Re: Scheduling Medicare Patients

[Guest guest]

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

I always find it interesting that when this question is asked, it is only asked

concerning Medicare patients. Medicare does not require you provide one-on-one

care to each and every Medicare outpatient. What they, as all payers, require is

that you bill appropriately based on how the patient was treated. The definition

of the one-on-one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the appropriate

number of units of the appropriate one-on-one CPT code(s). If you

provided therapy interventions to 2 or more patients at the same time and did

not spend any significant amount of time with either patient, that would be

group therapy, regardless of who the payer is, and each patient would get billed

1 unit of 97150.

 

Regarding all of your other questions, you will see variances in the answers you

receive. That is because it depends on the contracts that practices have signed,

the method of payment by the insurance company (i.e. per CPT code, per visit,

etc.), cancel/no show rate, number of supervised modalities provided, etc.

 

In my opinion, you need to look at your individual practice and look at your net

revenue after all expenses and salaries have been paid, including yourself. A

good number is 5%-10% profit, in my opinion.

 

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

Subject: RE: Scheduling Medicare Patients

To: PTManager

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

I always find it interesting that when this question is asked, it is only asked

concerning Medicare patients. Medicare does not require you provide one-on-one

care to each and every Medicare outpatient. What they, as all payers, require is

that you bill appropriately based on how the patient was treated. The definition

of the one-on-one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the appropriate

number of units of the appropriate one-on-one CPT code(s). If you

provided therapy interventions to 2 or more patients at the same time and did

not spend any significant amount of time with either patient, that would be

group therapy, regardless of who the payer is, and each patient would get billed

1 unit of 97150.

 

Regarding all of your other questions, you will see variances in the answers you

receive. That is because it depends on the contracts that practices have signed,

the method of payment by the insurance company (i.e. per CPT code, per visit,

etc.), cancel/no show rate, number of supervised modalities provided, etc.

 

In my opinion, you need to look at your individual practice and look at your net

revenue after all expenses and salaries have been paid, including yourself. A

good number is 5%-10% profit, in my opinion.

 

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

Subject: RE: Scheduling Medicare Patients

To: PTManager

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

B. Chacko,

If you consistently bill more than 32 codes in an 8-hour day then you

need to be able to show how and why you can perform such amazing

feats.

From Transmittal 1019...

" Certain services are limited to certain numbers of units per day for

physical therapy , occupational therapy and speech-language pathology,

separately to control inappropriate billing... "

" ...The expectation (based on the work values for these codes) is that

a provider's direct patient contact time for each unit will average 15

minutes in length. If a provider has a consistent practice of billing

less than 15 minutes for a unit, these situations should be

highlighted for review. "

http://www.cms.hhs.gov/transmittals/downloads/R1019CP.pdf

For example, I live in Southwest Florida. Nine months of the year

doctors, PTs, surgeons, etc. treat patients with some spare clinical

capacity.

For three months (Snowbird Season), we all run around like 'one-armed

paper hangers'. (Note: Doctors and surgeons bill using CPT codes than

do not typically require 15 minutes of one-on-one contact.)

Needless to say, in Snowbird Season we bill more group codes, do more

1- and 2-unit treatments and just try to give good care. Not all of

the care is charged.

There may be days (like today) that I bill 33, 35 or more codes per

day, consistent with the 8-minute rule.

Over the course of any rolling six-month period, however, my average

is closer to 15-minutes per unit.

Needless to say, my documentation reflects my billed charges.

Tim

Tim , PT

www.BulletproofPT.com

TimRichPT@...

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

[Guest guest]

B. Chacko,

If you consistently bill more than 32 codes in an 8-hour day then you

need to be able to show how and why you can perform such amazing

feats.

From Transmittal 1019...

" Certain services are limited to certain numbers of units per day for

physical therapy , occupational therapy and speech-language pathology,

separately to control inappropriate billing... "

" ...The expectation (based on the work values for these codes) is that

a provider's direct patient contact time for each unit will average 15

minutes in length. If a provider has a consistent practice of billing

less than 15 minutes for a unit, these situations should be

highlighted for review. "

http://www.cms.hhs.gov/transmittals/downloads/R1019CP.pdf

For example, I live in Southwest Florida. Nine months of the year

doctors, PTs, surgeons, etc. treat patients with some spare clinical

capacity.

For three months (Snowbird Season), we all run around like 'one-armed

paper hangers'. (Note: Doctors and surgeons bill using CPT codes than

do not typically require 15 minutes of one-on-one contact.)

Needless to say, in Snowbird Season we bill more group codes, do more

1- and 2-unit treatments and just try to give good care. Not all of

the care is charged.

There may be days (like today) that I bill 33, 35 or more codes per

day, consistent with the 8-minute rule.

Over the course of any rolling six-month period, however, my average

is closer to 15-minutes per unit.

Needless to say, my documentation reflects my billed charges.

Tim

Tim , PT

www.BulletproofPT.com

TimRichPT@...

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

[Guest guest]

Rick

I respectfully disagree with you on some over-generalizations-particularly your

last comment. While you opined regarding a 5-10% profit, a reference point is

essential-are you referring to a non-profit or for profit hospital which outside

of medicare enjoys significantly greater reimbursement than private practice and

rehab agency counterpoints? The " most favored nation " reimbursement of

hospitals is often 2-3x for private payors-especially in your state of Michigan

and this has significant impact on scheduling, productivity, documentation time,

and business expansion.

Additionally, scheduling medicare patients differently is a necessary and

integral strategy for success of patient care and compliance in my opinion

otherwise you might be setting practice up for non-malicious violation of

various rules that exist outside of the norm. Generalizing that one-on-one

isn't limited to medicare is very deceiving because as you know, it is the only

payor that has significant superimposed rules including explicit provider

requirements that don't exist in most state practice acts. Many payors use

different CPT guides and versions as well-particularly in work comp adding to

the mix of the " maze " practice management. Although there are a number of PT's

within our field that have an active agenda for making medicare rules de facto,

my hope is that we don't go down the road of reducing PT's to a blanket set of

rules that destroy our evolution towards practice autonomy. While navigating

complex and different set of rules, payor requirements, and the like is not

easy-it beats being reduced to a set of governing rules that have been formatted

outside of practice acts and practice standards that have withstood the vetting

process of PT's not beaurocrats or entities that are outside of our profession.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@...

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and go

to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\

ractice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\

gram-presentation-762713/>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.

From: PTManager [mailto:PTManager ] On Behalf Of

Rick Gawenda

Sent: Wednesday, February 18, 2009 8:44 AM

To: PTManager

Subject: Re: RE: Scheduling Medicare Patients

I always find it interesting that when this question is asked, it is only asked

concerning Medicare patients. Medicare does not require you provide one-on-one

care to each and every Medicare outpatient. What they, as all payers, require is

that you bill appropriately based on how the patient was treated. The definition

of the one-on-one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the appropriate

number of units of the appropriate one-on-one CPT code(s). If you provided

therapy interventions to 2 or more patients at the same time and did not spend

any significant amount of time with either patient, that would be group therapy,

regardless of who the payer is, and each patient would get billed 1 unit of

97150.

Regarding all of your other questions, you will see variances in the answers you

receive. That is because it depends on the contracts that practices have signed,

the method of payment by the insurance company (i.e. per CPT code, per visit,

etc.), cancel/no show rate, number of supervised modalities provided, etc.

In my opinion, you need to look at your individual practice and look at your net

revenue after all expenses and salaries have been paid, including yourself. A

good number is 5%-10% profit, in my opinion.

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

From: bchacko71 <bchacko71@...<mailto:bchacko71%40sbcglobal.net>>

Subject: RE: Scheduling Medicare Patients

To: PTManager <mailto:PTManager%40yahoogroups.com>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

Mr./ Ms Chacko,

Ideally, a therapist should generate 5x his salary(including salary, benefits,

vacation etc.). Although, i don't have the specific reference for this; 5x is a

good number. I'm sure, like myself, that is very hard and most business's are

around 4x. 3x, in my opinion, is grossly low for a therapist. You must remember

to take in account for all the therapists, assistants etc. Some PT's may get

paid more, but the overall practice number should not be lower than 4x. There

are a number of factors that effect this and you should look at those. For

example, there are patients that we cannot see in NY since they payors pay 27

per visit - 45 flat. This is not a choice of seeing patients, it is a business

decision to supplant this insurances with others that are better. We turn

people away, but I'm not going to hire a good PT for 50K in NY. So it is a

clear choice to not hire for more and get paid less. There are other issues

like ancillary staff, location, medicare mix, admin cost, etc.

Vinod Somareddy, PT, DPT

Sent from my BlackBerry® smartphone with SprintSpeed

RE: Scheduling Medicare Patients

To: PTManager <mailto:PTManager%40yahoogroups.com>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

Most insurances promulgate reimbursement based on CPT codes. The majority of

physical therapy procedures are found in the 97000 series of the AMA CPT manual,

which provides definition and guidance to code assignment. The non-timed based

codes, i.e., ther.ex are defined as one-to-one (clinician to patient). If more

than one patient should be seen at a time, then we are directed via the AMA-CPT

book to use 97150. There are exceptions (group programs, i.e., work

conditioning), but my experience over the past 25 years has taught me that in

most instances, multiple patients seen simultaneously and billed individually

is done so for profit, not for what is best for the patient regardless the

payer.

Chuck Nettles, PT, DPT

Director of Rehabilitation Services

Haywood Regional Medical Center

262 LeRoy Dr.

Clyde, N.C. 28721

Phone:

Fax:

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Larry Benz

Sent: Thursday, February 19, 2009 9:07 AM

To: PTManager

Subject: RE: RE: Scheduling Medicare Patients

Rick

I respectfully disagree with you on some over-generalizations-particularly your

last comment. While you opined regarding a 5-10% profit, a reference point is

essential-are you referring to a non-profit or for profit hospital which outside

of medicare enjoys significantly greater reimbursement than private practice and

rehab agency counterpoints? The " most favored nation " reimbursement of hospitals

is often 2-3x for private payors-especially in your state of Michigan and this

has significant impact on scheduling, productivity, documentation time, and

business expansion.

Additionally, scheduling medicare patients differently is a necessary and

integral strategy for success of patient care and compliance in my opinion

otherwise you might be setting practice up for non-malicious violation of

various rules that exist outside of the norm. Generalizing that one-on-one isn't

limited to medicare is very deceiving because as you know, it is the only payor

that has significant superimposed rules including explicit provider requirements

that don't exist in most state practice acts. Many payors use different CPT

guides and versions as well-particularly in work comp adding to the mix of the

" maze " practice management. Although there are a number of PT's within our field

that have an active agenda for making medicare rules de facto, my hope is that

we don't go down the road of reducing PT's to a blanket set of rules that

destroy our evolution towards practice autonomy. While navigating complex and

different set of rules, payor requirements, and the like is not easy-it beats

being reduced to a set of governing rules that have been formatted outside of

practice acts and practice standards that have withstood the vetting process of

PT's not beaurocrats or entities that are outside of our profession.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@...<mailto:larry%40physicaltherapist.com><mailto:larry@p\

hysicaltherapist.com<mailto:larry%40physicaltherapist.com>>

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and go

to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\

ractice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\

gram-presentation-762713/>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf

Of Rick Gawenda

Sent: Wednesday, February 18, 2009 8:44 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Re: RE: Scheduling Medicare Patients

I always find it interesting that when this question is asked, it is only asked

concerning Medicare patients. Medicare does not require you provide one-on-one

care to each and every Medicare outpatient. What they, as all payers, require is

that you bill appropriately based on how the patient was treated. The definition

of the one-on-one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the appropriate

number of units of the appropriate one-on-one CPT code(s). If you provided

therapy interventions to 2 or more patients at the same time and did not spend

any significant amount of time with either patient, that would be group therapy,

regardless of who the payer is, and each patient would get billed 1 unit of

97150.

Regarding all of your other questions, you will see variances in the answers you

receive. That is because it depends on the contracts that practices have signed,

the method of payment by the insurance company (i.e. per CPT code, per visit,

etc.), cancel/no show rate, number of supervised modalities provided, etc.

In my opinion, you need to look at your individual practice and look at your net

revenue after all expenses and salaries have been paid, including yourself. A

good number is 5%-10% profit, in my opinion.

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

From: bchacko71

<bchacko71@...<mailto:bchacko71%40sbcglobal.net><mailto:bchacko71%40sb\

cglobal.net>>

Subject: RE: Scheduling Medicare Patients

To:

PTManager <mailto:PTManager%40yahoogroups.com><mailto:PTManager%4\

0yahoogroups.com>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

Chuck,

I was waiting for an experienced and learned answer to compliment the

information contributed by Mr. Gawenda. Certain payer contracts may

allow for slight variation based on how they do their business, but the

rules seem pretty straight forward, don't they?

Dan , PT

PT Manager

Vernon Memorial Hospital

Viroqua, WI 54665

dnelson@...

From: PTManager [mailto:PTManager ] On

Behalf Of Chuck Nettles

Sent: Thursday, February 19, 2009 12:27 PM

To: PTManager

Subject: RE: RE: Scheduling Medicare Patients

Most insurances promulgate reimbursement based on CPT codes. The

majority of physical therapy procedures are found in the 97000 series of

the AMA CPT manual, which provides definition and guidance to code

assignment. The non-timed based codes, i.e., ther.ex are defined as

one-to-one (clinician to patient). If more than one patient should be

seen at a time, then we are directed via the AMA-CPT book to use 97150.

There are exceptions (group programs, i.e., work conditioning), but my

experience over the past 25 years has taught me that in most instances,

multiple patients seen simultaneously and billed individually is done so

for profit, not for what is best for the patient regardless the payer.

Chuck Nettles, PT, DPT

Director of Rehabilitation Services

Haywood Regional Medical Center

262 LeRoy Dr.

Clyde, N.C. 28721

Phone:

Fax:

________________________________

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ]

On Behalf Of Larry Benz

Sent: Thursday, February 19, 2009 9:07 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: RE: RE: Scheduling Medicare Patients

Rick

I respectfully disagree with you on some

over-generalizations-particularly your last comment. While you opined

regarding a 5-10% profit, a reference point is essential-are you

referring to a non-profit or for profit hospital which outside of

medicare enjoys significantly greater reimbursement than private

practice and rehab agency counterpoints? The " most favored nation "

reimbursement of hospitals is often 2-3x for private payors-especially

in your state of Michigan and this has significant impact on scheduling,

productivity, documentation time, and business expansion.

Additionally, scheduling medicare patients differently is a necessary

and integral strategy for success of patient care and compliance in my

opinion otherwise you might be setting practice up for non-malicious

violation of various rules that exist outside of the norm. Generalizing

that one-on-one isn't limited to medicare is very deceiving because as

you know, it is the only payor that has significant superimposed rules

including explicit provider requirements that don't exist in most state

practice acts. Many payors use different CPT guides and versions as

well-particularly in work comp adding to the mix of the " maze " practice

management. Although there are a number of PT's within our field that

have an active agenda for making medicare rules de facto, my hope is

that we don't go down the road of reducing PT's to a blanket set of

rules that destroy our evolution towards practice autonomy. While

navigating complex and different set of rules, payor requirements, and

the like is not easy-it beats being reduced to a set of governing rules

that have been formatted outside of practice acts and practice standards

that have withstood the vetting process of PT's not beaurocrats or

entities that are outside of our profession.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@... <mailto:larry%40physicaltherapist.com>

<mailto:larry%40physicaltherapist.com><mailto:larry@...

m <mailto:larry%40physicaltherapist.com>

<mailto:larry%40physicaltherapist.com>>

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox

and go to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on

Twitter<http://twitter.com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-cou

rse-in-practice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-resid

ency-program-presentation-762713/>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal

speak that none of us reads or understands if often contained here.

From: PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com> [mailto:PTManager

<mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com>] On Behalf Of Rick Gawenda

Sent: Wednesday, February 18, 2009 8:44 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com>

Subject: Re: RE: Scheduling Medicare Patients

I always find it interesting that when this question is asked, it is

only asked concerning Medicare patients. Medicare does not require you

provide one-on-one care to each and every Medicare outpatient. What

they, as all payers, require is that you bill appropriately based on how

the patient was treated. The definition of the one-on-one CPT codes

applies to all payers, not just Medicare. If you provided one-on-one

interventions to the patient, then you bill the appropriate number of

units of the appropriate one-on-one CPT code(s). If you provided therapy

interventions to 2 or more patients at the same time and did not spend

any significant amount of time with either patient, that would be group

therapy, regardless of who the payer is, and each patient would get

billed 1 unit of 97150.

Regarding all of your other questions, you will see variances in the

answers you receive. That is because it depends on the contracts that

practices have signed, the method of payment by the insurance company

(i.e. per CPT code, per visit, etc.), cancel/no show rate, number of

supervised modalities provided, etc.

In my opinion, you need to look at your individual practice and look at

your net revenue after all expenses and salaries have been paid,

including yourself. A good number is 5%-10% profit, in my opinion.

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

From: bchacko71 <bchacko71@...

<mailto:bchacko71%40sbcglobal.net>

<mailto:bchacko71%40sbcglobal.net><mailto:bchacko71%40sbcglobal.net>>

Subject: RE: Scheduling Medicare Patients

To: PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com><mailto:PTManager%40yahoogroups.com>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

I would not generalize that hospitals in Michigan have a profit that is

significantly higher than private practices. There are pros and cons of

practicing in either setting. If you had my payer mix, you would not stay open

as a private practice. Private practices in Michigan can't see and bill for

patients who have Medicaid and I do not see any private practitioners knocking

the door down at the state capital for it to be alllowed. I wonder why, poor

reimbursement? Several hospitals in Michigan lost money in 2008 due to the

worsening economy. Michigan ranks number 1 in unemployment and number 2 in

vacant homes in the United States.

Regarding CPT codes, the definition of one-on-one is the same for all payers

regardless of who provides the service if they are using the CPT codes as

developed by the AMA. With some payers, you can use aides to bill for therapy

services. The one-on-one requirement must still be met to bill for the

intervention if it is a one-on-one code. If your superimposed rule regarding

Medicare is that you can't use aides to bill for therapy services, they are not

the only payer that has that rule. All payers have rules and regulations, some

good and some not.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

Rick

I respectfully disagree with you on some over-generalizations-particularly your

last comment. While you opined regarding a 5-10% profit, a reference point is

essential-are you referring to a non-profit or for profit hospital which outside

of medicare enjoys significantly greater reimbursement than private practice and

rehab agency counterpoints? The " most favored nation " reimbursement of hospitals

is often 2-3x for private payors-especially in your state of Michigan and this

has significant impact on scheduling, productivity, documentation time, and

business expansion.

Additionally, scheduling medicare patients differently is a necessary and

integral strategy for success of patient care and compliance in my opinion

otherwise you might be setting practice up for non-malicious violation of

various rules that exist outside of the norm. Generalizing that one-on-one isn't

limited to medicare is very deceiving because as you know, it is the only payor

that has significant superimposed rules including explicit provider requirements

that don't exist in most state practice acts. Many payors use different CPT

guides and versions as well-particularly in work comp adding to the mix of the

" maze " practice management. Although there are a number of PT's within our field

that have an active agenda for making medicare rules de facto, my hope is that

we don't go down the road of reducing PT's to a blanket set of rules that

destroy our evolution towards practice autonomy. While navigating complex and

different set of rules, payor

requirements, and the like is not easy-it beats being reduced to a set of

governing rules that have been formatted outside of practice acts and practice

standards that have withstood the vetting process of PT's not beaurocrats or

entities that are outside of our profession.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@...

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and go

to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\

ractice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\

gram-presentation-762713/>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.

From: PTManager [mailto:PTManager ] On Behalf Of

Rick Gawenda

Sent: Wednesday, February 18, 2009 8:44 AM

To: PTManager

Subject: Re: RE: Scheduling Medicare Patients

I always find it interesting that when this question is asked, it is only asked

concerning Medicare patients. Medicare does not require you provide one-on-one

care to each and every Medicare outpatient. What they, as all payers, require is

that you bill appropriately based on how the patient was treated. The definition

of the one-on-one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the appropriate

number of units of the appropriate one-on-one CPT code(s). If you provided

therapy interventions to 2 or more patients at the same time and did not spend

any significant amount of time with either patient, that would be group therapy,

regardless of who the payer is, and each patient would get billed 1 unit of

97150.

Regarding all of your other questions, you will see variances in the answers you

receive. That is because it depends on the contracts that practices have signed,

the method of payment by the insurance company (i.e. per CPT code, per visit,

etc.), cancel/no show rate, number of supervised modalities provided, etc.

In my opinion, you need to look at your individual practice and look at your net

revenue after all expenses and salaries have been paid, including yourself. A

good number is 5%-10% profit, in my opinion.

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

From: bchacko71 <bchacko71@...<mailto:bchacko71%40sbcglobal.net>>

Subject: RE: Scheduling Medicare Patients

To: PTManager <mailto:PTManager%40yahoogroups.com>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

Chuck et. al -

Please keep in mind that HIPAA (a Federal law) mandates the use of a single

descriptor set for all insurance payors in the nation. That single

descriptor set is the CPT Codes.

Best regards

Dr. Dick Hillyer

W. Hillyer, DPT, MBA, MSM

Lee Therapist Group, LLC

Hillyer Consulting

Cape Coral, FL

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Chuck Nettles

Sent: Thursday, February 19, 2009 1:27 PM

To: PTManager

Subject: RE: RE: Scheduling Medicare Patients

Most insurances promulgate reimbursement based on CPT codes. The majority of

physical therapy procedures are found in the 97000 series of the AMA CPT

manual, which provides definition and guidance to code assignment. The

non-timed based codes, i.e., ther.ex are defined as one-to-one (clinician to

patient). If more than one patient should be seen at a time, then we are

directed via the AMA-CPT book to use 97150. There are exceptions (group

programs, i.e., work conditioning), but my experience over the past 25 years

has taught me that in most instances, multiple patients seen simultaneously

and billed individually is done so for profit, not for what is best for the

patient regardless the payer.

Chuck Nettles, PT, DPT

Director of Rehabilitation Services

Haywood Regional Medical Center

262 LeRoy Dr.

Clyde, N.C. 28721

Phone:

Fax:

________________________________

From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

[mailto:PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com] On

Behalf Of Larry Benz

Sent: Thursday, February 19, 2009 9:07 AM

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

Subject: RE: RE: Scheduling Medicare Patients

Rick

I respectfully disagree with you on some over-generalizations-particularly

your last comment. While you opined regarding a 5-10% profit, a reference

point is essential-are you referring to a non-profit or for profit hospital

which outside of medicare enjoys significantly greater reimbursement than

private practice and rehab agency counterpoints? The " most favored nation "

reimbursement of hospitals is often 2-3x for private payors-especially in

your state of Michigan and this has significant impact on scheduling,

productivity, documentation time, and business expansion.

Additionally, scheduling medicare patients differently is a necessary and

integral strategy for success of patient care and compliance in my opinion

otherwise you might be setting practice up for non-malicious violation of

various rules that exist outside of the norm. Generalizing that one-on-one

isn't limited to medicare is very deceiving because as you know, it is the

only payor that has significant superimposed rules including explicit

provider requirements that don't exist in most state practice acts. Many

payors use different CPT guides and versions as well-particularly in work

comp adding to the mix of the " maze " practice management. Although there are

a number of PT's within our field that have an active agenda for making

medicare rules de facto, my hope is that we don't go down the road of

reducing PT's to a blanket set of rules that destroy our evolution towards

practice autonomy. While navigating complex and different set of rules,

payor requirements, and the like is not easy-it beats being reduced to a set

of governing rules that have been formatted outside of practice acts and

practice standards that have withstood the vetting process of PT's not

beaurocrats or entities that are outside of our profession.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@physicalthera <mailto:larry%40physicaltherapist.com>

pist.com<mailto:larry%40physicaltherapist.com><mailto:larry@physicalthera

<mailto:larry%40physicaltherapist.com>

pist.com<mailto:larry%40physicaltherapist.com>>

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and

go to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.

<http://twitter.com/PhysicalTherapy> com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.

<http://blog.myphysicaltherapyspace.com/> myphysicaltherapyspace.com/>

EIM Executive Management Program<http://blog.

<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-prac

tice-management.html>

myphysicaltherapyspace.com/2008/11/eim-executive-course-in-practice-manageme

nt.html> and Orthopedic Residency<http://www.slidesha

<http://www.slideshare.net/1008/evidence-in-motions-residency-program-

presentation-762713/>

re.net/1008/evidence-in-motions-residency-program-presentation-762713/

>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal

speak that none of us reads or understands if often contained here.

From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com> [mailto:PTManager@yahoogrou

<mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com>] On Behalf Of Rick Gawenda

Sent: Wednesday, February 18, 2009 8:44 AM

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com>

Subject: Re: RE: Scheduling Medicare Patients

I always find it interesting that when this question is asked, it is only

asked concerning Medicare patients. Medicare does not require you provide

one-on-one care to each and every Medicare outpatient. What they, as all

payers, require is that you bill appropriately based on how the patient was

treated. The definition of the one-on-one CPT codes applies to all payers,

not just Medicare. If you provided one-on-one interventions to the patient,

then you bill the appropriate number of units of the appropriate one-on-one

CPT code(s). If you provided therapy interventions to 2 or more patients at

the same time and did not spend any significant amount of time with either

patient, that would be group therapy, regardless of who the payer is, and

each patient would get billed 1 unit of 97150.

Regarding all of your other questions, you will see variances in the answers

you receive. That is because it depends on the contracts that practices have

signed, the method of payment by the insurance company (i.e. per CPT code,

per visit, etc.), cancel/no show rate, number of supervised modalities

provided, etc.

In my opinion, you need to look at your individual practice and look at your

net revenue after all expenses and salaries have been paid, including

yourself. A good number is 5%-10% profit, in my opinion.

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

From: bchacko71 <bchacko71@sbcglobal <mailto:bchacko71%40sbcglobal.net>

..net<mailto:bchacko71%40sbcglobal.net><mailto:bchacko71%40sbcglobal.net>>

Subject: RE: Scheduling Medicare Patients

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com><mailto:PTManager%40yahoogroups.co

m>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

While it may be required, not all payers follow them. California Workers Comp

and Medi-Cal are two great examples. I am not an expert in this area on how they

do not have to comply, but maybe someone else can shed light on this subject.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

Chuck et. al -

Please keep in mind that HIPAA (a Federal law) mandates the use of a single

descriptor set for all insurance payors in the nation. That single

descriptor set is the CPT Codes.

Best regards

Dr. Dick Hillyer

W. Hillyer, DPT, MBA, MSM

Lee Therapist Group, LLC

Hillyer Consulting

Cape Coral, FL

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Chuck Nettles

Sent: Thursday, February 19, 2009 1:27 PM

To: PTManager

Subject: RE: RE: Scheduling Medicare Patients

Most insurances promulgate reimbursement based on CPT codes. The majority of

physical therapy procedures are found in the 97000 series of the AMA CPT

manual, which provides definition and guidance to code assignment. The

non-timed based codes, i.e., ther.ex are defined as one-to-one (clinician to

patient). If more than one patient should be seen at a time, then we are

directed via the AMA-CPT book to use 97150. There are exceptions (group

programs, i.e., work conditioning), but my experience over the past 25 years

has taught me that in most instances, multiple patients seen simultaneously

and billed individually is done so for profit, not for what is best for the

patient regardless the payer.

Chuck Nettles, PT, DPT

Director of Rehabilitation Services

Haywood Regional Medical Center

262 LeRoy Dr.

Clyde, N.C. 28721

Phone:

Fax:

________________________________

From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

[mailto:PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com] On

Behalf Of Larry Benz

Sent: Thursday, February 19, 2009 9:07 AM

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

Subject: RE: RE: Scheduling Medicare Patients

Rick

I respectfully disagree with you on some over-generalizations-particularly

your last comment. While you opined regarding a 5-10% profit, a reference

point is essential-are you referring to a non-profit or for profit hospital

which outside of medicare enjoys significantly greater reimbursement than

private practice and rehab agency counterpoints? The " most favored nation "

reimbursement of hospitals is often 2-3x for private payors-especially in

your state of Michigan and this has significant impact on scheduling,

productivity, documentation time, and business expansion.

Additionally, scheduling medicare patients differently is a necessary and

integral strategy for success of patient care and compliance in my opinion

otherwise you might be setting practice up for non-malicious violation of

various rules that exist outside of the norm. Generalizing that one-on-one

isn't limited to medicare is very deceiving because as you know, it is the

only payor that has significant superimposed rules including explicit

provider requirements that don't exist in most state practice acts. Many

payors use different CPT guides and versions as well-particularly in work

comp adding to the mix of the " maze " practice management. Although there are

a number of PT's within our field that have an active agenda for making

medicare rules de facto, my hope is that we don't go down the road of

reducing PT's to a blanket set of rules that destroy our evolution towards

practice autonomy. While navigating complex and different set of rules,

payor requirements, and the like is not easy-it beats being reduced to a set

of governing rules that have been formatted outside of practice acts and

practice standards that have withstood the vetting process of PT's not

beaurocrats or entities that are outside of our profession.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@physicalthera <mailto:larry%40physicaltherapist.com>

pist.com<mailto:larry%40physicaltherapist.com><mailto:larry@physicalthera

<mailto:larry%40physicaltherapist.com>

pist.com<mailto:larry%40physicaltherapist.com>>

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and

go to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.

<http://twitter.com/PhysicalTherapy> com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.

<http://blog.myphysicaltherapyspace.com/> myphysicaltherapyspace.com/>

EIM Executive Management Program<http://blog.

<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-prac

tice-management.html>

myphysicaltherapyspace.com/2008/11/eim-executive-course-in-practice-manageme

nt.html> and Orthopedic Residency<http://www.slidesha

<http://www.slideshare.net/1008/evidence-in-motions-residency-program-

presentation-762713/>

re.net/1008/evidence-in-motions-residency-program-presentation-762713/

>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal

speak that none of us reads or understands if often contained here.

From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com> [mailto:PTManager@yahoogrou

<mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com>] On Behalf Of Rick Gawenda

Sent: Wednesday, February 18, 2009 8:44 AM

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com>

Subject: Re: RE: Scheduling Medicare Patients

I always find it interesting that when this question is asked, it is only

asked concerning Medicare patients. Medicare does not require you provide

one-on-one care to each and every Medicare outpatient. What they, as all

payers, require is that you bill appropriately based on how the patient was

treated. The definition of the one-on-one CPT codes applies to all payers,

not just Medicare. If you provided one-on-one interventions to the patient,

then you bill the appropriate number of units of the appropriate one-on-one

CPT code(s). If you provided therapy interventions to 2 or more patients at

the same time and did not spend any significant amount of time with either

patient, that would be group therapy, regardless of who the payer is, and

each patient would get billed 1 unit of 97150.

Regarding all of your other questions, you will see variances in the answers

you receive. That is because it depends on the contracts that practices have

signed, the method of payment by the insurance company (i.e. per CPT code,

per visit, etc.), cancel/no show rate, number of supervised modalities

provided, etc.

In my opinion, you need to look at your individual practice and look at your

net revenue after all expenses and salaries have been paid, including

yourself. A good number is 5%-10% profit, in my opinion.

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

From: bchacko71 <bchacko71@sbcglobal <mailto:bchacko71%40sbcglobal.net>

..net<mailto:bchacko71%40sbcglobal.net><mailto:bchacko71%40sbcglobal.net>>

Subject: RE: Scheduling Medicare Patients

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com><mailto:PTManager%40yahoogroups.co

m>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

In Louisiana, we have a State Workers Comp Fee Schedule and special codes

for PT/OT. For example, the PT code for therex - initial 15 minutes is " PT220 "

and therex - each additional 15 minutes is " PT225 " . The OT code for therex

- initial 15 minutes is " OT220 " and therex - each additional 15 minutes is

" OT225. "

The Federal Workers Comp Fee Schedule and CPT codes are used if the patient

is a federal employee or is injured in offshore waters.

D. Cavitt, President

Medical Legal Alliance, LLC

600 Guilbeau Road, Suite A

Lafayette, LA 70506

In a message dated 2/19/2009 8:35:48 P.M. Central Standard Time,

rick0905@... writes:

While it may be required, not all payers follow them. California Workers

Comp and Medi-Cal are two great examples. I am not an expert in this area on

how

they do not have to comply, but maybe someone else can shed light on this

subject.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

_http://www.gawendashttp://www._ (http://www.gawendaseminars.com/)

On Feb 19, 2009, at 8:50 PM, " Dick Hillyer " <_RHillyer@..._

(mailto:RHillyer@...) > wrote:

Chuck et. al -

Please keep in mind that HIPAA (a Federal law) mandates the use of a single

descriptor set for all insurance payors in the nation. That single

descriptor set is the CPT Codes.

Best regards

Dr. Dick Hillyer

W. Hillyer, DPT, MBA, MSM

Lee Therapist Group, LLC

Hillyer Consulting

Cape Coral, FL

_____

From: _PTManager@yahoogrouPTMana_ (mailto:PTManager )

[mailto:_PTManager@yahoogrouPTMana_ (mailto:PTManager ) ] On

Behalf

Of Chuck Nettles

Sent: Thursday, February 19, 2009 1:27 PM

To: _PTManager@yahoogrouPTMana_ (mailto:PTManager )

Subject: RE: RE: Scheduling Medicare Patients

Most insurances promulgate reimbursement based on CPT codes. The majority of

physical therapy procedures are found in the 97000 series of the AMA CPT

manual, which provides definition and guidance to code assignment. The

non-timed based codes, i.e., ther.ex are defined as one-to-one (clinician to

patient). If more than one patient should be seen at a time, then we are

directed via the AMA-CPT book to use 97150. There are exceptions (group

programs, i.e., work conditioning)programs, i.e., work conditioning)<WBR>,

but m

has taught me that in most instances, multiple patients seen simultaneously

and billed individually is done so for profit, not for what is best for the

patient regardless the payer.

Chuck Nettles, PT, DPT

Director of Rehabilitation Services

Haywood Regional Medical Center

262 LeRoy Dr.

Clyde, N.C. 28721

Phone:

Fax:

________________________________

From: PTManager@yahoogrou <mailto:PTManager%mailto:PTManagmai> ps.com

[mailto:PTManager@[mailto:PTMana<mailto:PTManager%mailto:PTManagmai> ps.com]

On

Behalf Of Larry Benz

Sent: Thursday, February 19, 2009 9:07 AM

To: PTManager@yahoogrou <mailto:PTManager%mailto:PTManagmai> ps.com

Subject: RE: RE: Scheduling Medicare Patients

Rick

I respectfully disagree with you on some over-generalizationI respectfully

your last comment. While you opined regarding a 5-10% profit, a reference

point is essential-are you referring to a non-profit or for profit hospital

which outside of medicare enjoys significantly greater reimbursement than

private practice and rehab agency counterpoints? The " most favored nation "

reimbursement of hospitals is often 2-3x for private payors-especially in

your state of Michigan and this has significant impact on scheduling,

productivity, documentation time, and business expansion.

Additionally, scheduling medicare patients differently is a necessary and

integral strategy for success of patient care and compliance in my opinion

otherwise you might be setting practice up for non-malicious violation of

various rules that exist outside of the norm. Generalizing that one-on-one

isn't limited to medicare is very deceiving because as you know, it is the

only payor that has significant superimposed rules including explicit

provider requirements that don't exist in most state practice acts. Many

payors use different CPT guides and versions as well-particularly in work

comp adding to the mix of the " maze " practice management. Although there are

a number of PT's within our field that have an active agenda for making

medicare rules de facto, my hope is that we don't go down the road of

reducing PT's to a blanket set of rules that destroy our evolution towards

practice autonomy. While navigating complex and different set of rules,

payor requirements, and the like is not easy-it beats being reduced to a set

of governing rules that have been formatted outside of practice acts and

practice standards that have withstood the vetting process of PT's not

beaurocrats or entities that are outside of our profession.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@physicalthera <mailto:larry%mailto:larry%<WBmailto:>

pist.com<mailto:mailto:<WBR>larrmailto:<WBmai><mailto:mailto:<WBR>larrmai

<mailto:larry%mailto:larry%<WBmailto:>

pist.com<mailto:mailto:<WBR>larrmailto:<WBmai>>

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and

go to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<_http://twitter._'>http://twitter._

(http://twitter./)

<_http://twitter.http://twitter.htt_ (http://twitter.com/PhysicalTherapy) >

com/PhysicalTherapy>

blog: EvidenceInMotion<_http://blog._'>http://blog._ (http://blog./)

<_http://blog.http://blog.<WBRhttp://blog_

(http://blog.myphysicaltherapyspace.com/) > myphysicaltherapysphysicalt>

EIM Executive Management Program<_http://blog._'>http://blog._ (http://blog./)

<_http://blog.http://blog.<WBRhttp://bloghttp://blog.http://blohttp://blohttp_

(http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-prac)

tice-management.tice>

myphysicaltherapyspmyphysicalthemyphysicaltherapmyphysicaltmyphysicamyphysic

nt.html> and Orthopedic Residency<_http://www.slidesha_

(http://www.slidesha/)

<_http://www.slideshahttp://www.slidehttp://www.http://www.http://wwwhttp://w_

(http://www.slideshare.net/1008/evidence-in-motions-residency-program-)

presentation-present>

re.net/1008/re.net/Brre.net/Broore.net/Brore.net/100re.net/Brook

>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal

speak that none of us reads or understands if often contained here.

From: PTManager@yahoogrou <mailto:PTManager%mailto:PTManagmai>

ps.com<mailto:mailto:<WBmailto:<WBR>PTmai> [mailto:PTManager@ [mai

<mailto:PTManager%mailto:PTManagmai>

ps.com<mailto:mailto:<WBmailto:<WBR>PTmai>] On Behalf Of Rick Gawenda

Sent: Wednesday, February 18, 2009 8:44 AM

To: PTManager@yahoogrou <mailto:PTManager%mailto:PTManagmai>

ps.com<mailto:mailto:<WBmailto:<WBR>PTmai>

Subject: Re: RE: Scheduling Medicare Patients

I always find it interesting that when this question is asked, it is only

asked concerning Medicare patients. Medicare does not require you provide

one-on-one care to each and every Medicare outpatient. What they, as all

payers, require is that you bill appropriately based on how the patient was

treated. The definition of the one-on-one CPT codes applies to all payers,

not just Medicare. If you provided one-on-one interventions to the patient,

then you bill the appropriate number of units of the appropriate one-on-one

CPT code(s). If you provided therapy interventions to 2 or more patients at

the same time and did not spend any significant amount of time with either

patient, that would be group therapy, regardless of who the payer is, and

each patient would get billed 1 unit of 97150.

Regarding all of your other questions, you will see variances in the answers

you receive. That is because it depends on the contracts that practices have

signed, the method of payment by the insurance company (i.e. per CPT code,

per visit, etc.), cancel/no show rate, number of supervised modalities

provided, etc.

In my opinion, you need to look at your individual practice and look at your

net revenue after all expenses and salaries have been paid, including

yourself. A good number is 5%-10% profit, in my opinion.

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

From: bchacko71 <bchacko71@sbcglobabchack<mailto:bchacko71%mailto:bchacmai>

..net<mailto:mailto:<WBmailto:<WBR>mai><mailto:mailto:<WBmailto:<WBR>mai>>

Subject: RE: Scheduling Medicare Patients

To: PTManager@yahoogrou <mailto:PTManager%mailto:PTManagmai>

ps.com<mailto:mailto:<WBmailto:<WBR>PTmai><mailto:mailto:<WBmailto:<WBR>PTma

m>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

________________________________

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with it contains information that is confidential and privileged. This

information is intended only for the use of the individual(s) and

entity(ies) to whom it is addressed. If you are the intended recipient,

further disclosures are prohibited without proper authorization. If you are

not the intended recipient, any disclosure, copying, printing, or use of

this information is strictly prohibited and possibly a violation of federal

or state law and regulations. If you have received this information in

error, please notify Haywood Regional Medical Center Compliance Department

at and/or forward the message to compliancehaymed (DOT)

<mailto:compliance%mailto:comai> org and please delete or destroy all copies

of the message and any attachments.

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[Non-text portions of this message have been removed]

**************A Good Credit Score is 700 or Above. See yours in just 2 easy

steps!

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?redir=http:%2\

F%2Fwww.freecreditreport.com%2Fpm%2F

default.aspx%3Fsc%3D668072%26hmpgID%3D62%26bcd%3DfebemailfooterNO62)

[Guest guest]

Rick,

You are so right to point out that not all payers follow the rules. Medical

Assistance " discovered " that they need not pay their full visit rate (a whopping

$40.00 per day) if we list any CPT code on the bill for which the charge is less

than $40. For example, if we have performed two, three, or more units of

service, and one of those units is, say, Group Therapy, for which we charge less

than $40, we will be paid only for the Group Therapy code. (For the record, we

do not adjust any patient's treatment based on payor, thus we have many patients

that generate expenses far in excess of reimbursement.)

That payors " interpret " the rules and regulations with impunity is one of the

many great injustices in this very rotten system. I can't see how it will ever

change as long as there is a third party assuming the role of " customer, "

standing between the patient and the provider.

Not incidentally, this one way that the vast sea of rules and regulations makes

hospital-based outpatient physical therapy necessary. Private practices as a

rule avoid Medical Assistance like the plague; only providers who exist with a

service mission (like ours---we are a community-owned, not-for-profit hospital)

will treat MA-covered patients. MA patients happen to be a significant

percentage of our rural population here. And they are an even greater percentage

of our payer mix than they might otherwise be, on account of local private

practices, which take only better-pay patients. We here at the hospital see all

the rest, based on our service mission.

I would like all those who disparage hospital systems, especially those who make

glib statements about poor quality there, to consider this.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

RE: Scheduling Medicare Patients

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

ps.com<mailto:PTManager%40yahoogroups.com><mailto:PTManager%40yahoogroups.co

m>

Date: Tuesday, February 17, 2009, 9:55 PM

Dear Group,

How often do most of you schedule medicare patients for one therapists

schedule so that he can be compliant with medicare rules of providing

one on one care and also be productive in todays tough economic times?

How many patients can a therapist see in an 8 hour period and be

productive?

Do you find it difficult to have therapists complete their

documentation on the same day? What is the productivity standard that

is expected by most clinics? What kind of revenue should a therapist

generate in terms of his salary? Eg: Should a therapist generate three

or four times his salary?

Thank you all who will share their thoughts.

B. Chacko

Tricare Rehab Services

[Guest guest]

Larry,

it has been interesting to follow the debate between the two sides

represented in this argument. The facts, however, remain as Rick has

stated them: Medicare does not state which codes are to be

billed " one on one " , it is the definition of the code itself that

determines this. Now, the argument arises when we attempt to

determine what " one on one " means. Medicare has a very strong, black

and white definition while many state practice acts leave much more

room for interpretation. What I dont understand is how you can

justify to the non medicare patient, who is often paying much more

out of pocket than the medicare patient, that they will be treated

differently than the medicare patient. Do your non medicare patients

question why they are being treated in groups yet billed for one on

one care? Do they ever refuse to pay their co-pays when they are

being treated by non-liscensed personnel? How do you justify

treating two patients with the same diagnosis differently based

simply of the way you will be reimbursed?

E. s, PT, DPT

Orthopedic Clinical Specialist

Fellow American Academy Orthopedic Manual Physical Therapists

www.douglasspt.com

- In PTManager , Larry Benz wrote:

>

> Rick

>

> I respectfully disagree with you on some over-generalizations-

particularly your last comment. While you opined regarding a 5-10%

profit, a reference point is essential-are you referring to a non-

profit or for profit hospital which outside of medicare enjoys

significantly greater reimbursement than private practice and rehab

agency counterpoints? The " most favored nation " reimbursement of

hospitals is often 2-3x for private payors-especially in your state

of Michigan and this has significant impact on scheduling,

productivity, documentation time, and business expansion.

>

> Additionally, scheduling medicare patients differently is a

necessary and integral strategy for success of patient care and

compliance in my opinion otherwise you might be setting practice up

for non-malicious violation of various rules that exist outside of

the norm. Generalizing that one-on-one isn't limited to medicare is

very deceiving because as you know, it is the only payor that has

significant superimposed rules including explicit provider

requirements that don't exist in most state practice acts. Many

payors use different CPT guides and versions as well-particularly in

work comp adding to the mix of the " maze " practice management.

Although there are a number of PT's within our field that have an

active agenda for making medicare rules de facto, my hope is that we

don't go down the road of reducing PT's to a blanket set of rules

that destroy our evolution towards practice autonomy. While

navigating complex and different set of rules, payor requirements,

and the like is not easy-it beats being reduced to a set of governing

rules that have been formatted outside of practice acts and practice

standards that have withstood the vetting process of PT's not

beaurocrats or entities that are outside of our profession.

>

>

>

> __________________________________________

> Larry

>

> Larry Benz PT, DPT

> PT Development LLC

> 13000 Equity Place Suite 105

> Louisville, KY 40223

>

> larry@...

> mobile (Spinvox converts voice to email)

> office (if you get voice mail-don't worry, it will

Spinvox and go to email)

> (Fax. It will convert to email)

> Follow PhysicalTherapy updates on

Twitter<http://twitter.com/PhysicalTherapy>

> blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

> EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-

course-in-practice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-

residency-program-presentation-762713/>

> CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy

legal speak that none of us reads or understands if often contained

here.

>

>

> From: PTManager [mailto:PTManager ]

On Behalf Of Rick Gawenda

> Sent: Wednesday, February 18, 2009 8:44 AM

> To: PTManager

> Subject: Re: RE: Scheduling Medicare Patients

>

>

> I always find it interesting that when this question is asked, it

is only asked concerning Medicare patients. Medicare does not require

you provide one-on-one care to each and every Medicare outpatient.

What they, as all payers, require is that you bill appropriately

based on how the patient was treated. The definition of the one-on-

one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the

appropriate number of units of the appropriate one-on-one CPT code

(s). If you provided therapy interventions to 2 or more patients at

the same time and did not spend any significant amount of time with

either patient, that would be group therapy, regardless of who the

payer is, and each patient would get billed 1 unit of 97150.

>

> Regarding all of your other questions, you will see variances in

the answers you receive. That is because it depends on the contracts

that practices have signed, the method of payment by the insurance

company (i.e. per CPT code, per visit, etc.), cancel/no show rate,

number of supervised modalities provided, etc.

>

> In my opinion, you need to look at your individual practice and

look at your net revenue after all expenses and salaries have been

paid, including yourself. A good number is 5%-10% profit, in my

opinion.

>

> Rick Gawenda, PT

> President

> Section on Health Policy & Administration

> APTA

>

>

>

> From: bchacko71 <bchacko71@...<mailto:bchacko71%40sbcglobal.net>>

> Subject: RE: Scheduling Medicare Patients

> To: PTManager <mailto:PTManager%40yahoogroups.com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

:

You raise many questions and some insinuations. I realize that email

communication makes these types of issues difficult. Some responses:

-keep in mind that the original thread was a question about strategically

scheduling medicare patients and that person was rebuffed as though mere raising

of this question somehow violates some type of professional ethics. The fact of

the matter is that CMS has at least 10 superimposed rules that have to be abided

and therefore marking them as such in a scheduling pattern makes great sense to

me and many others. For example, with medicare you have to fill out a plan of

care and certification requirement that in almost all other cases are not

required. If you don't fill out that type of paperwork on non medicare are you

treating them differently? Of course not.

-CMS patients have an explicit provider list and have very stringent rules on

supervision, student care, etc. Clinics often choose to aggregate one on one

minutes instead of having patient concurrent (e.g. a non medicare patient

receiving some level of intervention) such that you do not have to bill " group

therapy " and this makes financial sense. Therefore, keeping in mind scheduling,

overlaps, staffing, payor mix etc. is prudent and justified and doesn't mean you

are treating patients differently.

-despite those on this listserve who obviously think otherwise, not every payor

abides by the AMA CPT code system. Lots of payors pay on a per diem, case rate,

etc. and some have their own unique billing codes. In addition, while some

payors abide by latest CPT codes, they may artificially limit # of codes. If a

payor only allows 2 CPT codes and a max of 6 visits do you treat them

differently?

-reimbursement drives practice. While I realize this isn't ideal, this is what

happens in the real world. My personal belief is that a fee for service

environment and particularly the current CPT code system is a barbaric approach

to current physical therapy (or for that matter the medical world) and that is

where we should be placing our efforts-changing it. There are many that are

equally disturbed at the many in our profession who simply want to impose the

medicare superimposed rules for all patients regardless of state practice acts,

practiced standards, and the notion of autonomous providers acting within their

professional judgment.

-I always find that going down this track, there are those that incorrectly

assume that those who adopt similar philosophy that I have outlined always

believe it is about " profit " or that you " just want to use techs for PT " instead

of debating the merits of the debate. A practice environments that are

unfettered by these rules include the military where reimbursement isn't really

much of an issue and their productivity, outcomes, and professional authority is

unquestioned. It is a great example of where PT's are allowed to act as

autonomous providers use non licensed support personnel under their

supervision/delegation and live the Vision 2020 that many within the profession

are fighting against.

-Isn't it a little interesting that in medicare part A environment there is not

a huge outcry for eliminating the use of support personnel but amongst PT's in

part B there is a huge outcry to not use them! Which environment are patients a

little more vulnerable?

-my understanding is that this year's Rothstein debate will focus on this notion

of treating all patients as though they are medicare. It should raise many of

these same issues.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@...

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and go

to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\

ractice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\

gram-presentation-762713/>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.

From: PTManager [mailto:PTManager ] On Behalf Of

s

Sent: Sunday, February 22, 2009 10:22 AM

To: PTManager

Subject: Re: Scheduling Medicare Patients

Larry,

it has been interesting to follow the debate between the two sides

represented in this argument. The facts, however, remain as Rick has

stated them: Medicare does not state which codes are to be

billed " one on one " , it is the definition of the code itself that

determines this. Now, the argument arises when we attempt to

determine what " one on one " means. Medicare has a very strong, black

and white definition while many state practice acts leave much more

room for interpretation. What I dont understand is how you can

justify to the non medicare patient, who is often paying much more

out of pocket than the medicare patient, that they will be treated

differently than the medicare patient. Do your non medicare patients

question why they are being treated in groups yet billed for one on

one care? Do they ever refuse to pay their co-pays when they are

being treated by non-liscensed personnel? How do you justify

treating two patients with the same diagnosis differently based

simply of the way you will be reimbursed?

E. s, PT, DPT

Orthopedic Clinical Specialist

Fellow American Academy Orthopedic Manual Physical Therapists

www.douglasspt.com

- In PTManager <mailto:PTManager%40yahoogroups.com>, Larry Benz

wrote:

>

> Rick

>

> I respectfully disagree with you on some over-generalizations-

particularly your last comment. While you opined regarding a 5-10%

profit, a reference point is essential-are you referring to a non-

profit or for profit hospital which outside of medicare enjoys

significantly greater reimbursement than private practice and rehab

agency counterpoints? The " most favored nation " reimbursement of

hospitals is often 2-3x for private payors-especially in your state

of Michigan and this has significant impact on scheduling,

productivity, documentation time, and business expansion.

>

> Additionally, scheduling medicare patients differently is a

necessary and integral strategy for success of patient care and

compliance in my opinion otherwise you might be setting practice up

for non-malicious violation of various rules that exist outside of

the norm. Generalizing that one-on-one isn't limited to medicare is

very deceiving because as you know, it is the only payor that has

significant superimposed rules including explicit provider

requirements that don't exist in most state practice acts. Many

payors use different CPT guides and versions as well-particularly in

work comp adding to the mix of the " maze " practice management.

Although there are a number of PT's within our field that have an

active agenda for making medicare rules de facto, my hope is that we

don't go down the road of reducing PT's to a blanket set of rules

that destroy our evolution towards practice autonomy. While

navigating complex and different set of rules, payor requirements,

and the like is not easy-it beats being reduced to a set of governing

rules that have been formatted outside of practice acts and practice

standards that have withstood the vetting process of PT's not

beaurocrats or entities that are outside of our profession.

>

>

>

> __________________________________________

> Larry

>

> Larry Benz PT, DPT

> PT Development LLC

> 13000 Equity Place Suite 105

> Louisville, KY 40223

>

> larry@...

> mobile (Spinvox converts voice to email)

> office (if you get voice mail-don't worry, it will

Spinvox and go to email)

> (Fax. It will convert to email)

> Follow PhysicalTherapy updates on

Twitter<http://twitter.com/PhysicalTherapy>

> blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

> EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-

course-in-practice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-

residency-program-presentation-762713/>

> CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy

legal speak that none of us reads or understands if often contained

here.

>

>

> From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>]

On Behalf Of Rick Gawenda

> Sent: Wednesday, February 18, 2009 8:44 AM

> To: PTManager <mailto:PTManager%40yahoogroups.com>

> Subject: Re: RE: Scheduling Medicare Patients

>

>

> I always find it interesting that when this question is asked, it

is only asked concerning Medicare patients. Medicare does not require

you provide one-on-one care to each and every Medicare outpatient.

What they, as all payers, require is that you bill appropriately

based on how the patient was treated. The definition of the one-on-

one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the

appropriate number of units of the appropriate one-on-one CPT code

(s). If you provided therapy interventions to 2 or more patients at

the same time and did not spend any significant amount of time with

either patient, that would be group therapy, regardless of who the

payer is, and each patient would get billed 1 unit of 97150.

>

> Regarding all of your other questions, you will see variances in

the answers you receive. That is because it depends on the contracts

that practices have signed, the method of payment by the insurance

company (i.e. per CPT code, per visit, etc.), cancel/no show rate,

number of supervised modalities provided, etc.

>

> In my opinion, you need to look at your individual practice and

look at your net revenue after all expenses and salaries have been

paid, including yourself. A good number is 5%-10% profit, in my

opinion.

>

> Rick Gawenda, PT

> President

> Section on Health Policy & Administration

> APTA

>

>

>

> From: bchacko71 <bchacko71@...<mailto:bchacko71%40sbcglobal.net>>

> Subject: RE: Scheduling Medicare Patients

> To:

PTManager <mailto:PTManager%40yahoogroups.com><mailto:PTManager%4\

0yahoogroups.com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

:

You raise many questions and some insinuations. I realize that email

communication makes these types of issues difficult. Some responses:

-keep in mind that the original thread was a question about strategically

scheduling medicare patients and that person was rebuffed as though mere raising

of this question somehow violates some type of professional ethics. The fact of

the matter is that CMS has at least 10 superimposed rules that have to be abided

and therefore marking them as such in a scheduling pattern makes great sense to

me and many others. For example, with medicare you have to fill out a plan of

care and certification requirement that in almost all other cases are not

required. If you don't fill out that type of paperwork on non medicare are you

treating them differently? Of course not.

-CMS patients have an explicit provider list and have very stringent rules on

supervision, student care, etc. Clinics often choose to aggregate one on one

minutes instead of having patient concurrent (e.g. a non medicare patient

receiving some level of intervention) such that you do not have to bill " group

therapy " and this makes financial sense. Therefore, keeping in mind scheduling,

overlaps, staffing, payor mix etc. is prudent and justified and doesn't mean you

are treating patients differently.

-despite those on this listserve who obviously think otherwise, not every payor

abides by the AMA CPT code system. Lots of payors pay on a per diem, case rate,

etc. and some have their own unique billing codes. In addition, while some

payors abide by latest CPT codes, they may artificially limit # of codes. If a

payor only allows 2 CPT codes and a max of 6 visits do you treat them

differently?

-reimbursement drives practice. While I realize this isn't ideal, this is what

happens in the real world. My personal belief is that a fee for service

environment and particularly the current CPT code system is a barbaric approach

to current physical therapy (or for that matter the medical world) and that is

where we should be placing our efforts-changing it. There are many that are

equally disturbed at the many in our profession who simply want to impose the

medicare superimposed rules for all patients regardless of state practice acts,

practiced standards, and the notion of autonomous providers acting within their

professional judgment.

-I always find that going down this track, there are those that incorrectly

assume that those who adopt similar philosophy that I have outlined always

believe it is about " profit " or that you " just want to use techs for PT " instead

of debating the merits of the debate. A practice environments that are

unfettered by these rules include the military where reimbursement isn't really

much of an issue and their productivity, outcomes, and professional authority is

unquestioned. It is a great example of where PT's are allowed to act as

autonomous providers use non licensed support personnel under their

supervision/delegation and live the Vision 2020 that many within the profession

are fighting against.

-Isn't it a little interesting that in medicare part A environment there is not

a huge outcry for eliminating the use of support personnel but amongst PT's in

part B there is a huge outcry to not use them! Which environment are patients a

little more vulnerable?

-my understanding is that this year's Rothstein debate will focus on this notion

of treating all patients as though they are medicare. It should raise many of

these same issues.

__________________________________________

Larry

Larry Benz PT, DPT

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@...

mobile (Spinvox converts voice to email)

office (if you get voice mail-don't worry, it will Spinvox and go

to email)

(Fax. It will convert to email)

Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy>

blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\

ractice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\

gram-presentation-762713/>

CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.

From: PTManager [mailto:PTManager ] On Behalf Of

s

Sent: Sunday, February 22, 2009 10:22 AM

To: PTManager

Subject: Re: Scheduling Medicare Patients

Larry,

it has been interesting to follow the debate between the two sides

represented in this argument. The facts, however, remain as Rick has

stated them: Medicare does not state which codes are to be

billed " one on one " , it is the definition of the code itself that

determines this. Now, the argument arises when we attempt to

determine what " one on one " means. Medicare has a very strong, black

and white definition while many state practice acts leave much more

room for interpretation. What I dont understand is how you can

justify to the non medicare patient, who is often paying much more

out of pocket than the medicare patient, that they will be treated

differently than the medicare patient. Do your non medicare patients

question why they are being treated in groups yet billed for one on

one care? Do they ever refuse to pay their co-pays when they are

being treated by non-liscensed personnel? How do you justify

treating two patients with the same diagnosis differently based

simply of the way you will be reimbursed?

E. s, PT, DPT

Orthopedic Clinical Specialist

Fellow American Academy Orthopedic Manual Physical Therapists

www.douglasspt.com

- In PTManager <mailto:PTManager%40yahoogroups.com>, Larry Benz

wrote:

>

> Rick

>

> I respectfully disagree with you on some over-generalizations-

particularly your last comment. While you opined regarding a 5-10%

profit, a reference point is essential-are you referring to a non-

profit or for profit hospital which outside of medicare enjoys

significantly greater reimbursement than private practice and rehab

agency counterpoints? The " most favored nation " reimbursement of

hospitals is often 2-3x for private payors-especially in your state

of Michigan and this has significant impact on scheduling,

productivity, documentation time, and business expansion.

>

> Additionally, scheduling medicare patients differently is a

necessary and integral strategy for success of patient care and

compliance in my opinion otherwise you might be setting practice up

for non-malicious violation of various rules that exist outside of

the norm. Generalizing that one-on-one isn't limited to medicare is

very deceiving because as you know, it is the only payor that has

significant superimposed rules including explicit provider

requirements that don't exist in most state practice acts. Many

payors use different CPT guides and versions as well-particularly in

work comp adding to the mix of the " maze " practice management.

Although there are a number of PT's within our field that have an

active agenda for making medicare rules de facto, my hope is that we

don't go down the road of reducing PT's to a blanket set of rules

that destroy our evolution towards practice autonomy. While

navigating complex and different set of rules, payor requirements,

and the like is not easy-it beats being reduced to a set of governing

rules that have been formatted outside of practice acts and practice

standards that have withstood the vetting process of PT's not

beaurocrats or entities that are outside of our profession.

>

>

>

> __________________________________________

> Larry

>

> Larry Benz PT, DPT

> PT Development LLC

> 13000 Equity Place Suite 105

> Louisville, KY 40223

>

> larry@...

> mobile (Spinvox converts voice to email)

> office (if you get voice mail-don't worry, it will

Spinvox and go to email)

> (Fax. It will convert to email)

> Follow PhysicalTherapy updates on

Twitter<http://twitter.com/PhysicalTherapy>

> blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/>

> EIM Executive Management

Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-

course-in-practice-management.html> and Orthopedic

Residency<http://www.slideshare.net/1008/evidence-in-motions-

residency-program-presentation-762713/>

> CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy

legal speak that none of us reads or understands if often contained

here.

>

>

> From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>]

On Behalf Of Rick Gawenda

> Sent: Wednesday, February 18, 2009 8:44 AM

> To: PTManager <mailto:PTManager%40yahoogroups.com>

> Subject: Re: RE: Scheduling Medicare Patients

>

>

> I always find it interesting that when this question is asked, it

is only asked concerning Medicare patients. Medicare does not require

you provide one-on-one care to each and every Medicare outpatient.

What they, as all payers, require is that you bill appropriately

based on how the patient was treated. The definition of the one-on-

one CPT codes applies to all payers, not just Medicare. If you

provided one-on-one interventions to the patient, then you bill the

appropriate number of units of the appropriate one-on-one CPT code

(s). If you provided therapy interventions to 2 or more patients at

the same time and did not spend any significant amount of time with

either patient, that would be group therapy, regardless of who the

payer is, and each patient would get billed 1 unit of 97150.

>

> Regarding all of your other questions, you will see variances in

the answers you receive. That is because it depends on the contracts

that practices have signed, the method of payment by the insurance

company (i.e. per CPT code, per visit, etc.), cancel/no show rate,

number of supervised modalities provided, etc.

>

> In my opinion, you need to look at your individual practice and

look at your net revenue after all expenses and salaries have been

paid, including yourself. A good number is 5%-10% profit, in my

opinion.

>

> Rick Gawenda, PT

> President

> Section on Health Policy & Administration

> APTA

>

>

>

> From: bchacko71 <bchacko71@...<mailto:bchacko71%40sbcglobal.net>>

> Subject: RE: Scheduling Medicare Patients

> To:

PTManager <mailto:PTManager%40yahoogroups.com><mailto:PTManager%4\

0yahoogroups.com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

I wanted to add to this discussion. Since Medicare is federal and a majority of

government based rules are derived from the prevention of prior codes,

situations and laws that were broken, it is should be easy to see how Medicare

guidlined have little to do with practice standards/guidlines. Those that think

someone in government is actively trying to assist/better clinical practice or

for that matter make rules that can help are not seeing it right(although

medicare thinks they are). The guidlines are set because its a bandaide for the

lack of forsight, planning, understanding, proper collaboration and past

misfortunes only to hold something in place to operate from. The " over "

management is simply a means of not allowing " us " to manage and comes from past

abuse or a poor existing Medicare structure. Remember the old slogan " the best

employee is the one that needs not be managed " . This is, undoubtfully, unideal

and can't/must not be seen as a norm or something relevant to practice

guidlines. Laws and regs are to be set with correct, real individualized data

that isn't general and is a made to progress, not prevent. The governments

lackluster decision making process and truths are never determines in this

means. Its built to prevent and inhibit; done based on past unfortunate

experiences. I can't believe that there may be PT's that may regard Medicare as

a friend to practice standards and make it known that it is a ok mode for the

future. We are dealing with the government.

Vinod

Sent from my BlackBerry® smartphone with SprintSpeed

RE: Scheduling Medicare Patients

> To:

PTManager <mailto:PTManager%40yahoogroups.com><mailto:PTManager%4\

0yahoogroups.com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

Interesting discussion. From the thread of the original email, the person was

not rebuffed. They were reminded that how you schedule and bill for patients is

not just dependent on whether they are Medicare, it is dependent on all payers

and the definition of CPT codes as developed by the American Medical

Association.

 

For those payers that pay on a per diem rate, you still bill them according to

the AMA definition of the CPT codes based on the amount of time you provided the

one-on-one care and/or supervised modalities. As long as your charges are above

the per diem rate, you get the per diem rate. The definition of concurrent

therapy does not exist outside of the SNF Part A for CMS and I have never seen

it used in a non-Medicare payer policy.

 

We keep talking about all of the CMS superimposed rules that other payers do not

have. Yes, CMS requires physicians/NPP's to sign the POC. Guess what, so does

Aetna and some state Medicaid plans. CMS does not allow the use of

non-therapists and assistants time treating patients to be billed to them. Guess

what, so do several BCBS and Medicaid plans as well as TriCare. In fact, TriCare

does not allow assistants to treat their patients in the private practice

setting. CMS does not limit you in how many units you can bill on a given day,

how many modality codes you can bill on a give day, etc. Guess what, other

payers do.

 

CMS has an arbitrary therapy cap per year that can be bypassed with the sue of

the KX modifier. Most other payers also have arbitrary limits on therapy

coverage per calendar year that can't be bypassed with any special modifier. You

have to get on the phone with the payer and try to get the extra coverage that

the patient requires.

 

Medicare has the " 8 minute rule " . Non-Medicare payers will follow the definition

of " each 15 minutes " of which you must do a substantial portion to bill.

 

CMS reimburses for self care, cognitive therapy, sensory integration, group

therapy, and aquatic therapy, to name a few. Guess what, many other payers do nt

reimburse for some or all of these codes.

 

Medicare requires a Progress Report every 10 visits or 30 calendar days,

whichever is less. Most payers recommend you do a Progress report, just do not

mandate the timeframe for completion.

 

I could go on, but I think I have said enough. To me, the definition of

superimposed means one payer does it while no other payers do. I do not think

CMS has as many superimposed rules as some people think when you look at all the

other payers.

 

I am interested to know who wants CMS rules and regulations applied to all

payers. I know I do not want all of them. I would love to eliminate the

certification and recertification requiremetn along with the " 8 minute rule " . I

would like to see modifications to the use of students in the outpatient setting

and the timeframe for Progress Reports change to just every 10 visits. My

personal opinion is I do not think one-on-one treatment provided by aides is

skilled and should be reimbursed by insurance payers. To me, the one-on-one to

be skilled requires the clinical judgment (therapist) or clinical knowledge

(therapist or assistant).

 

Regarding payment, the Medicare program tends to be one of the better payers for

my hospital and clients compared to rates that other payers are reimbursing.

 

Sincerely,

 

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

>

> From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> Subject: RE: Scheduling Medicare Patients

> To: PTManager@yahoogrou ps.com<mailto:PTManager% 40yahoogroups. com><mailto:

PTManager% 40yahoogroups. com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

Rick

Your examples support my point-payor plans are all over the map. Your point

regarding the requirement to bill using AMA CPT codes for per diem is not

correct-unless the contract spells it out and most that are on those types of

arrangements do not in my experience. Ironically, most of the cap contracts do

require. Bottom line is that it is a fragmented billing world and this is

problematic-the cure is not adoption of medicare as standard.

____________________________________

Larry

Larry Benz

13000 Equity Place Suite 105

Louisville, KY 40223

This message, including any attachments, contains confidential information

intended for a specific individual and purpose.

________________________________

From: PTManager <PTManager >

To: PTManager <PTManager >

Sent: Mon Feb 23 07:20:07 2009

Subject: RE: Re: Scheduling Medicare Patients

Interesting discussion. From the thread of the original email, the person was

not rebuffed. They were reminded that how you schedule and bill for patients is

not just dependent on whether they are Medicare, it is dependent on all payers

and the definition of CPT codes as developed by the American Medical

Association.

For those payers that pay on a per diem rate, you still bill them according to

the AMA definition of the CPT codes based on the amount of time you provided the

one-on-one care and/or supervised modalities. As long as your charges are above

the per diem rate, you get the per diem rate. The definition of concurrent

therapy does not exist outside of the SNF Part A for CMS and I have never seen

it used in a non-Medicare payer policy.

We keep talking about all of the CMS superimposed rules that other payers do not

have. Yes, CMS requires physicians/NPP's to sign the POC. Guess what, so does

Aetna and some state Medicaid plans. CMS does not allow the use of

non-therapists and assistants time treating patients to be billed to them. Guess

what, so do several BCBS and Medicaid plans as well as TriCare. In fact, TriCare

does not allow assistants to treat their patients in the private practice

setting. CMS does not limit you in how many units you can bill on a given day,

how many modality codes you can bill on a give day, etc. Guess what, other

payers do.

CMS has an arbitrary therapy cap per year that can be bypassed with the sue of

the KX modifier. Most other payers also have arbitrary limits on therapy

coverage per calendar year that can't be bypassed with any special modifier. You

have to get on the phone with the payer and try to get the extra coverage that

the patient requires.

Medicare has the " 8 minute rule " . Non-Medicare payers will follow the definition

of " each 15 minutes " of which you must do a substantial portion to bill.

CMS reimburses for self care, cognitive therapy, sensory integration, group

therapy, and aquatic therapy, to name a few. Guess what, many other payers do nt

reimburse for some or all of these codes.

Medicare requires a Progress Report every 10 visits or 30 calendar days,

whichever is less. Most payers recommend you do a Progress report, just do not

mandate the timeframe for completion.

I could go on, but I think I have said enough. To me, the definition of

superimposed means one payer does it while no other payers do. I do not think

CMS has as many superimposed rules as some people think when you look at all the

other payers.

I am interested to know who wants CMS rules and regulations applied to all

payers. I know I do not want all of them. I would love to eliminate the

certification and recertification requiremetn along with the " 8 minute rule " . I

would like to see modifications to the use of students in the outpatient setting

and the timeframe for Progress Reports change to just every 10 visits. My

personal opinion is I do not think one-on-one treatment provided by aides is

skilled and should be reimbursed by insurance payers. To me, the one-on-one to

be skilled requires the clinical judgment (therapist) or clinical knowledge

(therapist or assistant).

Regarding payment, the Medicare program tends to be one of the better payers for

my hospital and clients compared to rates that other payers are reimbursing.

Sincerely,

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

>

> From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> Subject: RE: Scheduling Medicare Patients

> To: PTManager@yahoogrou ps.com<mailto:PTManager% 40yahoogroups. com><mailto:

PTManager% 40yahoogroups. com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

Larry,

thank you for your reply and I want to assure you that my post was

not directed to you personally. I have no idea how you treat your

patients so if my questions were percieved as insinuations I

apologize. I raised the questions simply to generate discussion and

they remain unanswered so if anyone else out there finds themselves

asking these questions to the person looking back at them in the

mirror in the morning please chime in.

I think the answer to all of this will eventually be consumer

driven. As high co-pays, high deductibles and HSA's become more

the norm the patients will determine the value of our services.

They will decide if they want to pay for the services of unliscensed

personel, if they want the hot pack, cold pack, ultrasound and

massage. They will decide if it is worth the 50 bucks out of pocket

to come in, grab their exercise list and do exercises they could do

at home while hoping the PT eventually makes it over to their table

to check on their status.

E. s, PT, DPT

Orthopedic Clinical Specialist

Fellow American Academy of Orthopedic Manual Therapists

www.douglasspt.com

> >

> > From: bchacko71 <bchacko71@<mailto:bchacko71%40sbcglobal.net>>

> > Subject: RE: Scheduling Medicare Patients

> > To: PTManager <mailto:PTManager%

40yahoogroups.com><mailto:PTManager%40yahoogroups.com>

> > Date: Tuesday, February 17, 2009, 9:55 PM

> >

> > Dear Group,

> > How often do most of you schedule medicare patients for one

> therapists

> > schedule so that he can be compliant with medicare rules of

> providing

> > one on one care and also be productive in todays tough economic

> times?

> > How many patients can a therapist see in an 8 hour period and be

> > productive?

> > Do you find it difficult to have therapists complete their

> > documentation on the same day? What is the productivity standard

> that

> > is expected by most clinics? What kind of revenue should a

therapist

> > generate in terms of his salary? Eg: Should a therapist generate

> three

> > or four times his salary?

> > Thank you all who will share their thoughts.

> > B. Chacko

> > Tricare Rehab Services

> >

> >

[Guest guest]

Larry,

thank you for your reply and I want to assure you that my post was

not directed to you personally. I have no idea how you treat your

patients so if my questions were percieved as insinuations I

apologize. I raised the questions simply to generate discussion and

they remain unanswered so if anyone else out there finds themselves

asking these questions to the person looking back at them in the

mirror in the morning please chime in.

I think the answer to all of this will eventually be consumer

driven. As high co-pays, high deductibles and HSA's become more

the norm the patients will determine the value of our services.

They will decide if they want to pay for the services of unliscensed

personel, if they want the hot pack, cold pack, ultrasound and

massage. They will decide if it is worth the 50 bucks out of pocket

to come in, grab their exercise list and do exercises they could do

at home while hoping the PT eventually makes it over to their table

to check on their status.

E. s, PT, DPT

Orthopedic Clinical Specialist

Fellow American Academy of Orthopedic Manual Therapists

www.douglasspt.com

> >

> > From: bchacko71 <bchacko71@<mailto:bchacko71%40sbcglobal.net>>

> > Subject: RE: Scheduling Medicare Patients

> > To: PTManager <mailto:PTManager%

40yahoogroups.com><mailto:PTManager%40yahoogroups.com>

> > Date: Tuesday, February 17, 2009, 9:55 PM

> >

> > Dear Group,

> > How often do most of you schedule medicare patients for one

> therapists

> > schedule so that he can be compliant with medicare rules of

> providing

> > one on one care and also be productive in todays tough economic

> times?

> > How many patients can a therapist see in an 8 hour period and be

> > productive?

> > Do you find it difficult to have therapists complete their

> > documentation on the same day? What is the productivity standard

> that

> > is expected by most clinics? What kind of revenue should a

therapist

> > generate in terms of his salary? Eg: Should a therapist generate

> three

> > or four times his salary?

> > Thank you all who will share their thoughts.

> > B. Chacko

> > Tricare Rehab Services

> >

> >

[Guest guest]

It is wonderfully interesting and ironic that we have side-by-side threads here

on PT Mgr concerning third-party payment rules and the negative effects on

caseloads caused by a tanking economy. These two issues are linked like peanut

butter and jelly!

It is axiomatic that the customer ALWAYS determines value. In the case of

medical care, we seem often to need reminding that the customer is the PAYER. We

also seem to forget that a primary role of corporate payers (government,

private, and hybrid insurance companies) is to save money--the so-called " rules "

of reimbursement are in large part efforts to get more for less. It is very fair

to view those efforts as reasonable from the customer's perspective. We may

holler when the rules don't match what we think is in our best interest or that

of the patient, but really, what else should we expect when value is being

determined from a distance? The natural tools of central-control systems are the

broad brush (ALL patients and providers behave THIS way), the euphemism (this

regulation will produce higher QUALITY), and the freedom axe (you WILL pay, in

taxes and mandated insurance premiums, for the services WE deem valuable and

necessary).

It would seem such a system could never work for long, but it has stuttered

along for decades, mainly because, despite all the fussing, fuming, and

fighting, the cash kept flowing. But that was then, and this is now. After many,

many years of medical care and medical insurance rate increases at rates far in

excess of inflation, astonishing per-capita utilization increases, and the

creation of now stratospheric government and private debt, a twisted version of

market forces is edging its way into medical care. Suddenly co-pays exceed what

therapy services used to cost, dollar and visit caps are squeezing down like boa

constrictors, and third-party authorization and documentation requirements are,

amazingly, getting denser.

Uh-oh! Patients are making personal judgments about the value and necessity of

services, and backing out of services that appear too expensive, while the

third-party requirements (and costs) haven't gone away. The double-whammy!

This is a golden opportunity for real change, but if history is any indicator,

we are in for more of the same. The grip of centralized control systems will

probably tighten-costs will go up as efficiencies sink even lower. The only hope

is that we will come to our senses before the whole thing crashes down in a

flaming, over-priced heap.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

RE: Scheduling Medicare Patients

> To: PTManager@yahoogrou ps.com<mailto:PTManager% 40yahoogroups. com><mailto:

PTManager% 40yahoogroups. com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

Rick is spot on here. While I understand Larry's position, it does leave

some critical components out of the discussion particularly when trying to

compare such disparate practice settings such as the military practice

setting and the civilian private practice setting.

In the aforementioned military setting neither the third party payer nor

what constitutes " professional services " into account. In that setting all

that inevitably matters is outcome and that is where accountability

typically ends.

In the civilian arena accountability extends much further and is governed

first by state practice act and then the rules of the third party payer.

While there can be no arguing that much of what some provider extenders can

provide can be useful and practical in the eventual outcome, the q

> Interesting discussion. From the thread of the original email, the

> person was not rebuffed. They were reminded that how you schedule and bill

> for patients is not just dependent on whether they are Medicare, it is

> dependent on all payers and the definition of CPT codes as developed by the

> American Medical Association.

>

> For those payers that pay on a per diem rate, you still bill them according

> to the AMA definition of the CPT codes based on the amount of time you

> provided the one-on-one care and/or supervised modalities. As long as your

> charges are above the per diem rate, you get the per diem rate. The

> definition of concurrent therapy does not exist outside of the SNF Part A

> for CMS and I have never seen it used in a non-Medicare payer policy.

>

> We keep talking about all of the CMS superimposed rules that other payers

> do not have. Yes, CMS requires physicians/NPP's to sign the POC. Guess what,

> so does Aetna and some state Medicaid plans. CMS does not allow the use of

> non-therapists and assistants time treating patients to be billed to them.

> Guess what, so do several BCBS and Medicaid plans as well as TriCare. In

> fact, TriCare does not allow assistants to treat their patients in the

> private practice setting. CMS does not limit you in how many units you can

> bill on a given day, how many modality codes you can bill on a give day,

> etc. Guess what, other payers do.

>

> CMS has an arbitrary therapy cap per year that can be bypassed with the sue

> of the KX modifier. Most other payers also have arbitrary limits on therapy

> coverage per calendar year that can't be bypassed with any special modifier.

> You have to get on the phone with the payer and try to get the extra

> coverage that the patient requires.

>

> Medicare has the " 8 minute rule " . Non-Medicare payers will follow the

> definition of " each 15 minutes " of which you must do a substantial portion

> to bill.

>

> CMS reimburses for self care, cognitive therapy, sensory integration, group

> therapy, and aquatic therapy, to name a few. Guess what, many other payers

> do nt reimburse for some or all of these codes.

>

> Medicare requires a Progress Report every 10 visits or 30 calendar days,

> whichever is less. Most payers recommend you do a Progress report, just do

> not mandate the timeframe for completion.

>

> I could go on, but I think I have said enough. To me, the definition of

> superimposed means one payer does it while no other payers do. I do not

> think CMS has as many superimposed rules as some people think when you look

> at all the other payers.

>

> I am interested to know who wants CMS rules and regulations applied to all

> payers. I know I do not want all of them. I would love to eliminate the

> certification and recertification requiremetn along with the " 8 minute

> rule " . I would like to see modifications to the use of students in the

> outpatient setting and the timeframe for Progress Reports change to just

> every 10 visits. My personal opinion is I do not think one-on-one treatment

> provided by aides is skilled and should be reimbursed by insurance payers.

> To me, the one-on-one to be skilled requires the clinical judgment

> (therapist) or clinical knowledge (therapist or assistant).

>

> Regarding payment, the Medicare program tends to be one of the better

> payers for my hospital and clients compared to rates that other payers are

> reimbursing.

>

> Sincerely,

>

>

> Rick Gawenda, PT

> President

> Section on Health Policy & Administration

> APTA

>

>

> >

> > From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> > Subject: RE: Scheduling Medicare Patients

> > To: PTManager@yahoogrou ps.com<mailto:PTManager%

<PTManager%25>40yahoogroups. com><mailto:PTManager% 40yahoogroups. com>

> > Date: Tuesday, February 17, 2009, 9:55 PM

> >

> > Dear Group,

> > How often do most of you schedule medicare patients for one

> therapists

> > schedule so that he can be compliant with medicare rules of

> providing

> > one on one care and also be productive in todays tough economic

> times?

> > How many patients can a therapist see in an 8 hour period and be

> > productive?

> > Do you find it difficult to have therapists complete their

> > documentation on the same day? What is the productivity standard

> that

> > is expected by most clinics? What kind of revenue should a therapist

> > generate in terms of his salary? Eg: Should a therapist generate

> three

> > or four times his salary?

> > Thank you all who will share their thoughts.

> > B. Chacko

> > Tricare Rehab Services

> >

> >