Most everyone likes the convenience of paying bills online. It’s definitely my preference, since it seems most of the time I’m not home. I am from the generation that is use to writing a check every month, and trying to remember to buy enough stamps, so I enjoy the convenience of going online and pay a bill with my credit card or setting up an auto payment to pull funds right from my checking account. I like that I am emailed or sent a text of said funds have left my account-it’s just more convenient. With my Health Savings Account (HSA), I can also keep track of all my families medical expenses too and (again the word) conveniently pay with a debit card.
From a revenue standpoint in medical office, wouldn’t it be nice to give this convenience to your patients? Especially for families like mine where there is college student making their own medical appointments (no way I am going to give him my debit card), or a spouse who can never remember to grab the HSA card from my wallet.
For medical practices using BillFlash,there is a way to now set up auto draft payments for patients. There are two ways to do this-with StoredPay and with PlanPay.
With StoredPay, you’re able to make the authorized payment and email a receipt rather than just sending another bill and waiting to get paid. Securely store a payment method that you can use later as agreed with your patient.
PlanPay payments are not associated with any single bill/statement but are simply part of a plan to pay off an established liability like a car loan payment would do. Create and automate payments for payment plans/agreements you make with your patients (ex, payoff $2,400 liability by making a $100/mo. payment on the 15th of each month for 24 months).
CPT® 2017 has a few expanded codes for physical therapy evaluations and follow-up exams. These codes are in effect for dates of service starting January 1, 2017.
97001 to be replaced by three codes in 2017:
These new codes will add more specificity and details regarding the scope of the evaluation and states that it involves clinical decision-making of low/moderate/high complexity. The evaluation includes history to identify any factors that impact the plan of care; using standardized tests and measures to assess body structures and functions that may limit activity or restrict participation; and evaluation of the patient’s current status on presentation. The evaluation typically includes face-to-face time with the patient and/or family.
Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
CPT® 2017 adds 97164 to replace 97002 (Physical therapy re-evaluation).
The new code adds more specificity and details regarding the scope of the evaluation, which includes history review and standardized tests (criteria established and agreed upon by a group of experts) and measures to assess body structure and function; a revised plan of care using standardized instrument and measurable functional outcome assessment tool; and typically involves 20 minutes of face-to-face time with patient and/or family.
Consider these to be the equivalent of E&M codes (99000) for Physical Therapy. You should now consider these elements when coding for services:
Development of the care plan
The level of the PT evaluation performed depends on the clinical decision-making and the patient’s severity, according to CPT® instruction. For reporting, PTs must demonstrate review of these body regions and body systems:
Defined body regions such as the head, neck, back, lower extremities, upper extremities, and trunk
Musculoskeletal systems, which include gross symmetry, range of motion, strength, height, and weight
Neuromuscular systems, which includes gross coordinated movement and motor function
Cardiovascular and pulmonary systems, which include heart and respiratory rates, blood pressure, and edema
Integumentary system, which means assessing the pliability, scar formation, color, and integrity of the skin
One other thing-make sure to sequence these codes before your modality CPT codes (those starting at 97010).
OT and AT have similar changes. Look for those in a future post.
CPT® 2017 Professional Edition, American Medical Association, pages 664-668
Federal Register, Vol. 81, No. 136, Pat. 46162, July 15, 2016, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release: Medicare Advantage and Part D Medicare Advantage Provider Network Requirements’; Expansion of Medicare Diabetes Prevention Program Model”
With less than a year to go until the ICD-10 code set implementation deadline, physician practices should be pursuing a comprehensive plan designed to ensure a smooth coding transition with minimal cash flow disruption.
A key step in any ICD-10-CM transition strategy is to conduct a detailed assessment of existing workflows and processes to determine which elements will require modification, according to Bess Ann Bredemeyer, a consulting director with McKesson Business Performance Services (BPS).
By identifying each point in the claims lifecycle that ICD-10- CM will touch, appropriate adjustments can be made and simulations conducted to test the new processes against real-world conditions.
“The best way to proceed with an assessment is to begin at the patient encounter and then move through to the claim drop and denial management,” Bredemeyer said. “That way you won’t miss anything.”
Clinical Documentation Whether the clinical documentation is sent directly to a coder or to data entry personnel, it is also important to ensure that any changes in National Coverage Determinations (NCDs) and payer’s Local Carrier Determinations (LCDs) are incorporated and reflected in the claim. A good approach includes:
Identifying the top 50 most utilized diagnoses codes
Evaluating where additional documentation will be required
Mapping out modifications to support appropriate reimbursement
Updating charge tickets, super-bills and other revenue cycle tools
This is a Test With all the elements theoretically in place, it is critical to begin testing your new workflow to determine if it can handle ICD-10-CM. Code audits can assess both clinical documentation and coding to determine whether the claims should come through clean or not. A real-world testing process may also reveal previously unknown problems that would otherwise remain hidden until the ICD-10 go-live.
Don’t Be Denied Because of the complexity of ICD-10-CM and the sheer magnitude of the change, it’s reasonable to assume that even the best-laid plans may encounter some unexpected problems. For that reason, it makes sense to be prepared for a rise in denials. For physician practices, that means ensuring that staffing is adequate to manage an increase in volume, and that problems will be quickly identified and remediated.
“There is no denying that the transition to the new code set will require planning and resources to mitigate the burden of change,” Bredemeyer said. “That’s why you should get started now on developing a workflow analysis impact assessment that will help you develop a detailed ICD-10 timeline and budget.”
ReveNEWS, Industry Spotlight, “Walking Through the Workflow- An Important First Step,” November 2013 edition located on the McKesson ReveNEWS website