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Quite Simply, It’s Complex: The Truth About Four New PT Evaluation Codes

Just four new codes…seems easy, right? The truth is, this new evaluation code law for 2017 has a little more going on just below the surface. The standards of an evaluation will remain the same. The real curve-ball here is the newly added system to classify complexity. Physical therapists have four components to consider, and each level of complexity has criteria for elements from each. (Are you an Occupational Therapist? Click here) Here’s a quick breakdown:

1. Patient History

This includes comorbidities, their functioning level prior to what led them to seek care, relevant treatment approaches in the past, and various factors such as medications, work status, social history, and more. The key here is to only consider aspects of the patient’s history that directly impact the plan of care now.

2. Examination

Includes body structure and function, activity limitations, and participation restrictions. The last two might seem a little redundant, but there are subtle differences between them. The ICF defines activity limitations as “difficulties an individual may have in executing activities” and participation restrictions as “problems an individual may experience in involvement in life situations”. Here’s a post for reference on what the ICF is all about. Activities and participation include- but are not limited to- mobility, self-care, domestic life, interpersonal interactions and relationships, and civic life.

3. Clinical Presentation

The patient is stable and uncomplicated. This is your straightforward athlete with an ankle sprain- their ankle hurt the worst at time of injury, is getting better, and you can expect it to get better over time.

The patient has evolving clinical presentation with changing clinical characteristics. This patient could be someone who began treatment with neck and upper back pain and now also has numbness in the right arm and hand. The symptoms are evolving and definitely have the potential to get worse.

The patient has evolving clinical presentation with unstable and unpredictable characteristics. Take our back pain and hand numbness patient from a moment ago, and throw in orthostatic hypotension. There is a risk every time you have the patient change positions that their blood pressure can bottom out, ergo their blood pressure is unstable and unpredictable

4. Clinical Decision Making

The final piece of the puzzle. This is your judgement as a therapist based on the big picture of the patient regarding their treatment plan. It can be of low, moderate, or high complexity, and the decision must be made using a “standardized patient assessment instrument and/or measurable assessment of functional outcome”.

3 Interfaces Every Hospital Outpatient Clinic Needs

At Cedaron, we describe an interface as a handshake. Both sides must reach out and connect in order for the integration to be successful. This handshake is a crucial aspect for Hospital Outpatient Rehab Clinics to maximize productivity and efficiency. An Outpatient Rehab EMR that interfaces with the hospital ADT, Billing, and PCR is a vital tool for your organization- check it out:

1. ADT Interface

An ADT interface pulls all patient demographic information into the outpatient Rehab EMR, eliminating the need for your therapists to reenter all of this data and saving precious time. When John Doe is discharged from the hospital and coming into your clinic for rehab, you can automatically populate his name, DOB, address, ethnicity, MRN, Insurance and all other demographic information through this connection with the hospital ADT system. Save time and reduce entry errors with this automated process, and get right to the important stuff- treating your patient.

2. Billing Interface

Interfacing with billing is obviously a pretty important piece of the puzzle. This allows you to continue with business as usual with no disruptions to your work or billing cycle when implementing a Rehab EMR. Cedaron helps prevent denials as we create the entire bill based on Medicare Rules and other third party insurance rules. Make sure you see a winning track record before you trust a company to establish a connection between your Rehab EMR and current billing system.

3. Permanent Clinical Record Interface

PCR, or Permanent Clinical Record, integration streamlines the process of congregating all patient evaluations, health information, and reports in one place- a permanent health record. Printing, faxing, or walking documents to a records department is so 1990. Use a PCR interface to have these documents sent right from the record in your Hospitals EHR to the permanent record with the records department. Avoid mix-ups, lost records, and save yourself time with this valuable tool.

Make sure the Outpatient Rehab EMR you use is extending a hand for a firm shake. Other companies may talk the talk, but Cedaron walks the walk. We can successfully interface with any primary EHR, including but not limited to Epic, Meditech, Paragon, Cerner, McKesson and Siemens. You don’t have to compromise the quality of your documentation system in order to have a system that communicates effectively with the primary hospital EHR. Oh, and not to mention Cedaron is certified for Meaningful Use, meaning legislation like MIPS is no problem. You can have the most complete Rehab software solution and maintain that seamless communication.

Call Cedaron for a product that works best for the therapy practice and integrates with your hospital’s EHR.

Healthcare Technology

3 Reasons MIPS is More Important Than You Think

New evaluation codes are not the only change right around the corner. CMS released the final 2017 Medicare and CHIP Reauthorization ACT (MACRA) in October, and the provision that should be on every therapists’ radar is the Merit-Based Incentive Payment System (MIPS). Why is it relevant now when it doesn’t even apply to therapists yet? Take a look.

1. Your Rehab EMR may not be ready.

Is your Rehab EMR certified by the Office of the National Coordinator for Health Information Technology? Not many are. In order to meet the criteria for the “Advancing Care Information” category of MIPS, which is replacing Meaningful Use, your EMR must be. Cedaron’s Connect Rehab EMR is the only Rehab Specialty Solution that has certification. This allows users to participate in MIPS during the 2017-2018 voluntary period (more on this later) as well as avoid penalties when this system becomes mandatory in 2019. Certification can be a time-consuming process- if your system is not certified now, they may not be ready for mandatory participation in 2019.

2. You should be submitting to a national registry.

While it isn’t mandatory, MIPS is certainly geared towards submitting your data to an outcomes database, and it may very well become required in the future. Submitting your data allows you to benchmark your clinic against others nationally, and gives the therapy profession a variety of information to create quality measures. Cedaron’s customers are eligible to participate in our NOD (National Outcomes Database) for free or the AOTA’s registry at an additional cost. Unlike other registries that will require a considerable length of time to gather substantial data for benchmarking, Cedaron’s NOD already has a half million episodes of care documented by current users.

3. Therapists are getting a trial period.

While MIPS is mandatory for physicians, physicians’ assistants, nurse practitioners, and others in 2017, it will not be mandatory for therapists. However, therapists are being given the opportunity to voluntarily report- basically, two years of practice before facing potential penalties in 2019. Like most things, there is likely to be a learning curve when beginning to use these new measures, and those that are eligible to participate in the voluntary period will have an unprecedented advantage when reporting is required. One more thing- the bonuses. While penalties on the sliding scale may be as much as 9% by 2022, the bonuses may be as much as 3 times the maximum penalty. Cedaron’s Rehab EMR is ready for MIPS today. Customers can participate in MIPS without facing penalty, face significantly less denials in 2019 because they have gained experience, and even qualify for substantial bonuses.

Be prepared for all of the changes facing our evolving healthcare system- new evaluation codes, MIPS, and anything else that might get thrown your way in the future. Cedaron always thinks two steps ahead, and with our Rehab EMR you can be confident that you will transition toward value-based care with a system prepared for anything.

Healthcare Technology

Choosing an EMR: 8 Must Have Tools

When it Comes to Compliance…. not all EMRs are created equal. In fact, most — despite their claims — lack the robust technology and tools needed to effortlessly manage today’s growing payee regulations.

Since many first-time technology adopters “don’t know what they don’t know,” we’ve listed some of the must-have technologies that your clinic will want to ensure compliance.

1. Regulatory Alerts

Notify users when a record requires a report, modifier, question, authorization, or certification. These vital alerts should include:

Progress Report Alerts
Authorization and Re-Certification Alerts
Unanswered Pain Question Alerts
Modifier Alerts

2. G-Code Alerts

Automatically appear when needed for a particular visit, reducing G-code-related denials and streamlining manual processes. Alerts should also notify users when they come close to 60 days or any other issues that might compromise prompt payment.

3. A Medicare Therapy Fee Cap

Calculator tracks the therapy fee cap at the Patient Dashboard and Therapist Dashboard level. Users instantly know when they need to add a modifier or submit for a Medical Necessity, drastically increasing compliance and revenue cycles with the ultimate goal of reducing denials.

4. Medicare Compliant Multi-Discipline Billing

Automatically transfers charges properly and ensures assignment of primary G-code so multi-discipline bills are not denied.

5. Automatic Goal Builders

Generate goal templates if using the ICF to choose the functional limitation of the patient to ensure compliance and flexibility.

6. Document Management Lists and Alerts

Indicate what required documents are missing based upon pre-determined rules for specific types of patients or insurance companies. This eliminates the manual process of checking each patient file to make sure all documents have been completed.

7. ICD 10 Functionality

As clinicians enter diagnostic information during the encounter – using simple, standard clinical terms – the number of available ICD-10 codes is narrowed, making code choices easy and accurate.

8. New Evaluation Codes Based on Patient Complexity

Required beginning Jan, 1^st 2017. Be confident that your EMR is equipped with automatic alerts to keep you compliant and denials at bay.

CONCLUSION:

If compliance counts in your clinic be sure to closely compare tools and features before rushing into a solution that looks like a value but could cost you thousands of dollars down the road.

Many systems are available today but none meet the extensive customization, adherence to regulations and documentation needs of a larger outpatient rehabilitation facility.

Investigate for yourself: Checkout our EMR system and see how it can keep your practice compliant, reduce denials, increase reimbursements, streamline workflow, and ultimately increase your bottom line!

Healthcare Technology

Get Invested in New Evaluation Codes

By now, you’ve probably heard the news. January 1, 2017 marks the end of physical therapy evaluation codes 97001 and 97002, and the beginning of brand new evaluation codes based on patient complexity. The two old codes, established in 1998, are being replaced by four new codes: 97161 for low complexity evaluation, 97162 for moderate complexity evaluation, 97163 for high complexity evaluation, and 97164 for re-evaluation. For the first time, physical therapists will have a coding system that reflects on the variation in the treatment provided for a patient based on how complex the patient’s needs are. There will be new Occupational Therapy evaluation codes as well following the same design, however the codes themselves and the relative values differ.

Preparing for New Evaluation Codes: Get Back to the Basics

As we become more and more advanced, sometimes it is necessary to take a step back and return to the basics. Without a strong foundation, the whole building comes down. This can be widely applied to nearly every profession, sport, science, and everything in between. That being said, what are the basics of coding for patient documentation? If you practice in the US, you would most likely tell me ICD-10. Across the pond, however, they probably would default to the ICF. What’s the difference between the two?

Quite Simply, It’s Complex: The Truth About Four New PT Evaluation Codes

1. Patient History

2. Examination

3. Clinical Presentation

4. Clinical Decision Making

3 Interfaces Every Hospital Outpatient Clinic Needs

1. ADT Interface

2. Billing Interface

3. Permanent Clinical Record Interface

3 Reasons MIPS is More Important Than You Think

1. Your Rehab EMR may not be ready.

2. You should be submitting to a national registry.

3. Therapists are getting a trial period.

Choosing an EMR: 8 Must Have Tools

1. Regulatory Alerts

2. G-Code Alerts

3. A Medicare Therapy Fee Cap

4. Medicare Compliant Multi-Discipline Billing

5. Automatic Goal Builders

6. Document Management Lists and Alerts

7. ICD 10 Functionality

8. New Evaluation Codes Based on Patient Complexity

Get Invested in New Evaluation Codes

Preparing for New Evaluation Codes: Get Back to the Basics

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