Guest guest Posted February 17, 2009 Report Share Posted February 17, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2009 Report Share Posted February 17, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2009 Report Share Posted February 18, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2009 Report Share Posted February 18, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2009 Report Share Posted February 18, 2009 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 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2009 Report Share Posted February 18, 2009 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 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2009 Report Share Posted February 19, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2009 Report Share Posted February 19, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2009 Report Share Posted February 19, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2009 Report Share Posted February 19, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2009 Report Share Posted February 19, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2009 Report Share Posted February 19, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2009 Report Share Posted February 19, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2009 Report Share Posted February 20, 2009 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] ________________________________ This e-mail, facsimile, or letter and any files or attachments transmitted 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. 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Guest guest Posted February 20, 2009 Report Share Posted February 20, 2009 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 : 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 : 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 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 > > > > Quote Link to comment Share on other sites More sharing options...
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