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December 5, 2011

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[image: Your Daily Update] December 5th, 2011 Physical Therapist

Clint Verran running for four Olympic trials in a row

<http://ptmanagerblog.com/physical-therapist-clint-verran-running-for-f>

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Clint Verran running for four Olympic trials in a row

[image: Hansons- runner Clint Verran hopes to qualify for the

Olympic trials next month.]

Purchase Image

Hansons- runner Clint Verran hopes to qualify for the Olympic trials

next month. / RASHAUN RUCKER/Detroit Free Press

By Jo-Ann

Barnas<http://www.freep.com/article/20111204/SPORTS17/112040520/Jo-ann-Barnas-Ru\

nning-for-four-in-a-row/mailto:jbarnasfreepress>

Despite recent setbacks, distance runner Clint Verran is competing in

today's California International Marathon with hopes of qualifying for his

fourth-straight Olympic trials next month in Houston.

Regardless of what happens in the " last chance " race in Sacramento, though,

Verran won't be

retiring<http://www.freep.com/article/20111204/SPORTS17/112040520/Jo-ann-Barnas-\

Running-for-four-in-a-row#>his

racing shoes anytime soon.

" If I don't qualify, I'm going to keep running, " he said. " It's part of me. "

Verran, who's a member of the Rochester Hills-based Hansons- Distance

Project, has posted top-20 results in his three Olympic trials races: 18th

in 2008 (the race was held in November 2007 in New York); fifth in 2004,

and 11th in 2000.

As impressive as that streak is, Verran reminded me that it's not as lofty

as the five Olympic marathon trials that Livonia native Doug Kurtis

qualified for between 1980 and 1996.

Verran is a veteran in the sport -- and he has the surgery scars to prove

it. In 2008, he competed with a sore left hip in the Free Press Marathon

(finishing second in 2:18:21) and had labrum surgery a few months later.

Then in 2010, he underwent microfracture surgery on his right knee. A

physical therapist and founder of his own

sports<http://www.freep.com/article/20111204/SPORTS17/112040520/Jo-ann-Barnas-Ru\

nning-for-four-in-a-row#>medicine

clinic, Verran said recovering from that operation was a process

that took a lot of patience.

Verran's career has come full circle. He was a former cross-country state

champion at Lake Orion High before winning the 1995 Mid-American Conference

Championship in cross-country at Eastern Michigan in 1995. In 1999 he

became one of the " charter members " of a post-collegiate group formed by

brothers and Hanson of Rochester Hills. Their mission hasn't

strayed from its beginnings a dozen years ago: to develop and promote

American distance running.

In 2008, Hansons- produced its first Olympic marathoner: Sell.

So far, more than a dozen team members have qualified for the 2012 Olympic

marathon trials on Jan. 14, the most acclaimed being Davila, whose

2:22:38 in taking second at the Boston Marathon remains the top time in the

U.S. this year among women.

Hansons- is also the training home of Mike , who was the top

American male marathoner at the world championships two months ago.

Today's California International Marathon -- which begins at Folsom Dam and

ends at the State Capitol in Sacramento -- will offer a $1,000 bonus to

each runner who meets the " A " standard for the Olympic trials (2:19 for

men; 2:39 for women).

" It's the fastest-lastest race, " Verran said with a smile. " We'll see what

I can do. "

via

freep.com<http://www.freep.com/article/20111204/SPORTS17/112040520/Jo-ann-Barnas\

-Running-for-four-in-a-row>

What patients need to know about

coding<http://ptmanagerblog.com/what-patients-need-to-know-about-coding>

Posted about 20 hours ago by [image: _portrait_thumb] Kovacek,

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What patients need to know about coding

by

Betancourt<http://www.kevinmd.com/blog/post-author/brandon-betancourt>|

in

Physician <http://www.kevinmd.com/blog/category/physician> |

Health insurance is very complicated. At our practice, we deal with health

insurance all the time and even for us, it gets to be very complicated

sometimes. So it is natural that patients have a hard time understanding it

as well.

Therefore, I decided to summarize a conversation I had with a patient in an

effort to help other patients understand, at the very least, a portion of

how medical health insurance works.

At a restaurant, generally you’ll get an itemized check that shows all the

things you’ve ordered. Doctors do the same thing, but they do it in the

medical chart.

Virtually every doctor who accepts health insurance uses codes called CPT

codes that are assigned to every task they and their staff performs.

Everything from a simple blood draw, to immunizations, to the ear check, to

specimen handling — all these services are “coded” separately.

These codes are used by the patient’s health insurance company to determine

the payment amount that the doctor will receive for his or her services. In

other words, the health insurance company (the one actually paying for the

services) wants to see what was done during a patient’s appointment. Hence,

everything the doctor and the staff does has a code.

For example, if you are coming in for a child’s well visit, the

pediatrician will submit a “claim” to the insurance company using the

following codes:

Established Well Visit – 99392

Developmental Testing – 96110

Hemoglobin – 85018

Finger/heel/ear stick – 36416

Lead Testing -83655

Hearing Screen – 92587

If the child gets immunizations, the vials have codes too.

DTAP-IPV – 90696

Flu – 90660

Vaccine administration also uses a distinct set of codes.

Admin – 90460

Admin – 90461

Let’s say while you are in the examining room with your child and you ask

the doctor, “Ya know doc, little has been pulling on her ear lately…

she may have an ear infection. Can you check that for me really quick?”

This question requires the doc to perform an entirely different assessment

than the well visit the child was getting.

The doctor, in order to show the insurance company that she did a

completely different assessment, codes the ear pain diagnosis and adds a

99213 – which is an evaluation and management code that documents in the

chart and on the claim to the insurance company that the doctor also

checked the patient’s ear.

Parents often think when they are looking at the bill that the doctor is

nickel-and-diming parents, when in reality, it is the insurance company

that requires the doc to show their work in this matter.

The health insurance company doesn’t accept the doctor telling them, “I did

a well visit — pay me our agreed-upon fee.” They want to know all the

things the doctor did during a patient’s visit so they can decide how much

they ought to pay the doctor for his/her services.

Since most patients don’t pay the doctors directly, but rather the health

insurance company, they want to know what took place during the visit so

they know how much they ought to pay the doctor.

It is the same as going to the restaurant and getting billed for all the

side and extra orders. Although the main meal is accompanied by other

things, like french fries or a salad, refills, side orders, substitutions

and additions to the order are billed as extra.

Health care services is a la carte as well.

* Betancourt manages a pediatric practice and blogs at

*Pediatric Inc<http://pediatricinc.wordpress.com/>

*.*

via kevinmd.com <http://www.kevinmd.com/blog/2011/12/patients-coding.html>

5 Physical Therapy Career

Challenges<http://ptmanagerblog.com/5-physical-therapy-career-challenges>

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5 Physical Therapy Career Challenges

Chad Fisher <http://www.businessinsider.com/author/chad-fisher>, Term Life

Insurance <http://www.termlifeinsurancenews.com/> | Dec. 3, 2011, 7:03 AM |

57 |

Working as a physical therapist can be a rewarding experience. Graduates

from physical therapy schools <http://www.PTSchools.com> have the

opportunities to

help<http://www.businessinsider.com/5-physical-therapy-career-challenges-2011-12\

#>people

regain mobility and reclaim independence every single day. Before

you decide to pursue a career in physical therapy, however, you need to be

aware of some of the most common challenges therapists face.

*1. Significant Educational Investment -* Physical therapists must complete

at least six years of higher education before they can begin to work in the

community. A bachelor's degree and a master's degree are minimum

requirements. Part of your education will include working in practical

clinic or hospital settings as a therapist assistant so that you can gain

the experience you need to find a job once you graduate. Expect to

invest<http://www.businessinsider.com/5-physical-therapy-career-challenges-2011-\

12#>several

years and several thousands of dollars toward your education.

*2. Emotional Stress -* A physical therapist works with people who have

been through traumatic illnesses or injuries. Although your ultimate goal

is to help your clients regain their independence, you will spend much of

your time pushing them to do the hard work required to achieve that goal.

It can be emotionally draining to face client after client who is

struggling with the aftermath of an illness or injury.

*3. Physical Demands -* Part of your job as a physical therapist will be to

literally offer support to your clients as they work toward supporting

themselves. You may be required to lift someone into and out of equipment.

You may need to help someone stand or sit. At the very least, you should

expect to be on your feet moving around during almost all of your therapy

sessions with patients. A physical therapist needs to be strong and in good

shape so that they are prepared for every possible situation.

*4. Long Work Hours -* As with any medical profession, physical therapy is

not a strictly 9:00 to 5:00 job. You will need to spend more time with

patients who need a little extra work when it is important. Schedules can

become stretched due to patients who are late for their appointments,

sessions that run long, or patients who need to be squeezed into an already

full schedule. When you are not working directly with a patient, there are

still plenty of documents you need to complete and file for each patient on

your schedule. Even if the physical therapy sessions run smoothly, the

paperwork can keep you at the office long after you expected to go home for

the day.

*5. Continuing Education Requirements -* Even after you graduate from

school and begin working in the community, you will still need to keep up

with current industry trends. Most state certifications require that

physical therapists complete a specific number of continuing

education<http://www.businessinsider.com/5-physical-therapy-career-challenges-20\

11-12#>credits

every year in order to maintain their certification. While you will

have the freedom to choose the continuing education that you would like to

take, you will need to carve several hours out of your busy schedule each

year so that you can attend workshops or conferences to keep your education

current. Most continuing education options also require a fee for attending

the classes or workshops.

via

businessinsider.com<http://www.businessinsider.com/5-physical-therapy-career-cha\

llenges-2011-12>

When is it time to break up with your

doctor?<http://ptmanagerblog.com/when-is-it-time-to-break-up-with-your-doctor>

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When is it time to break up with your doctor?

by Marni ,

MD<http://www.kevinmd.com/blog/post-author/marni-nicholas>| in

Physician <http://www.kevinmd.com/blog/category/physician> | no responses

- Tweet <http://twitter.com/share>

“When is it time to break up with your doctor? It can be a tough decision

to make. After all, if you don’t like your experience at a store, you shop

somewhere else next time. If you go for a haircut and hate it, you find

someone else.

With your doctor, it’s a bit different. This is someone who might know

some of your deepest, darkest secrets. There is a history to that

relationship. Logistically, it is also a bit of a pain in the butt. All

of your records are with your doctor. You might need to have a chat with

your insurance company. Then you actually have to go through the process

of finding a new doctor you like. So, when is it worth it to take the

plunge?

First things first, try to articulate to yourself *why* you want a new

doctor. Did you have one really bad appointment, but otherwise have had

good experiences? If so, you should probably talk to your doctor about

your concerns before you jump ship. Your doctor might have just been

having a bad day. Not that that’s an excuse, but it is an explanation.

Doctors are people, too. We get sick. We have worries about kids and

family. However, if you repeatedly have not been satisfied at your

appointments, you might want to seek a new doctor.

Is it a personality issue? Do you and your doctor just not “click?” If

that’s the case, you probably are better off finding someone else. You

need to be able to completely trust your primary care doctor, and if you

can’t be comfortable with him/her, it’s not going to work.

Is it the office staff? Is someone at the front desk always rude? Do you

always get put on hold for 20 minutes when you call? For these issue, I

strongly suggest that you talk to your doctor. Here’s the truth- since

we’re not patients in our own offices, we often have no idea of what’s

going on up front. Sad, but true. However, we can easily remedy many of

these issues *if we know about them.* So, don’t switch for these reasons.

Talk to your doc first, and give it a bit more time. If there is no

improvement in services, then it’s time to make a move.

Now the harder stuff: care issues. By this, I mean that you have concerns

about the level of care that your doctor is giving you. This is a very

tough one, because unless you are in the health care field yourself, you

might not be able to accurately assess this. The internet is changing

this, however, and more and more people are reading online and educating

themselves about their health conditions. This is a good thing. However,

just because your doctor is treating you one way, and you read about a

different treatment online, doesn’t mean that your doctor is wrong. The

practice of medicine is an art, and highly individualized. If you have

concerns, you *must* talk to your doctor. You might even want to get a

second opinion from another doctor. A reasonable doc should *never* be

angry about you getting another opinion. If your issues about the level of

care you are getting are legitimate, you should definitely find another

doctor.

Lastly, whenever you think of switching doctors, I ask you to look at

yourself, too. Have you been to doctor after doctor after doctor, never

finding one who has satisfied you? The problem might not be your doctor.

Nothing strikes dread into the heart of a primary care physician like

having a patient say, “I’ve been to ten other doctors and no one has

listened to me/been able to help me.” Are your expectations of your doctor

unrealistic? I have one patient who left my practice because she wanted a

personal phone call from me with all of her lab results. Now, I do send

out letters for all results, but I can’t make calls to everyone. I review

about 50 lab results a day. If I called everyone personally, that’s *all* I

would be able to do.

So, it’s a complicated subject. However, I hope I’ve gotten across the one

recurring theme … talk to your doctor. The worst that can happen is that

you mutually decide to part ways.

*Marni is an internal medicine physician who blogs at *Patients,

Patience, and Paces <http://patientspatienceandpaces.blogspot.com/>*.*

*Submit a guest post and be

heard<http://www.kevinmd.com/blog/heard-social-medias-leading-physician-voice>on

social media’s leading physician voice.

*

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CMS Tightening the Screws on Unnecessary Procedures in Florida and

10 Other States -

Forbes<http://ptmanagerblog.com/cms-tightening-the-screws-on-unnecessary-proc>

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12/04/2011 @ 5:10PM |162 views

CMS Tightening the Screws on Unnecessary Procedures in Florida and 10 Other

States

After years of criticism that it has paid billions of dollars for

unnecessary procedures, the Centers for Medicare & Medicaid Services (CMS)

will soon ramp up efforts to rein in costs for unnecessary procedures. In

2012 CMS will perform an audit *before *paying for several big ticket

cardiology and orthopedic procedures in certain key states. The news has

provoked strong reactions from cardiologists and Wall Street.

In Florida <http://medicare.fcso.com/Billing_news/224921.asp>, in fact,

100% of stent, ICD, and pacemaker implantation procedures will undergo

review before payment. Similar programs will take place in California,

Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North

Carolina, and Missouri, but the precise percentage and mix of cases that

will undergo auditing has not yet been stated.

On November 15 the demonstration program was announced by

CMS<http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4176 & intNumPerPage\

=10 & checkDate= & checkKey= & srchType=1 & numDays=3500 & srchOpt=0 & srchData= & keywordType\

=All & chkNewsType=6 & intPage= & showAll= & pYear= & year= & desc= & cboOrder=date>

:

The Recovery Audit Prepayment Review demonstration will allow Medicare

Recovery Auditors (RACs) to review claims before they are paid to ensure

that the provider complied with all Medicare payment rules. The RACs will

conduct prepayment reviews on certain types of claims that historically

result in high rates of improper payments. These reviews will focus on

seven states with high populations of fraud- and error-prone providers (FL,

CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short

inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This

demonstration will also help lower the error rate by preventing improper

payments rather than the traditional “pay and chase” methods of looking for

improper payments after they have been made.

On November 21 Aranda, Jr, the president of the Florida chapter of the

American College of Cardiology (ACC), sent a letter to all ACC members in

Florida about the “very serious proposed changes… that you need to be aware

of immediately.” Arunda said that the Florida ACC “is fighting these

onerous regulations” and that staff at the national ACC headquarters

planned to meet with CMS officials.

Details of the CMS initiative only became widely known on Friday, when

Wells Fargo analyst Larry Biegelsen issued a report summarizing the

initiative in which he cited “reimbursement experts who have all indicated

that this initiative seems onerous for hospitals and will likely reduce

procedure volume because hospitals will begin making sure that every

patient meets the coverage criteria.”

Reaction to the report on Wall Street was immediate. According to an

article in Bloomberg

News<http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2011/12/02/bloomberg_artic\

lesLVLIFY1A1I4H.DTL>,

hospital and medical device stocks plunged after the report was issued on

Friday. Tenet Healthcare dropped 11% while Medtronic lost 6%.

Here is the position of the Florida ACC chapter, as stated by Jerold Saef,

the chair of the Third Party Reimbursement committee of the chapter, in the

letter to Florida cardiologists:

As of the first of the year, there will be 100% pre-payment audits on all

inpatient hospital stays relative to 15 DRG’s. 11 of these are cardiac and

4 are orthopedic. This means that all inpatient stays involving a listed

DRG will trigger a hold on any payment associated with Part A

reimbursement. Hospitals will not be paid for 100% of these admissions

pending record review. There will be a 30-60 day period during which the

hospital records will be reviewed for whether they support medical

necessity for procedures which occurred during the stay. The Part B

(physician) payment will proceed. If the determination is made that

records do not support necessity, then the entire hospital stay will be

denied. The physicians will receive a form letter which will be entitled a

“Take-Back Letter” requiring return of any funds paid in conjunction with

the affected hospitalization. This will affect all cardiologists and

orthopedists involved in the care – both invasive and noninvasive. This

may include outpatient reimbursement for follow-up care related to the

hospitalization. It’s not clear whether other specialists or primary care

physicians will also receive Take-Back Letters.

The premise under which this program is being initiated is that physicians

are not adequately documenting the justification for their procedures and

that as many as half the procedures performed may be unnecessary. This

estimate apparently arises from White House and Congressional concerns that

unnecessary procedures are being funded. They draw their conclusions from

Comprehensive Error Rate Testing (CERT).

In our discussions with FCSO, we are told this is an instruction from The

Center for Medicare and Medicaid Services (CMS), and that it is being

implemented nationally. We have confirmed via the National ACC that this

is the case in at least 10 other states. We are also told that if, after a

matter of months, it appears that the scrutiny being used is unnecessary,

there will be a shift in focus away from the initial DRG’s towards other,

different DRG’s.

The Chapter leadership is concerned that the Pre-Payment Audit Initiative

is being launched at all and, additionally, that it is being launched with

little more than 6 weeks warning. The FCACC and the Florida Orthopedic

Society both think that the previous Local Coverage Determinations (LCD)

that were formulated should have provided FCSO with the necessary tools to

fight over-utilization and fraud, and that no additional measures are

necessary at this time. It occurs when holidays are imminent and end of the

year finances are being addressed. We consider this unfair and

unprecedented. We are concerned that cardiology practices, already subject

to huge technical component cuts, loss of consult codes, increasing

certification overhead, costs of implementation of electronic medical

record systems and the Sustainable Growth Rate issue, will now be

threatened by unjustified “Take-Back” strategies.

Here is the list of DRGs

<http://medicare.fcso.com/Billing_news/224921.asp>which will be

subject to 100% prepayment medical review in Florida:

- 226 — Cardiac defibrillator implant without (w/o) cardiac catheter

with (w/) major complications or comorbitities (MCC)

- 227 — Cardiac defibrillator implant w/o cardiac catheter w/o MCC

- 242 — Permanent cardiac pacemaker implant w/MCC

- 243 — Permanent cardiac pacemaker implant w/CC

- 244 — Permanent cardiac pacemaker implant w/CC or MCC

- 245 — Automatic implantable cardiac defibrillator (AICD) generator

procedures

- 247 — Percutaneous cardiovascular procedure w/drug eluding stent w/o

MCC

- 251 — Percutaneous cardiovascular procedure w/o coronary artery stent

w/o MCC

- 253 — Other vascular procedures w/CC

- 264 — Other circulatory system or procedures

- 287 — Circulatory disorders except acute myocardial infarction (AMI),

w/cardiac catheter w/o MCC

- 458 — Spinal fusion except cervical w/spinal curve, malign, or 9+

fusions w/o CC

- 460 — Spinal fusion except cervical w/o MCC

- 470 — Major joint replacement or reattachment of lower extremity w/o

MCC

- 490 — Back and neck procedures except spinal fusion w/CC/MCC or disc

device/neurostimulator

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