EMR Documentation

May 9, 2012

What documentation program do you use in your facility? We struggle to

maintain good documentation as our facility tried to develop an EMR in house

and it has been a disaster.

Thank you.

Sperry PT OCS

From: ez, Joyce

Sent: Wednesday, May 09, 2012 8:42 AM

To: PTManager

Subject: RE: Re: Therapy Cap for Hospital Based OP

Thanks for the summary Tom!

We strictly follow Medicare guidelines and have successfully passed

Medicare/JCAHO audits in the past. Every single one of our Medicare and

non-Medicare patient's plan of care (initial eval and re-cert) is signed

by the referring MDs certifying the need for or continuation of skilled

PT,OT or ST services. Our therapists do a great job with documentation,

they write substantial daily SOAP notes, detailed assessment of

objective measurements and goal attainment every 6 visits plus a

progress report written once every 10 treatment days or at least once

every 30 calendar days, whichever is less.

Since we're already doing all that, the only thing added to the process

is using a KX modifier and undergoing a " manual medical review " . I will

contact our MAC to get more details and I'm sure Rick Gawenda will have

a webinar about this as well.

Thanks again and have a great day!

Joyce

Joyce ez, PT

Outpatient Rehab Manager

Provena Saint ph Hospital

Phone: ext. 5177

Email: Joyce.ez@... <mailto:Joyce.ez%40provena.org>

<blocked::mailto:Joyce.ez@...

<mailto:Joyce.ez%40provena.org> >

Important Notice:

This message and any attachments are confidential and maybe protected by

legal privilege. If you are not the inted recipient, be aware that any

disclosures, copying, distribution, or use of this message or any

attachment is prohibited. If you recieved this in error, please notify

us immediately by returning it to sender and deleting the copy from your

system. Thank you.

________________________________

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

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

Behalf Of M. Howell PT, MPT

Sent: Tuesday, May 08, 2012 6:21 PM

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

Subject: RE: Re: Therapy Cap for Hospital Based OP

Hi Joyce,

I would highly recommend that you look up the information on it on the

CMS

site or at the APTA site for full details on the current regulations.

A short summary is that any Part B Medicare outpatient beneficiary

reaching

the combined PT/ST cap of $1880 has a couple of choices. One is that

they,

in discussion with their PT, can end therapy when the cap is reached.

Second, is that if the PT has determined and documented the medical

necessity to continue and it is approved in the plan of care signed by

the

provider (mostly the referring physician) that PT should continue care.

The

billing of claims once the cap is reached must be submitted with a -KX

modifier to indicate that the therapy is continuing under the

" Exceptions "

process. The continued therapy MUST be justified as reasonable and

necessary in the notes with objective data to support that continued

therapy

is medically necessary. This process continues as long as care is needed

BUT now there is a new added regulation that these claims that continue

under the KX modifier now MUST undergo a " manual medical review " once

the

claim reaches $3700. That " manual medical review " is brand new and no

proposed regulations for it have been released yet so no-one knows how

it

will work.

Basically, this is a process by which you can continue therapy past the

cap

as long as you can justify it based on how Medicare wants it justified

and

as long as the plan of care to continue is approved. The new wrinkle is

that manual medical review.

For the details of how the KX modifier gets on claims and where it goes,

you

need to consult the source. A good place to start is the MAC( Medicare

Administrative Contractor) for your region. Most have online training

courses just for this and I am sure they will have plenty more in

preparation for October.

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

<mailto:thowell@... <mailto:thowell%40fiberpipe.net>

<mailto:thowell%40fiberpipe.net> >

thowell@... <mailto:thowell%40fiberpipe.net>

<mailto:thowell%40fiberpipe.net>

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its

attachments, please be advised that you have received this email in

error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If

you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

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

<mailto:PTManager%40yahoogroups.com>

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

<mailto:PTManager%40yahoogroups.com> ]

On Behalf

Of ez, Joyce

Sent: Tuesday, May 08, 2012 3:19 PM

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

<mailto:PTManager%40yahoogroups.com>

Subject: RE: Re: Therapy Cap for Hospital Based OP

Being a hospital based OP therapy department, we have not paid attention

to the therapy cap until now. Can somebody please explain what a KX

modifier is?

Joyce ez, PT

Outpatient Rehab Manager

Provena Saint ph Hospital

Phone: ext. 5177

Email: Joyce.ez@... <mailto:Joyce.ez%40provena.org>

<mailto:Joyce.ez%40provena.org>

<blocked::mailto:Joyce.ez@...

<mailto:Joyce.ez%40provena.org>

<mailto:Joyce.ez%40provena.org> >

Important Notice:

This message and any attachments are confidential and maybe protected by

legal privilege. If you are not the inted recipient, be aware that any

disclosures, copying, distribution, or use of this message or any

attachment is prohibited. If you recieved this in error, please notify

us immediately by returning it to sender and deleting the copy from your

system. Thank you.

________________________________

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

<mailto:PTManager%40yahoogroups.com>

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

<mailto:PTManager%40yahoogroups.com>

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

Behalf Of M. Howell PT, MPT

Sent: Monday, May 07, 2012 10:20 PM

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

<mailto:PTManager%40yahoogroups.com>

Subject: RE: Re: Therapy Cap for Hospital Based OP

Hi ,

To the best of my knowledge, that is incorrect. A Medicare beneficiary

has an $1880/year PT/ST cap, period. The difference is that as of Oct 1,

2012, hospital-based outpatient practices are no longer exempt from the

cap. As of Oct 1, 2012 any outpatient part therapy done from Jan 1, 2012

to Oct 1, 2012, no matter where it was done will apply towards the cap,

even if it was being done in the exempt outpatient center all along.

That is my understanding of it and why it is causing a concern. But also

remember that you can use the KX modifier, technically up to $3699, then

the manual medical review will kick in.

I suspect what hospital-based departments may do is append the KX

modifier for most patients that have had prior therapy and have reached

the cap but are below $3700. If on October 1 a patient goes to the

hospital outpatient department and has greater than $3699 in prior

therapy, the department MUST request a manual medical review first.

Unfortunately we still do not know how the manual medical review will

operate. Bottom line, hospital outpatient departments must do a lot of

education between now and October so their staff is ready and they must

make sure that their billing departments and/or front office know how to

check to see if the patient has any prior therapy and how much. Plus all

staff must be clear on when and how to use the correct ABN form.

This is an ingenious plan to ration therapy services and reduce costs.

We must accept that the cost of providing outpatient PT through Medicare

has continued to climb at a very high rate. Nothing has stopped that

growth except severe austerity measures which is what this October is

about.

Unfortunately those that will be hurt the most are those that need it

the most - the severely involved long term rehab patients needed PT,OT,

ST. The only hope is that the manual medical review will recognize the

need and keep authorizing PT for these folks.

The trick will be for clinics to use the KX modifier enough to keep

seeing patients but not so much that they trigger an audit.

And just when you get the hang of it, remember that the exceptions

process expires December 31, 2012 and with a lame-duck Congress - we may

lose that KX exceptions process again. I hope everyone is ready to mount

a lobbying campaign - we will need it big time!

I encourage all PT's to review the alternative payment system for

outpatient PT that the APTA is proposing and releasing to the rank and

file soon. The faster we get this system to its most useable form, the

faster we can try to make the caps go away with a system that will mean

less regulation, less rules and more indication of our value as PT's and

PTA's.

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

<mailto:thowell@... <mailto:thowell%40fiberpipe.net>

<mailto:thowell%40fiberpipe.net>

<mailto:thowell%40fiberpipe.net> >

thowell@... <mailto:thowell%40fiberpipe.net>

<mailto:thowell%40fiberpipe.net>

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its attachments, please be advised that you have received this email in

error and that any use, dissemination, distribution, forwarding,

printing or copying of this email or any attached files is strictly

prohibited. If you have received this email in error, please immediately

purge it and all attachments and notify the sender by reply email.

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

<mailto:PTManager%40yahoogroups.com>

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

<mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com> ]

On Behalf Of Witt

Sent: Monday, May 07, 2012 12:02 PM

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

<mailto:PTManager%40yahoogroups.com>

Subject: Re: Re: Therapy Cap for Hospital Based OP

Is it correct to say that MC beneficiaries now have $1880 of PT/ST per

yr non hospital AND $1880 of PT/ST per yr in a hospital (outpt) setting?

Witt, PT

Certified Golf Fitness Instructor

Titleist Performance Institute

Segal & Witt Physical Therapy

5162 Linton Boulevard, Suite 105

Delray Beach, FL 33484

C

O

F

wittpt@... <mailto:wittpt%40att.net> <mailto:wittpt%40att.net>

<mailto:wittpt%40att.net>

American Physical Therapy Association

Vestibular Disorders Association

On May 7, 2012, at 11:48 AM, " R " <bperlson@...

<mailto:bperlson%40asante.org>

<mailto:bperlson%40asante.org> <mailto:bperlson%40asante.org> > wrote:

A transmittal

(http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012-

Transmittals-Items/R2457CP.html)

was released to MACs two weeks ago. Presumably instructions to providers

will follow before too long.

The caps pertain to Medicare allowable charges, not hospital charges.

And as you probably know, the implementation starts on October 1, but

the limits apply to all charges incurred since January 1. Beyond that,

stay tuned.

bob perlson

Director, Rehabilitation Services

Rogue Valley Medical Center

Medford, OR

>

> Being in a hospital based OP therapy department, we have not paid

> attention to the OP Therapy Cap. Now that it is going to apply to the

> hospital based departments, is there a simple breakdown of OP therapy

> Cap process? It would be helpful to know:

>

> 1. Does the benefit amount refer to billed charges?

>

> 2. What is KX modifier?

>

> 3. Process used by private clinics to ensure compliance with this

> provision?

>

> I appreciate any information.

>

> Thanks.

>

> -----------------------------------------

>

May 9, 2012

Quick EMR. VERY user friendly and not too expensive. Feel free to email me if

you have any questions.

Balan

Solex Physical Therapy

Naples, Fl

Sent from my HTC smartphone on the Now Network from Sprint!

----- Reply message -----

To: <PTManager >

Subject: EMR Documentation

Date: Wed, May 9, 2012 3:15 pm