RE: Medicare Medical Necessity

[Guest guest]

Hi Group,

I have been treating a patient for 4 months S/P femur bone cancer. His

progress is slow. He can walk indep with a walker. He is unsafe to walk

without one without assistance. He has no pain and reports subjectively " 85%

better. " His lower extremity functional scale went DOWN this past month.Â

The guy will walk indep without assistive device if I continue to treat him but

showing this prediction on paper seems quite challenging.

Â

Questions: Do I discharge based on lack of measuable progress? Even though

progress is there but very slow? Do I have him sign a ABN? What if he signs it

and medicare denies..then I have to chase him down for the money? Can he go

private pay if we decide Medicare will not pay for it?

Â

Thank you!

Schweitzer, DPT, OCS

Â

Â

Â

________________________________

To: " 'PTManager ' " <PTManager >

Sent: Tuesday, February 14, 2012 7:49 AM

Subject: Re: Front desk/support metrics

Â

Thanks much, Dick, I appreciate your input!

And thanks to all. This group is such a great resource!

Meryl W. Freeman, MS PT

Manager, Outpatient Rehab

Rex Hospital

(919)784-4676 (office)

(919)621-3787 (cell)

From: Dick Hillyer

Sent: Monday, February 13, 2012 10:36 PM

To: PTManager <PTManager >

Subject: RE: Front desk/support metrics

Hi, Meryl -

As a quick rule of thumb in outpatient clinics in which the support staff do

all appointments, verify coverages, obtain authorizations, handle all

incoming telephone calls, assemble, maintain, and forward discharged charts

to a central medical records (HIM), where they enter charges to patient

accounts electronically, and where there is distinct seasonality, I like to

recommend two support staff for the first 25 patient visits per day. One

does front desk, and the other does the " back office " tasks.

When the patient load goes over 25, and up to about 50-65 per day, a third

person would be scheduled for the office. When the load gets above 60, a

fourth person is scheduled. An experienced team, accustomed to working

collaboratively should be abe to function without undue stress, and thereby

remain consistent.

That is just a " quick and dirty " rule of thumb. To support that group,

therapists are expected to complete evals by the end of the workday, to

chart as they treat the patient, and to turn in all charts right after the

patient visit so that billing may be done ona roling basis all day long.

(30-50 charts turned in at 11:30 a.m. and 4:30 p.m. would overwhelm the

billing entry team member, and is therefore unacceptable.)

There are no " national standards " of PT practice metrics. As close as it

gets is when some very large organizations set their own preferred standards

and mandate adherence in order to achieve their own goals.

Hope that's useful. Of course, any practice should be determining what is

appropriate for itself, with the help of their independent outside

consultant, to keep it realistic.

Dick Hillyer, DPT

Dr. Hillyer

Hillyer Consulting

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Mobile

www.DickHillyer.com

_____

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

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

Of Freeman, Meryl

Sent: Monday, February 13, 2012 1:58 PM

To: 'PTManager <mailto:%27PTManager%40yahoogroups.com>'

Subject: Front desk/support metrics

Hi all,

At our main clinic, I have 3 full-time front desk/intake people who do

reception, scheduling, registration, collections, insurance verification,

phones, etc. for 16 clinicians (a mixture of full and part-time). Upper

management wants to pile on duties for another adjacent clinic. I am

fighting this, as I feel they are already overwhelmed with their current

duties.

Are there any standard metrics out there for a clinician:support staff

ratio? I need to have some numbers to support my position.

Thanks in advance.

Meryl W. Freeman, MS PT

Manager, Rex Hospital Outpatient Rehab

2709 Blue Ridge Road, Suite 200

Raleigh, NC 27607

(office)

(cell)

----- Confidentiality Notice -----

This e-mail and any attached documents contain confidential information

belonging to the sending entity, Rex Healthcare, and is intended only for

the

use of the individual(s) or entity(s) associated with the recipient

addresses

listed in the message header. The authorized recipient of this information

is

prohibited from disclosing this information to any other party. If you are

not

the intended recipient, you are hereby notified that any disclosure,

copying,

distribution or action taken in reliance on the contents of the email and/or

attachments is strictly prohibited. If you received this e-mail transmission

in

error, please notify the sender immediately to arrange for return or

destruction of this information.

To report abuse or inappropriate use, please email

abuse@...<mailto:abuse%40rexhealth.com>

<mailto:abuse%40rexhealth.com> .(

[Guest guest]

Hi Group,

I have been treating a patient for 4 months S/P femur bone cancer. His

progress is slow. He can walk indep with a walker. He is unsafe to walk

without one without assistance. He has no pain and reports subjectively " 85%

better. " His lower extremity functional scale went DOWN this past month.Â

The guy will walk indep without assistive device if I continue to treat him but

showing this prediction on paper seems quite challenging.

Â

Questions: Do I discharge based on lack of measuable progress? Even though

progress is there but very slow? Do I have him sign a ABN? What if he signs it

and medicare denies..then I have to chase him down for the money? Can he go

private pay if we decide Medicare will not pay for it?

Â

Thank you!

Schweitzer, DPT, OCS

Â

Â

Â

________________________________

To: " 'PTManager ' " <PTManager >

Sent: Tuesday, February 14, 2012 7:49 AM

Subject: Re: Front desk/support metrics

Â

Thanks much, Dick, I appreciate your input!

And thanks to all. This group is such a great resource!

Meryl W. Freeman, MS PT

Manager, Outpatient Rehab

Rex Hospital

(919)784-4676 (office)

(919)621-3787 (cell)

From: Dick Hillyer

Sent: Monday, February 13, 2012 10:36 PM

To: PTManager <PTManager >

Subject: RE: Front desk/support metrics

Hi, Meryl -

As a quick rule of thumb in outpatient clinics in which the support staff do

all appointments, verify coverages, obtain authorizations, handle all

incoming telephone calls, assemble, maintain, and forward discharged charts

to a central medical records (HIM), where they enter charges to patient

accounts electronically, and where there is distinct seasonality, I like to

recommend two support staff for the first 25 patient visits per day. One

does front desk, and the other does the " back office " tasks.

When the patient load goes over 25, and up to about 50-65 per day, a third

person would be scheduled for the office. When the load gets above 60, a

fourth person is scheduled. An experienced team, accustomed to working

collaboratively should be abe to function without undue stress, and thereby

remain consistent.

That is just a " quick and dirty " rule of thumb. To support that group,

therapists are expected to complete evals by the end of the workday, to

chart as they treat the patient, and to turn in all charts right after the

patient visit so that billing may be done ona roling basis all day long.

(30-50 charts turned in at 11:30 a.m. and 4:30 p.m. would overwhelm the

billing entry team member, and is therefore unacceptable.)

There are no " national standards " of PT practice metrics. As close as it

gets is when some very large organizations set their own preferred standards

and mandate adherence in order to achieve their own goals.

Hope that's useful. Of course, any practice should be determining what is

appropriate for itself, with the help of their independent outside

consultant, to keep it realistic.

Dick Hillyer, DPT

Dr. Hillyer

Hillyer Consulting

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Mobile

www.DickHillyer.com

_____

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

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

Of Freeman, Meryl

Sent: Monday, February 13, 2012 1:58 PM

To: 'PTManager <mailto:%27PTManager%40yahoogroups.com>'

Subject: Front desk/support metrics

Hi all,

At our main clinic, I have 3 full-time front desk/intake people who do

reception, scheduling, registration, collections, insurance verification,

phones, etc. for 16 clinicians (a mixture of full and part-time). Upper

management wants to pile on duties for another adjacent clinic. I am

fighting this, as I feel they are already overwhelmed with their current

duties.

Are there any standard metrics out there for a clinician:support staff

ratio? I need to have some numbers to support my position.

Thanks in advance.

Meryl W. Freeman, MS PT

Manager, Rex Hospital Outpatient Rehab

2709 Blue Ridge Road, Suite 200

Raleigh, NC 27607

(office)

(cell)

----- Confidentiality Notice -----

This e-mail and any attached documents contain confidential information

belonging to the sending entity, Rex Healthcare, and is intended only for

the

use of the individual(s) or entity(s) associated with the recipient

addresses

listed in the message header. The authorized recipient of this information

is

prohibited from disclosing this information to any other party. If you are

not

the intended recipient, you are hereby notified that any disclosure,

copying,

distribution or action taken in reliance on the contents of the email and/or

attachments is strictly prohibited. If you received this e-mail transmission

in

error, please notify the sender immediately to arrange for return or

destruction of this information.

To report abuse or inappropriate use, please email

abuse@...<mailto:abuse%40rexhealth.com>

<mailto:abuse%40rexhealth.com> .(

[Guest guest]

Hi ,

It would help to know what other (if any)functional outcomes tests you are

using, what the patient's goals are and what are the barriers at home he

has to negotiate (or simply can you relate a functional goal to a need to

have him walk independently without a device?)

That being said, one of the things you can do is use other outcomes

scales: Timed up and Go, Berg Balance, 6 Minute Walk etc and see if he

falls in the at risk categories. That would help justify continued

therapy on fall risk alone. Second if there is a safety issue with using

an assistive device in his home and it would be safer for him to be at

home without a device, that would justify more treatment.

If those don't apply, then consider a maintenance program set up which

would allow you periodic paid visits to reassess and modify the plan. Set

up a written and documented plan to reaassess every 3 - 4 weeks, give the

patient a solid home program and stay in touch with follow up calls. This

gives the patient a sense that you are still treating and it falls within

Medicare rules for care. You certainly can discuss payment out-of-pocket

for continued treatment but that often doesn't go over very well with the

patient.

Another option is exists if you have discharged clients come back to your

clinic and use it as a fitness center. This option is usually lower cost

and more attractive to some seniors that may want to come back as a social

outing. This would still need an ABN signed. It would allow you to

continue to monitor the patient's progress.

Bottom line, sometimes 85% better is the goal when the patient is a low

fall/safety risk, has help at home or is safe at their current level even

with an assistive device BUT you can still demonstrate continued care

through a maintenance program set up (see the specifics in the Medicare

Benefits Policy manual on maintenance programs) or

through an aftercare program. You can also look to justify more treatment

using safety issues vis outcomes tools.

M Howell, PT, MPT

IPTA Payment Specialist

Meridian, ID

thowell@...

Hi Group,

> I have been treating a patient for 4 months S/P femur bone cancer. His

> progress is slow. He can walk indep with a walker. He is unsafe to

> walk without one without assistance. He has no pain and reports

> subjectively " 85% better. " His lower extremity functional scale went

> DOWN this past month. The guy will walk indep without assistive

> device if I continue to treat him but showing this prediction on paper

> seems quite challenging. Â

> Questions: Do I discharge based on lack of measuable progress? Even

> though progress is there but very slow? Do I have him sign a ABN? What

> if he signs it and medicare denies..then I have to chase him down for

> the money? Can he go private pay if we decide Medicare will not pay

> for it? Â

> Thank you!

> Schweitzer, DPT, OCS

> Â

> Â

> Â

>

>

> ________________________________

>

> To: " 'PTManager ' " <PTManager >

> Sent: Tuesday, February 14, 2012 7:49 AM

> Subject: Re: Front desk/support metrics

>

>

> Â

> Thanks much, Dick, I appreciate your input!

>

> And thanks to all. This group is such a great resource!

>

>

> Meryl W. Freeman, MS PT

> Manager, Outpatient Rehab

> Rex Hospital

> (919)784-4676 (office)

> (919)621-3787 (cell)

>

> From: Dick Hillyer

> Sent: Monday, February 13, 2012 10:36 PM

> To: PTManager <PTManager >

> Subject: RE: Front desk/support metrics

>

>

>

> Hi, Meryl -

>

> As a quick rule of thumb in outpatient clinics in which the support

> staff do all appointments, verify coverages, obtain authorizations,

> handle all incoming telephone calls, assemble, maintain, and forward

> discharged charts to a central medical records (HIM), where they enter

> charges to patient accounts electronically, and where there is distinct

> seasonality, I like to recommend two support staff for the first 25

> patient visits per day. One does front desk, and the other does the

> " back office " tasks.

>

> When the patient load goes over 25, and up to about 50-65 per day, a

> third person would be scheduled for the office. When the load gets above

> 60, a fourth person is scheduled. An experienced team, accustomed to

> working collaboratively should be abe to function without undue stress,

> and thereby remain consistent.

>

> That is just a " quick and dirty " rule of thumb. To support that group,

> therapists are expected to complete evals by the end of the workday, to

> chart as they treat the patient, and to turn in all charts right after

> the patient visit so that billing may be done ona roling basis all day

> long. (30-50 charts turned in at 11:30 a.m. and 4:30 p.m. would

> overwhelm the billing entry team member, and is therefore unacceptable.)

>

> There are no " national standards " of PT practice metrics. As close as it

> gets is when some very large organizations set their own preferred

> standards and mandate adherence in order to achieve their own goals.

>

> Hope that's useful. Of course, any practice should be determining what

> is appropriate for itself, with the help of their independent outside

> consultant, to keep it realistic.

>

> Dick Hillyer, DPT

>

>

> Dr. Hillyer

> Hillyer Consulting

> 700 El Dorado Pkwy W.

> Cape Coral, FL 33914

>

> Mobile

> www.DickHillyer.com

>

>

> _____

>

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

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

> On Behalf Of Freeman, Meryl

> Sent: Monday, February 13, 2012 1:58 PM

> To: 'PTManager <mailto:%27PTManager%40yahoogroups.com>'

> Subject: Front desk/support metrics

>

> Hi all,

>

> At our main clinic, I have 3 full-time front desk/intake people who do

> reception, scheduling, registration, collections, insurance

> verification, phones, etc. for 16 clinicians (a mixture of full and

> part-time). Upper management wants to pile on duties for another

> adjacent clinic. I am fighting this, as I feel they are already

> overwhelmed with their current duties.

>

> Are there any standard metrics out there for a clinician:support staff

> ratio? I need to have some numbers to support my position.

>

> Thanks in advance.

>

> Meryl W. Freeman, MS PT

> Manager, Rex Hospital Outpatient Rehab

> 2709 Blue Ridge Road, Suite 200

> Raleigh, NC 27607

> (office)

> (cell)

>

> ----- Confidentiality Notice -----

> This e-mail and any attached documents contain confidential information

> belonging to the sending entity, Rex Healthcare, and is intended only

> for the

> use of the individual(s) or entity(s) associated with the recipient

> addresses

> listed in the message header. The authorized recipient of this

> information is

> prohibited from disclosing this information to any other party. If you

> are not

> the intended recipient, you are hereby notified that any disclosure,

> copying,

> distribution or action taken in reliance on the contents of the email

> and/or attachments is strictly prohibited. If you received this e-mail

> transmission in

> error, please notify the sender immediately to arrange for return or

> destruction of this information.

>

> To report abuse or inappropriate use, please email

> abuse@...<mailto:abuse%40rexhealth.com>

> <mailto:abuse%40rexhealth.com> .(

>

>