessments.

In Touch EMR has grown to over 1000 clients, our company / founders have been mentioned on CNN, Forbes, Huffington Post, Amazon, been featured as a Cleardata success story, received the prestigious ONC certification, 2015 and 2016 PQRS registry designation, integrated with Microsoft’s cutting edge patient portal technology and initiated groundbreaking healthcare partnerships with companies like Novartis. All of this is possible thanks to clients across the country, who have embraced In Touch EMR.

In Touch EMR is featured on our HIPAA compliant hosting partner (Cleardata) website along with other industry leaders such as the Cleveland clinic, Nexttech, Saint Mary’s regional medical center and UCLA health.

SIMPLE, TRANSPARENT PRICING MODEL

At In Touch EMR, we charge a flat fee per licensed clinician (no hidden fees or surprises) and it includes everything, unlimited claims and notes and infinite custom template creation. We are also a CMS recognized PQRS registry, we automate the reporting of PQRS and Functional Limitation G codes and provide automatic alerts for plan of care expirations, authorizations, progress note reminders and KX modifier alerts.

Clients also get a self-paced video training program on how to get up and running, custom documentation template builder, iPad app – one touch document import, Instant Intake iPad app, unlimited patient manager and patient portal.

Every license unlimited ongoing support (phone / email / live chat), billing software integration, unlimited appointments, unlimited documentation, unlimited document uploads and unlimited electronic faxing.

OFFICE OF THE NATIONAL COORDINATOR CERTIFIED ELECTRONIC HEALTH RECORD TECHNOLOGY

We are a premier vendor in the rehabilitation space, and on the prestigious, certified Health IT Product List, which is a division of the office of the National Coordinator for Health Information Technology, a division of the Department of Health and Human Services.

Very few vendors can make this claim, and they generally won’t bring this up (in some cases, out of ignorance) mostly because this is not a mandatory certification, it is optional and requires a significant investment of time and effort. This certification is a sign of our commitment to a HIPAA compliant, secure and stable EMR system for your clinic.

If you ever get audited, the fact that you are using ONC-certified EHR technology (CEHRT) will work in your favor. CMS looks favorably on the use of CEHRT since HHS is trying to encourage the adoption of CEHRT amongs providers nationwide as part of a long term push towards electronic documentation and interoperability between EMR systems. Your practice can state that it carefully vetted and selected “a rehabilitation-specific vendor that passed  all of the ONC HIT 2014 Edition EHR Certification criteria required to satisfy the Base EHR definition”

Since In Touch EMR has been very proactive at staying at the forefront of emerging guidelines for EMR vendors, you are assured higher quality, higher security and more compliance with CMS and other payer regulations.

For more information about the ONC, please visit:

http://www.healthit.gov/newsroom/about-onc

In Touch EMR is one of the only EMR vendors in the rehabilitation space to pass all the 2014 Edition EHR Certification criteria required to satisfy the Base EHR Definition as stated by the Office of the National Coordinator for Health Information Technology, as listed here: http://www.healthit.gov/sites/default/files/pdf/BaseEHR_8-18-12_Final.pdf

In Touch EMR is on the Certified Health IT Product List (CHPL) website.

http://www.healthit.gov/policy-researchers-implementers/certified-health-it-product-list-chpl

The product is listed here:

http://oncchpl.force.com/ehrcert?q=chpl

Search for In Touch EMR > CHPL Product Number: 150002R00

PRAISE FROM THOUSANDS OF SATISFIED CLINICS ACROSS THE UNITED STATES

“In Touch EMR has emerged as a comprehensive, customizable EMR solution for our growing organization. Support is always there when we need it, options to customize options to match our workflow are endless, clinicians find it simple and easy to use, front desk and billing love the integration between documentation and claims and compliance is built-in. This is exactly what we needed and it has boosted our efficiency. Couldn’t have asked for more. In Touch EMR is a leader in web-based EMR for our practice. Thank you!”

Julie Edelman PT, DPT – Avanti Therapy

“Moving to In Touch EMR was a process of adjustment, but it was worth it, for several reasons. Not only has the staff at In Touch EMR been proactive in adding new features and responding to support calls and streamlining our billing processes, they have been understanding, professional, polite and patient. The ability to create our own documentation templates, generate professional reports on demand and submit claims to billing with one click has allowed us to streamline our practice. The billing software is extremely versatile – I can review number of claims sent / on hold, payer breakdown, charges per visit and collections per visit. Our biller is able to pull up detailed reports, exactly the way we want. My front desk staff has the ability to track authorizations and create progress note alerts, physician prescription alerts and fax reports to physicians with the click of a button in In Touch EMR. My management is now exploring analytics to identify areas of growth and efficiency and expect to drive our practice further with analytic insights. Best of all, the transition for our entire staff was streamlined and consistent and help was readily available. I like that we are able to talk to someone whenever we need to. If you are looking for a powerful, reliable, and responsive team to help you implement EMR and billing software to grow your practice, look no further than the team at In Touch EMR. We support this therapist owned EMR company wholeheartedly.”

Matthew S. Fischer, MSPT – Fischer Physical Therapy

“In my 30+ years as a compliance auditor, author and instructor, I have yet to see an EMR and billing software as comprehensive as In Touch EMR. If you are looking for compliant ICD-10 documentation, and a ‘gold standard’ that can survive auditing, get In Touch EMR. A well defined workflow for the front desk, clinicians, billers and coders makes this a one-stop shop for quick, compliant documentation and flawless billing. I’m impressed with their HIPAA compliance, PHI protection and data breach prevention protocols. The front desk automation (certification alerts, patient portal, birthday reminders, e-newsletters) and clinician automation (progress note and reevaluation countdown, autotext technology, flowsheet templates, tasks and messages) are sufficient to set them apart. They didn’t stop there. The billing automation (claim cleanser, automatic transmission to billing, CCI edits – modifier 59 automation, autopost ERAs) and the administrator functions (access controls, audit logs, time tracking, productivity metrics) result in an incredible EMR and billing software combination for all clinicians. It’s a no brainer – forget the hype from other products and get In Touch EMR”

Cheryl House RMC, CHI  Compliance Auditor, Author, Coder and Instructor at Illinois Valley Community College

“I was looking for a Practice Management Software that combined both documentation and billing platform systems that work in unison. I had previously tried more complicated systems that made me exhausted at the end of the day. In Touch EMR and In Touch Biller Pro represent a united and unified package that helps the private practice clinician govern a practice. It’s easy to use, it is concise, and it has a plenty of analysis variables to study.”

Sammy K. Bonfim PT – Rehabilitation & Performance Center

All In Touch EMR customers get unlimited support via phone, email and live chat.

Start your Free 30 Day Trial of In Touch EMR Now (No Credit Card Required)

At In Touch EMR, we charge a flat fee per licensed clinician (no hidden fees or surprises) and it includes everything, unlimited claims and notes and infinite custom template creation. We are also a CMS recognized PQRS registry, we automate the reporting of PQRS and Functional Limitation G codes and provide automatic alerts for plan of care expirations, authorizations, progress note reminders and KX modifier alerts. Start your FREE 30 day trial now (no credit card required) and see why practices across the country are switching to In Touch EMR.

CLICK HERE TO START YOUR FREE 30 DAY TRIAL

10 Ways In Touch Outcomes™ Powered by FOTO™ Beats other Outcome Tools

10 Ways In Touch Outcomes™ Powered by FOTO™ Beats other Outcome Tools

10 Ways In Touch Outcomes™ Powered by FOTO™ Beats other Outcome Tools


iteoutcomesThe biggest way in which the Affordable Healthcare Act has changed patient care and reimbursements is the emphasis on measuring outcomes and patient satisfaction.

Designed to provide transparency, reduce costs and deliver an enhanced level of care, Obamacare also ties practitioner reimbursements from Medicare directly to the level of patient satisfaction.

The Act has left many clinicians searching for fair and reliable outcomes solutions that provide the required reporting information. Complicating the reporting requirements is the fact that patient satisfaction is a subjective matter based on perception and may have nothing to do with the actual quality of care an individual receives. At times, the two may be contradictory.

The Centers for Medicare & Medicaid Services (CMS) states that quality healthcare is a primary goal for all practitioners and facilities. CMS wants to encourage transparency and accountability. This should lead to improved patient care with lower costs.

There are 10 functionalities that outcomes software should encompass. In Touch Outcomes™ powered by FOTO™ is a complete outcomes tracking solution that offers all the necessary tools to meet the outcomes and reporting criteria for CMS, while providing clinicians with a powerful tool for risk adjustment, and marketing.

Automatic, Integration Between In Touch EMR to In Touch Outcomes – So Seamless You Won’t See It

In Touch Outcomes™ powered by FOTO™ offers an integrated solution. Patient data from In Touch EMR is seamlessly transmitted to In Touch Outcomes ™, eliminating the manual entering of data and reducing errors. Documentation and errors resulting from the manual input of data are two of the most time-consuming problems for practitioners. When done incorrectly, this can result in claim denials, which critically interrupt the flow of revenue.

Ten risk adjustment factors are used to reflect the patient’s symptoms for accuracy, functional limitation reporting with a scale of 0 to 100, and national comparisons. The system provides three functional status measurements – initial, predicted goal and discharge.

Outcomes can vary widely among patients and between clinics depending upon a number of factors and In Touch Outcomes™ powered by FOTO™ helps level the playing field for benchmarking and reporting, while providing an efficient tool for managing pay for performance (P4P) programs. This gives the user some powerful competitive advantages.

Risk Adjusted Data

In Touch Outcomes™ powered by FOTO™ provides a tested, reliable algorithm with automatic risk adjustment and helps the clinician to make evidence-based decisions to get patients better, faster. The sophisticated algorithm provides more meaningful results, makes reporting more efficient and results in a better patient experience. The outcomes assessment doesn’t need to be long or complicated. Five or six functional questions are enough to obtain a precise clinical picture, and establish a foundation for risk adjustment.

Recommended by CMS = No Other Outcomes Tracking Tool Can Make This Claim. Game Over.

Since reporting measures are designed to satisfy CMS, it makes sense to utilize software that meets the organization’s criteria. In Touch Outcomes™ powered by FOTO™ is recommended by Medicare for medical necessity for exceeding the therapy cap, functional limitation documentation and provides critical information on whether a cap will be exceeded. The sophisticated algorithm automatically looks up the correct G-code and can be used for bonus programs with private payers.

Approved for PQRS. In Fact, We’re Setting New Standards for PQRS with Proprietary, Stand-Alone Measures

All reporting information and data submitted through this system is approved for PQRS. It provides seven stand-alone measures that are body-part driven and practitioners can gather other criteria if they desire. The system provides quality metrics and is approved for reporting all general outcomes, analysis measures and the PQRS approved data registry.

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Data You Can Trust - Functional Limitation Reporting and Severity Modifier Accuracy - Recommended by CMS

Multiple Endorsements by NQF and APTA. We Know Our Stuff.. and The Big Guys Say So

In Touch Outcomes™ powered by FOTO™ leverages a variety of prestigious and practical accolades FOTO™ has garnered that include endorsement by the National Quality Forum (NQF), committed to improving quality in healthcare. In Touch Outcomes™ powered by FOTO™ has also been recommended by Medicare, endorsed by the American Physical Therapy Association’s (APTA’s) Section on Women’s Health (SOWH), and is an official Physical Therapy Outcomes Registry (PTOR) Partner being developed by the APTA.

Registry-Based Reporting Directly to CMS. You Pick. We Send. As Simple As That.

The software offers registry based instead of claims based reporting with over 14.2 million assessments upon which to draw. CMS requires clinicians to report at least nine measures to avoid penalties, but not all of those are always available, depending on the reason for the individual’s visit. The software provides practitioners with a list from which they can pick and choose the measures that are most applicable.

Over 19,100 participating practitioners, clinicians have access to satisfaction and outcome reporting for their organization

National Benchmarks – Based on Input from over 19,000 Providers. The Future of Pay for Performance Benchmarking is Here.

With over 19,100 participating practitioners, clinicians have access to satisfaction and outcome reporting for their organization, as well as how they rank against, and compare with other clinics and clinicians.  Customized widgets displaying those rankings can be used to market their practice and focus on improvement by specific body part. Practitioners set the levels of access and those levels can be established for multiple clinics and clinicians. A benchmark scorecard presents national averages and how the clinic’s and clinician’s outcomes compare. This has unlimited potential when marketing to patients and referral sources. Imagine being able to say “We are better than xyz percentage of clinics based on xyz national averages. Come to us because we get you better, faster.”

The reports enable clinicians to improve compliance, see emerging patterns within the practice and compare them to other clinics across the nation for improved efficiency and greater patient satisfaction. Practitioners can determine which type of injuries and conditions with which the clinic has the best success and results can be grouped by body part or injury.

Treatment and outcome measurementsPredictive Outcomes = Better Patient Care. Yes, This is Artificial Intelligence for Your Private Practice.

In Touch Outcomes™ powered by FOTO™ provides practitioners with predictions to enable greater efficiency in reporting how many visits a patient will require and the changes in functional status with each visit. Practitioners can demonstrate the progress each patient has made from visit to visit as compared to the predicted number of visits.

An added benefit is that the software is multi-lingual, supporting both English, French and Spanish. Combined with the patient’s intake assessment, clinicians can measure outcomes, manage quality of care and utilize the results to market their clinic’s particular strengths.

At the intake phase, In Touch Outcomes™ powered by FOTO™ provides patients with a self-assessment featuring a user-friendly interface with large print. The assessment can be completed online and the data is available to the practitioner when the patient arrives.

The assessment takes approximately six minutes to complete and automatically applies risk adjustment and predictive analytics for a patient score and provides a summary of the impairment level and limitations based on the patient’s information. The data is automatically tied to potential G-codes and severity modifiers. Patients complete a patient satisfaction survey upon discharge.

HIPAA Compliant Access Anytime, Anywhere. Push a Button and Run our Predictive Analysis Anytime

A cloud-based system is critical for today’s fast-paced clinics and In Touch Outcomes™ powered by FOTO™ can be employed on laptops, tablets and smartphones, accessed from any location with an Internet connection for complete convenience, and is fully HIPAA compliant. It offers enhanced convenience, condition specific assessments, and clinicians can utilize computer adaptive testing. Goal status can be predicted using risk adjusted predictions for more accurate results.

Skyrocket Credibility with Website Widgets. You’re Better and the World Should Know. Don’t Tell Them, Show Them.

In Touch Outcomes™ powered by FOTO™ provides clinicians with mobile marketing tools for sharing success through social media. The clinic’s successes and rankings can be promoted on the practice website and the practitioner selects the criteria for national rankings against which the clinic will be compared.

The software provides practitioners with easily recognizable website widgets to communicate with colleagues, physicians  and patients for increased referrals and new patient acquisition. This is effective for increasing payer reimbursements, while allowing clinicians to differentiate their practice and demonstrate why they are better.

If There Ever was a No-Brainer for your Practice, This is It

In Touch Outcomes™ powered by FOTO™ is utilized by more than 19,000 clinicians in over 3,800 clinics nationwide. The software contains over 14.2 million assessments and more than 3.7 million completed patient episodes from which data is drawn. It’s an affordable option that helps clinicians avoid the 2 percent penalty imposed in 2016 that requires three reported measures over one NQS domain and three measures over one NQS domain.

The system provides pertinent data about patient satisfaction, pain levels, treatment and success levels to meet all registry requirements with precise data, making it easy to track and view the effectiveness and efficiency of treatment and patient satisfaction.

Healthcare is evolving from the traditional model of being paid for services to a system in which clinicians are reimbursed based on performance according to specific benchmarks, making it essential that practitioners can demonstrate success in effective treatment outcomes and patient satisfaction. In Touch Outcomes™ powered by FOTO™ provides the solution for accomplishing those goals in an efficient and cost effective way.

 

To Learn More About The Cost for In Touch Outcomes and How to Add it to your In Touch EMR Account, please call your account manager, or call (800)-421-8442 extension 1 (Sales).

How to Find and Screen Medical Billing Companies

How to Find and Screen Medical Billing Companies

Outsourcing to reputable medical billing companies has quickly become a popular and efficient way to handle medical billing needs for practices of many sizes and disciplines.

Medical billing companies are becoming industry partners with a growing percentage of clinics, especially for clinics that are starting out.

Medical Billing CompaniesMedical coding, billing, and receivables form a chain that truly becomes the backbone of a practice, and screening medical billing companies to find the right fit is crucial for practice owners.

Now, more than ever, it is an absolute necessity to approach the screening process by examining the fundamentals (some of which go easily overlooked) of outsourced medical billing best practices.

Versatility

Medical billing companies should have the flexibility to submit claims via various resources, depending on the specific need of the practice.  While most clinics will have no preference of one clearinghouse over another, an outsourced medical billing company that has the ability to submit to more than one clearinghouse is an indicator of experience in submission variances.  At a minimum, one of the clearinghouse partners the medical billing company works with should coordinate with the clinic directly, in tandem with billing team members, for enrollments purposes.

Additionally, the medical billing company should offer integration via medical coding and billing components of practice management software.  A streamlined workflow operates on integration, so your EMR/EHR (which should be certified by the ONC like In Touch EMR is), practice management software, and billing should all flow together in one continuous cycle, allowing your staff to have direct access to what the billing team is doing and allowing the clinical manager or owner to audit billing flow and correlate this with front desk and clinical results.

For clinics operating in conjunction with or under the business umbrella of a hospital, the ability to handle both CMS (HCFA) 1500 as well as UB-04 claims is an absolute must.  This also applies to clinics or practices looking to expand into institutional billing.

Measuring Against Industry Standards

medical billing vs industryIn order to know how a medical billing company will perform for you, it’s important to know what the general concept of “good performance” amounts to in the world of outsourced medical billing. These concepts are called Industry Standards, and are the baseline for what is the average performance of a nominally priced outsourced billing provider.  The two most important Industry Standards to look at are collections percentage and first pass rate.

The collections percentage is the amount the medical billing company charges a clinic, calculated as a percentage of either the total amount they collect on the clinic’s behalf or on the total amount billed out.  Avoid any medical billing company that charges based upon the total amount billed out. You should only pay for the amount of money that is collected and that’s how we charge at In Touch Billing.

Collections percentages should be based only on the amount collected by the company on behalf of the clinic.  There are two simple reasons for this:

  • Clinics should not be responsible for paying a percentage on claims that may never be reimbursed.
  • Pressure should always be on the medical billing company to secure the highest reimbursement possible in the shortest amount of time.

The easiest way to think of it is: the medical billing company should only be paid on a claim when the clinic is paid on a claim.  The Industry Standard for average collections percentage is currently 6% of collections, depending on claim volume.  Companies may also charge a monthly minimum for billing in an effort to cover overhead in the event that the clinic has an unexpected period of lower claim volume.  This is a common practice, but be sure to do the math of monthly minimums.  A common tactic of unscrupulous companies is to advertise low percentages, but hide high monthly minimums in their contracts.  Monthly minimum charges should never be higher than what a clinic would reach during an average billing cycle and should always be openly discussed in negotiations.

First pass rate is the Industry Standard for the success rate of claims being submitted to a payer, via a clearinghouse, and being accepted and paid accordingly on the first attempt.

Currently, the average first pass rate fluctuates between 88% and 90%.

These two simple pieces of information can help in the screening of medical billing companies by comparing where they stand against common Industry Standards.  The best companies will have a collection percentage lower than 6%, while maintaining a first pass rate above 90%.

BONUS TIP: Another Industry Standard to keep in mind in length of term. This is the term of the contractual agreement between the practice and the billing company. Most contracts will automatically renew after the initial term unless renegotiation is requested by either party (usually the clinic). While practices should never expect to automatically get a lower rate after an initial term, billing companies should remain open to renegotiation based upon increases in claim volume. Additionally, beware of any medical billing company that requires a length of term longer tan 24 months. Common terms are 12 months and 24 months. Any longer, and there may be unknown risks or ulterior motives.

Security

Technical terminology can make this aspect of screening for medical billing companies feel overwhelming or convoluted, but knowing what to look for and what information to ask about can make or break your compliance in era of ever-tightening regulations.

Medical billing companies should strictly comply with HIPAA, FDCPA, Patients Privacy Act and HITECH regulatory standards.  They should be ISO 27001 certified to ensure the highest level of data protection at all times.  The International Organization for Standardization (ISO) 27001 certification helps companies establish effective data management systems.  The medical billing company should also be ISO 9001 certified on the basis of continual improvement initiatives related to the transparency of data and increase in quality of services.

An aspect of security sometimes overlooked is FTP.  Before considering a medical billing company, always ask if they have their own secure FTP servers.

Expectations of Work Flow and Metrics Data

Medical coding, billing, and receivables management are all data driven aspects that depend on proper workflow.  As such, knowing the specifics on how a practice’s claims and AR will be handled is key.

Upon receipt of documentation and service data, the first and most obvious step is for the medical billing company to check for standard coding issues.  This happens faster and more efficiently when the integration discussed in section one is in place.  Once documentation is finalized, it should appear in your integrated practice management and billing software that your staff has access to and that the billing team works out of directly.  If this isn’t in place, the onus is on the practice to provide access to this information to the billing team.

As a general rule, claims should be created within 24 hours of receipt of service data and the claim created, pre-scrubbed, and submitted within five days.

A practice that uses an ONC certified EMR platform will already provide the billing company with service data containing ICD-10 codes to the more specific level, correctly applied functional limitation G-codes, background data on 8 minute rule calculations where applicable, and PQRS will automatically be reported (for best results, use an ONC certified EMR/EHR platform that is also it’s own PQRS registry).

If a practice is not utilizing an EMR platform that automates these processes, the medical billing company should be checking each aspect of the claim data while performing other procedural checks, such as for NPIs, payer identification numbers, claim specific patient demographics, etc.

When searching for a medical billing company, be sure their team includes an EDI specialist who will analyze any rejected claims should they occur, correct the errors, and resubmit a clean claim. Simultaneously, any errors received should be shared and filed with the billing team members responsible for charge entry and any on-staff coding specialists to minimize re-occurrence of errors.

As practice owners or clinical managers compare medical billing companies and their workflow, ensuring a payment posting team quickly (within 24 hours) reviews the EOB files received through scans or ERAs through the clearing house should be another factor to consider. Before posting payments, this team analyzes and reconciles deposit slips, insurance check copies, patient payments, etc., and calculates total payments received by batch with the amounts received from the payer.

Check to be sure that the contract between the practice and medical billing company includes the services of a dedicated AR specialist. This specialist generates reports of claims which are unpaid for more than 30/60/90 days and analyzes them. The AR specialist follows up with the payer with respect to the pending claim status, analyses why the claims remain unpaid and takes appropriate action to get the claim paid. No additional costs should be associated with this vital step.

If a practice has decided on a medical billing company integrated with practice management and EMR software, reporting and metrics tracking easily becomes an advanced tactic capable of populating any scalable metric entered into the system from intake to posting.  This set up allows practice owners and manager to trend referral sources, income based upon code, provider performance, rejection and denials over time and based on cause, evaluation lineage, and more.

For companies or set ups that don’t fully integrate all of these features, a 15 day and 30 day billing summary should be provided alongside all weekly standard Accounts Receivable reports.  The medical billing company should also provide an option (not a mandate) to send patient statements on behalf of the practice.

BONUS TIP: Avoid interaction between billing companies and patients.  Once the statements are sent, the patient should communicate with the practice in all matters, even those related to payments.  The patient experience is the responsibility of the clinical staff, and clinical culture should never rest upon interaction with an outsourced billing team.

Knowing what to look for, what to expect, and the right questions to ask can take the complicated process of finding and screening medical billing companies, and simplify it.  Always remember that the medical billing company should operate as your ally in the quest for full and prompt payment from insurance companies.  Ensure you’re signing a contract with a company that will act as your partner, and know the facts before ever signing.

Outsourcing to reputable medical billing companies has quickly become a popular and efficient means of handling medical billing needs for practices of many sizes and disciplines.

Physical Therapy CPT Codes – Everything You Need to Know

Physical Therapy CPT Codes – Everything You Need to Know

Physical Therapy CPT Codes – Everything You Need to Know

Physical therapy billing and coding consists of diagnosis codes (ICD-10) and treatment codes (CPT). The ICD-10 selection tells the payer “here’s the diagnosis” and the CPT code tells the payer “Here’s the treatment – and what you need to pay for”.

The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel.The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.

A CPT code is a five digit numeric code that is used to describe medical, surgical, therapeutic, radiology, laboratory, anesthesiology, and evaluation/management services across the entire spectrum of medical and rehabilitation billing. In this article, we will focus on physical therapy CPT codes as they pertain to physical therapy billing and coding. The complete list of the most common physical therapy CPT codes is very extensive, and we have done the hard work to analyze and compare medical billing software, so that we can present you with digital download file that you can access immediately, for free.

If you like, you can click the ‘Download Now’ button below to get an email with a printer-friendly version of the most commonly used physical therapy CPT codes. If you’re more interested in diagnosis codes, check out the resource on the physical therapy billing and coding cheat sheet, a guide to physical therapy ICD-10 coding.

The Diagnosis

The diagnosis sets the stage for documentation and reimbursement. Click the icon to learn more about ICD-10 coding and download a billing and coding cheat sheet.

The Treatment

The right documentation, to justify the use of the most appropriate CPT codes puts you in the best position to get paid for your services. Click the icon to get examples of physical therapy documentation templates and best practices with physical therapy forms.

The Payment

The right billing and coding team will help you maximize reimbursements. Click the item to discover how to find and screen medical billing companies to help you collect the maximum possible amount from insurance companies.

The Importance of Physical Therapy CPT Codes

physicaltherapycptcodes-medPhysical therapy CPT codes reflect what was done for that visit, and are an indication to the payer, saying “pay me for this work done”. The clinician must select the most appropriate CPT code for that encounter and make sure that documentation is compliant, and supportive of the codes that are billed out.

The best way to justify physical therapy coding with CPT codes is to enter supporting documentation in the flowsheet.

A flowsheet should be more than an exercise log. It should be a complete summary of all services rendered (procedures and modalities), duration of service (used to calculate units), extent of services rendered (repetitions, sets and duration) and supporting documentation to justify services rendered.

With In Touch EMR, supporting documentation in the flowsheet can be made mandatory, improving physical therapy billing and coding compliance. Comprehensive notes from the clinician enable auditors and payors to verify that the clinician is meeting or exceeding medical necessity for that visit.

The flowsheet is the foundation of physical therapy billing. It reveals not only what the clinician is doing and what the clinician is billing out, but also why it is being done. In the absence of supporting documentation on the flowsheet, payments for services may be withheld or recouped by payers.

Every time that the patient is seen, it is important to enter supporting documentation to justify the ongoing medical need for therapy services. The question “Why are you continuing to see the patient?” has to be answered conclusively with every flowsheet.

Meeting medical necessity is an ongoing process. As a physical therapy billing best practice, supporting documentation should be distinct and unique for each visit.

Physical therapy CPT codes may also be associated with two digit modifiers, used to clarify or modify the description of the procedure. Adding a modifier to a CPT code line item is saying to the payer “There are some special circumstances related to this treatment, and these codes provide more information and / or impact the payment for these line items”.

The Two Types of Physical Therapy CPT Codes

There are two types of CPT codes used in physical therapy coding: time codes and untimed codes.

Timed Codes

Physical therapists bill one unit for the first 15 minutes of treatment for most timed codes. Additional units can be billed based on the duration of the treatment time. The longer the treatment time, the higher the number of units that can be billed.

Untimed codes

Untimed codes are generally billed once per day. If the treatment area is different and the treatment purpose differs, then the clinician or the physical therapy coder can bill the untimed codes more than once (with appropriate modifiers like 59, 76 or 77 to prove that the second billed CPT code is not a duplicate of first billed same CPT code).

Procedures that REQUIRE direct one-on-one patient contact with therapists

physicaltherapycptcodes-med-1In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients.

Examples include:

  • Any two CPT codes for “therapeutic procedures” requiring direct one-on-one patient contact (CPT codes 97110-97542);
  • Any two CPT codes for modalities requiring “constant attendance” and direct one-on-one patient contact (CPT codes 97032 – 97039);
  • Any two CPT codes requiring either constant attendance or direct one-on-one patient contact – as described above – (CPT codes 97032- 97542).
  • For example: Any CPT code for a therapeutic procedure (example: 97116-gait training) with any attended modality CPT code (example: 97035-ultrasound);
  • Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110 – 97542) with the group therapy CPT code (97150) requiring constant attendance. For example: group therapy (97150) with neuromuscular reeducation (97112);
  • Any CPT code for modalities requiring constant attendance (CPT codes 97032 – 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035);
  • Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 – 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150)

Procedures that DO NOT REQUIRE direct one-on-one patient contact with therapist

In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where “supervised modalities” are defined by CPT as untimed and unattended — not requiring the presence of the therapist (CPT codes 97010 – 97028).

One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact.

However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist.

The Most Commonly Used Physical Therapy CPT Codes

Most physical therapists believe there are only a handful of cpt codes that can be billed out by physical therapists. The fact is, there are almost 600 physical therapy cpt codes that can be billed out. However, it is true that a small number of them (approximately 30) are the most used physical therapy cpt codes. They are listed in green, and in blue below.

Before you review this list, please note that physical therapy billing and physical therapy coding practices vary from one clinic to another. As a clinician, you always want to bill the most appropriate CPT codes for that encounter, and your clinical judgement and supporting documentation should justify the use of the physical therapy CPT codes that are being billed out.

We have tried to make this list as comprehensive as possible, but we recommend you identify the specific CPT codes that are applicable to your practice and conduct your own research as well.

Green = Most Common (20 codes)

Blue = Somewhat Common (10 codes)

Red = Least Common (574 codes)

This is a total of 604 CPT codes. You can download the entire list of the most commonly used physical therapy CPT codes by clicking on the button below.

  • Most Common Physical Therapy CPT COdes 3.3%
  • Somewhat Common Physical Therapy CPT Codes 1.6%
  • Least Common Physical Therapy CPT Codes 95%

MOST COMMON

97001
Physical therapy evaluation

97002
Physical therapy re-evaluation

97003
Occupational therapy evaluation

97004
Occupational therapy re-evaluation

97012
Application of a modality to 1 or more areas; traction, mechanical

97032
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes

97035
Application of a modality to 1 or more areas; ultrasound, each 15 minutes

Click ‘Download Now’ for the COMPLETE list

SOMEWHAT COMMON

97016
Application of a modality to 1 or more areas; vasopneumatic devices

97018
Application of a modality to 1 or more areas; paraffin bath

97028
Application of a modality to 1 or more areas; ultraviolet

97034
Application of a modality to 1 or more areas; contrast baths, each 15 minutes

97036
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes

90911
Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG
and/or manometry

Click ‘Download Now’ for the COMPLETE list

LEAST COMMON

97033
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes

97150
Therapeutic procedure(s), group (2 or more individuals)

97533
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minute

97537
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes

Click ‘Download Now’ for the COMPLETE list

Download the Complete List of Physical Therapy CPT Codes

The selection of these CPT codes is very important, since it reflects what procedures / modalities were provided for that visit. This determines how much you get paid. Therefore, it is crucial that you bill out the most appropriate CPT codes at all times.

CMS 1500 form modifier requirements as of Jan. 1, 2014 require that all therapy codes billed on the CMS 1500 form must use modifiers consistent with Medicare rules to distinguish the discipline of the plan of care.

The GP modifier indicates services delivered under an outpatient physical therapy plan of care and the GO modifier indicates services delivered under an outpatient occupational therapy plan of care.

In reviewing the above list, it’s easy for CPT coding to become a bit overwhelming.

That’s why it’s important to have physical therapy billing and coding specialists working to ensure your claims are properly coded (in fact, many physical therapists under-bill their services.).

It is also helpful to download and review the entire list of the most commonly used physical therapy CPT codes. Click here to download the complete list of physical therapy CPT codes.

Need More Information? Contact Us

In Touch Billing provides billing and coding services with an expert team of physical therapy coders.  In Touch Billing has an average first pass rate 8% higher than industry standard, with costs averaging 2% lower.

Schedule a discovery call today to get your no obligation billing quote from In Touch Billing.

In Touch Billing is one of the few medical billing companies offering unlimited support via phone, email and live chat, and we guarantee to lower your medical billing costs, and provide you with outstanding customer service.

Click here to schedule a free ‘billing strategy’ call with the experts at In Touch Billing, or call (800)-421-8442 to learn more.

To get an overview of all the services at In Touch Billing, watch this video below:

10 Minutes Can Slash your Billing Costs by up to 20%..

This no-obligations 10 minute call has helped organizations discover ways to reduce costs, and increase monthly revenue.. and now it’s your turn. When an integrated software suite (EMR, scheduler and billing software) combined with a meticulous billing service, your practice can save tens of thousands of dollars each year. Learn more, in this free, no-obligations ‘billing analysis’ call. We’ll tell you how you can increase your revenue, and if you decide to work with us, great! If no, not a problem. This is a no-obligations, no pitch, no pressure phone call.

Click Here to Schedule

Definitive Guide to Physical Therapy ICD-10 Coding

Definitive Guide to Physical Therapy ICD-10 Coding

Physical Therapy Coding Cheat Sheet – Your Definitive Guide to Physical Therapy ICD-10 Coding

Most physical therapy private practices use the same, or similar set of diagnosis and treatment codes in outpatient physical therapy practice. Physical therapy billing requires a careful selection of ICD-10 and CPT codes to maximize reimbursement.

physical therapy coding, physical therapy coders, physical therapy coding companiesWe’ll focus on physical therapy ICD-10 guidelines in this article. If you’re more interested in treatment codes, check out the resource on the most common physical therapy cpt codes.

ICD-10 – A New Era of Specificity in Physical Therapy Coding

ICD-10 codes represent diagnosis, and are the foundation of physical therapy coding. These codes are used by providers and physical therapy coders to classify ailments and injuries. This is a prerequisite for compliant documentation and claim reimbursement from payers.

ICD-10 is a vast and, to many, an overwhelming system – so much so that there are physical therapy coding companies who specialize in creating properly coded claims for practices.

ICD-10 was endorsed by the World Health Assembly in May 1990 and has been in use in WHO Member States beginning in 1994. ICD-10 went into effect for the U.S. healthcare industry on Oct. 1, 2015, after a series of lengthy delays.

While ICD-10 can be confusing, it is a superior system, especially for physical therapy coding largely due to its diagnostic specificity. In other words, the clinician can (and is now expected to) get really specific about the diagnosis of the patient.

Specific improvements in physical therapy related diagnosis codes include expanded injury codes, combined codes, laterality codes and greater specificity in code assignment.

Download the Physical Therapy Coding Cheat Sheet – The First of its Kind in the Industry

With the complexity and confusion surrounding ICD-10, the staff at In Touch Billing has put together a physical therapy coding cheat sheet, geared specifically for ICD-10.

This is a list of ICD-10 codes commonly used in physical therapy coding. We have analyzed the 68,000 + ICD-10 codes, and have identified approximately 11,000 codes that are relevant to physical therapy billing and coding.

In Touch Billing has spent over 100 hours to organize this document, and we’re making this available to the entire physical therapy community to show you how awesome we are (and to earn your business if you ever look for a physical therapy emr, physical therapy billing software, or physical therapy billing service).

We have accounted for every imaginable condition treated by physical therapists, which is why this document contains almost 11,000 line items.

The listing in this document includes, but is not limited to ICD-10 code options for:

  • Spasm muscle
  • Muscle weakness (general)
  • Backache
  • Cervicalgia
  • Pain joint shoulder region
  • Pain joint pelvis & thigh
  • Lumbagophysical therapy coding, physical therapy coders, physical therapy coding companies
  • Muscle disuse atrophy
  • Stiffness joint neck and shoulder region
  • Abnormality of gait
  • Lumbar disorders
  • Pain joint ankle & foot
  • Sciatica
  • Abnormal posture
  • Pain thoracic spine
  • Plantar fibromatosis
  • Pain joint hand
  • Fibromyalgia
  • Pain joint upper arm
  • Lumbar sprain
  • Stiffness joint neck, multiple sites
  • Shoulder region disorders
  • Muscle/ligament fascia disorders
  • Dizziness & giddiness
  • Abdominal tenderness
  • Chronic pain
  • Degenerative lumbar intervertebral disc problems
  • Facial weakness
  • Tension headache

and much more….

Click the button below to gain access to this list.

Please note that this list is not exhaustive and should not be used exclusively; accompany them with the ICD-10-CM Official Guidelines, tables, and index.

You should certainly know which ICD-1o codes are specific to physical therapy and rehabilitation (so you can bill them), but you should also know which ICD-10 codes are truncated / unspecified / invalid (so you can avoid them). That’s why we have created another list for you….

Introducing The Dreaded Truncated / Invalid / Unspecified ICD-10 Codes for Physical Therapy – Avoid Billing these Codes at all Costs

Clinicians aren’t physical therapy coders, and shouldn’t be expected to know the ins and outs of the complex world of physical therapy billing and coding.

All ICD-10 codes must be documented to the highest level of specificity.

Truncated / invalid / unspecified ICD-10 codes will result in rejections. That’s why we did something significant for our readers.

The ICD-10 certified coders at In Touch Billing, the sister company of In Touch EMR, have analyzed all the ICD-10 codes, and put together a comprehensive tool. We have created a list of truncated / invalid / unspecified ICD-10 codes to help physical therapy providers, billers and coders. We went to great lengths to create this, by reviewing every single ICD-10 code, we didn’t just search for ‘unspecified’ codes and give you that list. We worked much harder than that.

Click the button below to gain access to the entire list of ICD-10 codes to avoid.

Here’s a summary of the data you can expect in this groundbreaking list.

The asterick * indicates unspecified / invalid / truncated ICD-10 codes that must be avoided.

  • The ICD-10 C Code Family – Neoplasms (C00-D49) – 448 ICD-10 codes *
  • The ICD-10 D Code Family – Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) – 189 ICD-10 codes *
  • The ICD-10 F Code Family -Mental, Behavioral and Neurodevelopmental disorders (F01-F99) 336 ICD-10 codes *
  • The ICD-10 G Code Family – Diseases of the nervous system (G00-G99) – 292 ICD-10 codes *
  • The ICD-10 H Code Family – Diseases of the eye and adnexa (H00-H59) – 1272 ICD-10 codes *
  • The ICD-10 I Code Family – Diseases of the circulatory system (I00-I99) – 560 ICD-10 codes *
  • The ICD-10 J Code Family – Diseases of the respiratory system (J00-J99) – 157 physical therapy coding, physical therapy coders, physical therapy coding companiesICD-10 codes *
  • The ICD-10 M Code Family – Diseases of the musculoskeletal system and connective tissue (M00-M99) – 3772 ICD-10 codes *
  • The ICD-10 N Code Family – Diseases of the genitourinary system (N00-N99) – 221 ICD-10 codes *
  • The ICD-10 R Code Family – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) – 196 ICD-10 codes *
  • The ICD-10 S Code Family – Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) – 8306 ICD-10 codes *
  • The ICD-10 T Code Family – 561 ICD-10 codes *
  • The ICD-10 V Code Family – 1471 ICD-10 codes *
  • The ICD-10 W Code Family – 521 ICD-10 codes *
  • The ICD-10 X Code Family – 202 ICD-10 codes *
  • The ICD-10 Y Code Family – 598 ICD-10 codes *
  • The ICD-10 Z Code Family – 354 ICD-10 codes *

Total – 19456 ICD-10 codes

Non specific codes will result in claim rejections at the clearinghouse or payer level. If this happens, clinicians / billing will need to re-code to a high level of specificity and resubmit.

This includes codes from the C, D, F, G, H, I, J, M, N, R, S, T, V, W, X, Y, Z family of ICD-10 codes that fall into the truncated / invalid / unspecified category and must be avoided.

The easiest way to simplify and streamline the coding aspect of documentation is to utilize an EMR that has built in ICD-10 technology to help clinicians choose the best (and most specific) codes.

In Touch EMR not only includes extensive ICD-10 technology, but is backed by an expert team of ICD-10 certified physical therapy coders at In Touch Billing.

Physical therapists and clinic owners benefit with a compliant, current system, with a qualified team to support it.

In Touch EMR is a fully customizable EMR, certified by the Federal Office of the National Coordinator so that physical therapists can rest assured that they are using the most compliant and secure system possible.

In Touch Billing, which is an add-on service with In Touch EMR, has helped thousands of therapists get higher reimbursements at well below average costs for billing services.

Next Step – Schedule a Demo of In Touch EMR and In Touch Biller Pro

If you have any questions, please click here to schedule a demo of In Touch EMR to learn more.

If you can’t wait, here is a quick, 10 minute walkthrough of In Touch EMR software.

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Here is a 10 minute of In Touch Biller Pro software – the fully integrated revenue cycle management and billing software from In Touch EMR.

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