Monday, August 29, 2016

Health & Fitness for People Who Work in an Office

As a health and movement advocate who happens to also have a desk job, I understand that healthy can be hard. We live in a fast paced world with more and more conveniences being thrown our way in order to keep up. As obesity and diabetes rates continue to rise and cancer diagnosis reach record highs, the facts can no longer be ignored. Our health and well being is directly impacted by what we put into our mouths and how we move our bodies. I’m here to share simple ways where healthy does’t have to be so hard. 

1. Commit to moving everyday. Research shows on average office workers are spending 10 hours a day in a sitting posture! As of June 2015, experts recommended us ‘sitters’ try to add at least 2 hours of standing a day and try to increase this to 4. Suggestions on ‘how?’ include replacing traditional desks with new sit-to-stand desks. If this is not an option, try taking calls standing or even walking in place while on a call or on hold. A tech-savvy way to help inspire this change is to invest in a Fitbit or App that tracks daily steps. This has really helped me reach my daily steps goal.
2. Preparation is key when it comes to changing lifestyle and food choices. In order for real change to stick, real change may need to take place in the grocery store, then kitchen, then pantry, then when out and about, etc. If you are use to grabbing meals on the go, find the time to make home-made versions of those meals and schedule the time into your calendar to do so. That way you grab-and-go from your own home. Afterall, the more time you put into taking care of yourself, the more time you will have for living.

Written by: Keely Henry, StrataPT AR Specialist 

Thursday, August 14, 2014

Physical Therapy Billing: A Day in the Life of an AR Specialist

"So what do you do for a living?" 

That very basic question is one that everyone has or will be asked at some point in their life. It’s a conversation starter and often a measurement of your status and potential in the eyes of others. My usual response to this inquiry is, “I handle billing and credentialing for multiple physical therapy practices around the country for StrataPT”. On most occasions, I am met with a blank stare or "Oh that sounds interesting". If an explanation is desired, I then go on to say that I call medical, automobile, and workers compensation insurance companies as well as attorneys' offices to determine why our client has not received payment yet for their services. This can be due to any number of reasons such as notes are required, specific modifiers are needed, there is no W9 on file, the patient information is invalid, authorization is required or needs to be updated and the list goes on and on.

The task does not seem too difficult at face value, however in most cases there is always some form of a "bump" in the road. First, we will begin with automated systems which I believe can be your best friend or your worst enemy. I do not want to praise or insult any specific insurance company but I will say that there are some IVRS (interactive voice response systems) that I actually get excited about calling and then there are others that malfunction and hang up on you if you breath too loudly (thank goodness for mute buttons). In my experience, IVRS are either extremely user friendly or they are going to make you job extremely hard to get anything accomplished.

A few other obstacles that my coworkers and I constantly run into are being accidentally disconnected, being transferred endlessly, constantly leaving messages, and the best of all - long hold times. Thankfully, I have not personally been disconnected too many times, however it seems that whenever I am disconnected it's only after I have been holding for over a half an hour or the representative answers the phone, obtains all provider and patient information, and then accidentally hangs up when they put me on hold to search for details. Come to think of it, I retract that previous statement...I have been disconnected a lot, thus the process has to start
all over again.

Next are the lovely transfers, that mind you, in most cases get you nowhere. Every transfer begins with the promise that they will definitely be sending you to the correct area, plan, state, and representative, so you hold for another ten minutes only to be told that they have no idea why you would be transferred to them in the first place.

Then there is leaving messages which I have personalized my own since I leave so many. Generally I'll say, "Hi, my name is Danielle, I am calling with (insert company) on our patient (insert patient name), his/her (insert CL#/ID#) and I was calling to obtain (insert reason for call), I would appreciate a call back at 866-281-7636, thank you"In a perfect world, representatives, adjusters, and attorneys would actually call back in the next 24-48 business hours as promised by their voice mails. Unfortunately, this is very rarely the case.  As a result, anywhere from 5-20 messages will be made in some cases.

And last, but certainly not least...hold times. The thing about hold times is that it does not only refer to the initial time spent just waiting for the first representative to answer your call. Hold times also refer to the time period in which the phone has already been picked up, but now the representative needs to do "further research" which can result in very long hold times. My record was set last week.  I have been working on a specific patients' claims now for about three months and without fail every time I call, the representatives cannot locate the patient, cannot locate the provider, cannot locate the claims, have no idea what I am talking about and then finally after three hours find all of the appropriate information only to tell me that they need to escalate the claims inquiry again.

Although I have made the responsibilities of an AR Specialist appear fairly bleak and tedious, it can be very rewarding. Some might question why we fight so hard for just a few dollars or even pennies, but in the large scheme of things, every penny counts.  If we let a few dollars go here and then a few dollars go there, by the end of the year, our clients would most likely be short a few hundred dollars; which is unacceptable.

Accounts receivable follow up is one of the most important components of the physical therapy billing process that leads to the financial success of an outpatient physical therapy practice. We pride ourselves in providing our clients with the #1 accounts receivable collection rates in the industry which I believe is a direct reflection of our commitment to ensure that our clients receive every penny owed to them. Not to mention, it feels pretty amazing when payment finally does come through, no matter how small or large it may be!

By: Danielle Barrett
AR Specialist

Tuesday, July 29, 2014

Focus On Your Core Competencies.

Efficiently running a physical therapy practice is no easy task that requires you to wear a number of different hats.  Some hats may fit with ease and prove to be something you are comfortable with, while other hats are ill-fitting and end up draining you of your original inspiration to start your own practice.

As a business owner myself, one of the most valuable lessons that I learned and embraced is the simple fact that although there are many hats to be worn, I simply cannot be an “expert” at everything.  Years ago, I came across a great quote by Bill Gates that sheds a lot of light on this valuable lesson.

 “An Important Principle Is That Companies Should Focus On Their Core Competencies And Outsource Everything Else.” - Bill Gates

How many companies do you know of that do every component of their business in-house?  If they do everything in-house, are they experts at every component?

This was my “a-ha” moment in which I realized that I am not an expert at every component of my business.  Instead, I applied this valuable lesson by surrounding my company with people who are experts in the areas in which I needed assistance. By having a team of experts that I view as an extension of my company concentrate on specific competencies, I am able to focus on the core competencies of my business.

The same can be said about your physical therapy business in order to achieve success. Concentrate on your core competencies and outsource the components of your business where you do not consider yourself to be an expert in. 

When it comes to the daily business operations necessary to run your practice, do you feel like you are wearing too many “hats” without having the time and or expertise? 

Wednesday, July 16, 2014

A Key Component For Business Success

Whether it is a physical therapy practice or a fast food restaurant, efficient systems are the lifeblood of any successful business.

Let’s use the phenomenal story of the leading fast food restaurant in the world; McDonald’s as an example. The McDonald’s story all started back in 1948 when a set of brothers founded McDonald’s after shutting down their original BBQ business for a few months in order to implement their innovative "Speedee Service System" - an efficient assembly line for hamburgers. As a result, McDonald’s was able to make a 15 cent hamburger the staple of their menu. At 15 cents, McDonald’s hamburgers were not only half the price of other diners in the area but they were served immediately.

In 1954, the McDonald’s brothers were approached by entrepreneur and milkshake-mixer salesman Ray Kroc with the proposition to let him franchise McDonald’s restaurants outside the company’s home base of California and Arizona. In 1955, Ray Kroc founded "McDonald's Systems, Inc." and opened his first McDonald’s restaurant in Des Plaines, Illinois. In 1958, McDonald’s Worldwide sold its 100 millionth hamburger. Today McDonald’s has grown to over 35,000 restaurants in more than 100 countries.  McDonald’s also employs more than 1.7 million people who serve over 70 million customers each day.

So how was founder Ray Kroc able to do this? The answer is “systems.” By having exceptionally strong systems in place, McDonald's is able to hire and train their employees to become extremely efficient and successful at their position. The burger always has the same taste, the burger always has the same look and the burger is almost always prepared before you can even make it to the drive through window. All of these items are made possible because of the step by step systems that have been implemented.

The significance of systems is that once they are developed and implemented properly, the company can move towards an operationally independent identity. This in return is what allows the duplication of the systems and the overall growth of a company.

Whether you are admitting a new patient or ordering supplies for your clinic, each physical therapy business should have a policy and procedures manual outlining their systems. As the director of five outpatient physical therapy clinics in Florida and Ohio, the implementation of systems was a critical component of the day to day operations of each clinic. When I was first introduced to this role, my colleagues always joked with me that I should carry a hose around because it seemed like all I did was put out fires. It did not take long for me to realize that something needed to be done in order to dissolve the operational hurdles that were clearly limiting the practice from maximizing their potential.

We didn't need better equipment, better staff or better marketing. Instead, we needed better systems. It wasn't until I created and implemented efficient systems that were universal throughout all five locations, that each clinic became more and more operationally independent.

If you find yourself reading this and are feeling very similar as if nothing productive can be accomplished because all you do is “put out fires”, I challenge you to start simple and identify the fires that are draining you. Make a list of them as they present themselves. However, don’t just make a list. Take the next step and develop a solution. Once you have identified an operational hurdle, develop and implement a system that will streamline the process and eliminate that fire or operational hurdle from happening again. 

Do not get discouraged.  Remember that systems whether small are large are contributions towards making your clinic one step closer to becoming operationally independent.

Monday, July 7, 2014

The Customer Service Difference.

How many times have you hung up the phone or read an email from a company and thought to yourself, “Wow that was awesome customer service!”? Unfortunately, in today’s environment, we often times find ourselves experiencing the complete opposite. It is a sad reality but I can name on one hand how many companies I have received such extraordinary customer service that it has left a lasting impression. There is no doubt that many companies offer “okay” or “good” customer service but how many companies have you dealt with that fall into the category of providing “extraordinary” customer service?

“Customer service is the provision of service to customers before, during and after a purchase.” – Wikipedia

About seven years ago, we had an issue with the power bill at one of the outpatient physical therapy clinics that I worked at here in Florida. I called the power company and from my very first interaction, their customer service was top notch. They not only corrected the power bill but they took the extra step by sending a service representative out to the clinic to do a full walk through and make sure that our lights, doors, and windows were as efficient as possible. The gentleman who came out was respectful, patient, educated, and thorough. He also followed up several days later with a phone call to see if I had any additional questions. It probably sounds like he was trying to sell me something but the reality was that he was just providing what I consider to be extraordinary customer service. To this day, seven years later, I still remember the impact that customer service experience had on me.

When I started StrataPT, one of my top priorities was to exceed client expectations by ensuring that we consistently deliver high quality products that are paired with extraordinary customer service. In my experience, there are plenty of great products and services that fail to reach their full potential simply because they are missing the valuable link of being supported by extraordinary customer service.

Simply put, communication is critical to the success of any product or service. In the technology advanced world that we live in, we are very fortunate to have so many different ways to be able to communicate with each other. Whether it is by means of phone, email, text, internet, video conferencing or faxing just to name a few, when you combine the valuable technology that we have at our finger tips with the right team of professionals, there is no excuse why one should not be able to provide extraordinary customer service.

”Choose to deliver amazing service to your customers. You'll stand out because they don't get it anywhere else”. -Kevin Stirtz

If you run an outpatient physical therapy clinic, you clearly understand that word of mouth referrals play a key part in achieving your company’s revenue goals. With that in mind, why not make every encounter with a patient an experience that they walk away and say, “Wow…that was extraordinary customer service!”? This doesn’t just entail their clinical care with you as the therapist, but the experience stems back to their initial phone call, their interaction with your front desk, and their experience during check out and scheduling. At the end of the day, patients go home and tell their neighbors, tell the lady at the hair salon and tell their friends on the golf course about their PT visit if it was an extraordinary experience. What better referral than one that is the result of the service you and your staff provided?

“Do right. Do your best. Treat others as you want to be treated”. -Lou Holtz

Below is a list of customer service tips that you may find helpful for your business.

1.) Communicate timely and effectively.
2.) Always seek feedback, listen to your patients and implement their feedback when appropriate.
3.) Be helpful - even if there is no immediate profit in it.
4.) Never over promise and under deliver.
5.) Train your staff to always be helpful, courteous, and knowledgeable.
6.) Always take the extra step.

In closing, my best advice is to make every patient a “raving fan.”

Tuesday, June 24, 2014

How Does The Sequestration Order Reduce Your Medicare Payments?

In our last blog, we discussed the MPPR policy and how the formula reduces your overall payment from Medicare.  In addition to MPPR, Medicare implemented an additional order in April of 2013 that lowers your reimbursement even further.  This order is referred to as Sequestration and means “reduction in federal payment.”

The Sequestration applies a 2% reduction to the Medicare payments that you receive for your physical therapy services.  However, understanding the calculation of the Sequestration Order has a similar level of complexity as the MPPR.  The 2% reduction only applies to the 80% paid by Medicare.  It does not apply to the 20% that falls to either the patient’s secondary insurance or to their personal responsibility. Additionally, if the patient has not met their Medicare deductible, the 2% reduction does not apply to their deductible amount.

Example provided by CMS:
“A provider bills a service with an approved amount of $100.00, and $50.00 is applied to the deductible. A balance of $50.00 remains. We normally would pay 80% of the approved amount after the deductible is met, which is $40.00 ($50.00 x 80% = $40.00). The patient is responsible for the remaining 20% coinsurance amount of $10.00 ($50.00 - $40.00 = $10.00). However, due to the sequestration reduction, 2% of the $40.00 calculated payment amount is not paid, resulting in a payment of $39.20 instead of $40.00 ($40.00 x 2% = $0.80).”

What can you look for to determine how your payments are being affected by the sequestration reduction? For part B providers, the reduction will be noted on your Medicare ERA per line item.  In addition to the standard contract adjustment (CO-45), you will notice an additional reduction noted with CO-253.  This amount indicates the sequestration reduction.  In addition, you will also see the MPPR adjustment designated by CO-59. 

Medicare has certainly found ways to reduce reimbursement which has resulted in challenging times for many providers. In 2013, the Sequestration Order led to over $11 billion in reductions across Medicare providers. With the recent cuts over the past two years, it is vitally important that you are receiving every penny owed to you and following up on any denials.  With the addition of Functional Limitation Reporting, Medicare has found a number of ways to deny claims much more easily.  If you feel that your practice is not collecting on every penny owed to you, please do not hesitate to call us to discuss how our physical therapy billing services can help to improve your collections and increase your practice’s overall revenue.

Friday, June 20, 2014

Physical Therapy Billing: Multiple Procedure Payment Reduction (MPPR)

Medicare implemented a new payment policy called "Multiple Procedure Payment Reduction" in 2011 and it continues to be in effect through 2014.  Under this new policy, Medicare will only reimburse the procedure with the highest practice expense at full price.  All other procedures billed on the same day will be reduced using the MPPR formula.

The MPPR formula is not immediately obvious.  To understand it, you must first understand the manner in which Medicare calculates their payment rates.  Medicare payments are derived using a combination of your locality and the procedure involved.  Additionally, each procedure is factored into three components: Work Expense, Practice Expense, and Malpractice Expense.

The MPPR reduction only affects the Practice Expense component of the calculation.  The current MPPR factor (as of this posting) is 50%.  This means that the Practice Expense component is reduced by 50% on all affected procedures.

A common misconception about MPPR is that it reduces the totality of reimbursement by 50%.  This simply is not true.  The actual reduction is far less; more in the area of 8-9%, however varies dependent on combination of CPT codes billed.

Below is a very general example of how the MPPR is calculated.

CPT Code “ABCDE” (without MPPR factored in)
Work Expense -            $8
Practice Expense -        $4
Malpractice -                 $8  
Total Reimbursement:    $20

If ABCDE was billed with another unit or another CPT Code with a higher Practice Expense, each consecutive unit would be reduced by the MPPR Policy.  Most would assume that they will be reimbursed 50% of the $20, however this is not true.  You will be reimbursed in the following manner:

CPT Code “ABCDE” (when MPPR factored in)
Work Expense -            $8
Practice Expense -        $2 (reduced by 50%)
Malpractice-                  $8  
Total Reimbursement:    $18 

In this example, the reimbursement after the MPPR is factored in is completely dependent on the practice expense value of that specific CPT code.

One of the most confusing parts of MPPR is understanding the fact that a CPT can vary in reimbursement based on what other codes were billed that day.  If you bill a single unit of therex on the day of a patient’s evaluation, the evaluation will pay at full price. However, the unit of therex will be discounted by the MPPR policy (because the eval has the higher practice expense).  Then let’s say the patient returns two days later and you bill a unit of therex with an ultrasound.  The unit of therex will pay at full price and the ultrasound will be discounted (because the therex has the higher practice expense).  Upon receipt of payment from Medicare, if you were to compare your reimbursement for the therex on the evaluation day versus the second visit, you would note that you were reimbursed two completely different amounts for the unit of therex.  Additionally, if you were to bill two units of therex and one unit of ultrasound, those two units on the same day would be reimbursed two different amounts because the first unit of therex is paid at full price, while the second unit of therex is reduced by the MPPR policy.

Over the years, Medicare has found ways to make the billing process extremely confusing by implementing new policies such as the MPPR.  In an effort to eliminate the confusion and allow therapists to get a clear picture of what they should expect to be reimbursed for each procedure in 2014, we have created a 2014 Medicare reimbursement calculator.  Select your locality, procedure(s) and let the calculator do the rest!

2014 Medicare Reimbursement Calculator