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Tag Archives: THERAPY

SNF therapy contracts: Your risks and what you need to know Q&A

SNF therapy contracts: Your risks and what you need to know Q&A

Editor’s note: The following Q&A was written by Reginald Hislop III.

 

Q: When we receive proposals from various therapy companies, they all represented that they would increase our Part A and Part B billings. Should this somehow be incorporated into the ­contract?

 

A: Yes. Absolutely. If they’re willing to say that to you and they tell you, "That’s the reason why you’re going to go with us is because we’re going to do this," I am going to hold them accountable for that, and I first want to know how you determine that and how are you going to do that because I’m going to tell them right there before we even get to a contract, I’m going to say that they need to fundamentally prove it. How do you know it, how’s it going to happen, and be prepared because yeah, you’re going to put in the contract, you’re going to represent it, it’s going to be legal and you’re going to do it over what period of time? I’m then going to hold them accountable for it.

Otherwise, it becomes a common game of therapy contractors: "We’re going to make your world so much better than the last group that was in here." I’ve never seen a contractor come in and say, "We looked at your last experience with your last therapy contractor and the amount of stuff that they were doing, and by the way, we got to tell you, it really makes us nervous, and fundamentally if you go with us, we’re going to shrink your revenue by 15% because we think there’s a whole bunch of erroneous and falsely billed claims." I’ve never seen that happen. Everybody comes in and says, "Yes, we can improve your performance over this group, and we’re going to do it by a pretty impressive margin, and your revenue is going to go up, your claims are going to go up." I want to know how they’re going to do that, I want it in the contract, and I want full transparency. I want to know over what time period, because without that, they haven’t actually validated they will be able to do that. That’s a standard pitch, and they have never yet been expected in many cases to be accountable for those kind of numbers. It’s just a sales pitch, but, if they’re going to say it, I want it in the contract.

 

Q: Would the indemnification clause you mentioned, indemnification not just for the therapy component but the whole amount?how can the therapy company indemnify money they did not receive?

 

A: How can they indemnify money they did not receive? We’re not talking about necessarily indemnification for money they received. We’re talking about indemnification for services that they provided as part of the representation that all of our services that we provide are going to be compliant and in concert with the law. Since the SNF is responsible for that, my responsibility then is to negotiate with that company and say, "By the way, if in fact we’re involved in this work and you’re going to be part of this process and you’re going to have input in terms of what we RUG, what we bill, part of our triple check and all the rest of that other kind of stuff, there is dollars on the table, and anything that you did that was illegal, unethical, or improper that caused us to lose revenue as a result of your actions and your documentation, all those other kinds of things because you’re going to represent to me that you’re going to do this, you’re going to properly manage and supervise your employees and all those other kinds of things, that if in fact you didn’t do that, you’re going to be responsible not just for what we paid you but also for what your bad acts caused this facility." Yes, I can indemnify them for that because they are part and parcel to that. They’re going to represent to me that they’re going to do this the right way, and if they don’t, then they’re going to have shared risk for anything that occurs that they were responsible for or could be tied to them that cost my facility money or my organization money.

 

Q: How do we hold the therapy provider accountable for an 80% productivity level?

 

A: You actually monitor their productivity levels. Their treatment records should be open. Their minutes should be open. I should be able to see when they were on-site, what their time was spent on this site, what I was billed for because I’m being billed for their time. And I should be able to go to treatment logs and treatment records and look at what their billing time was and their documentation time was, and I can quickly do a simple calculation that says if I had a physical therapist here for eight hours and she was here for four days a week or five days a week, I ought to be able to convert that based on treatment records and treatment logs to what her productivity percentage was, what her care percentage time was, and it better not be more than 80%.

 

Q: Our present contract doesn’t include much of anything you mentioned. How do we change it or get the therapy provider to go along with your recommendation?

 

A: There are two ways to do that. One is basically to tell them you attended this seminar and their contract stinks and you want to renegotiate it. I don’t know what your out clauses look like in your contracts. Typically there will be some kind of out clause that will allow you some leverage. If not, when your contract comes up for renewal, make them well aware that these are all going to be key components of your RFP process. You’re going to put it out there, you’re going to bid them unless they’re going to come to the table and do it, they’re not going to have this contract anymore, and generally I have suggested providers to tell them this in advance, good advance. Tell them, "[We] might be six months away from when our contract renews, but here’s a list of the things that we’re going to require of you going forward. So, if you want to keep this contract, we can talk about this now or you can basically be assured that if you’re not going to do this now or have some conversation with us now, chances are relatively poor that you will retain this contract." I haven’t seen a contractor yet that won’t under certain circumstances if you raise most of these issues, at least be willing to start conversations with them about them.

 

Q: What tools do you suggest in guiding SNF therapists into making appropriate decisions regarding choosing a RUG?

A: Again, the best process for this is your triple check. There are some very good software programs out there, and I’m not going to try to pitch too many companies, but most software programs, AOD does a good job. Rehab Optima also does a good job. Develop a good triple-check process, have good education, make sure your MDS coordinator is certified, RAC certified as part of this process. The RAC certification and staying current on the certification is amajor help in terms of appropriate RUGs based on the documentation. Use your triple check, have everybody together in terms of being able to access and identify your MDSs, what your sections mean, what your documentation is to support your RUG categories. It’s not that difficult, but it does require some work, and it’s really critical that you have good software and a good MDS coordinator who’s RAC certified.

If you don’t have a good MDS coordinator or a coordinator that is RAC certified, rent one. There are services out there that you can go to that will in fact help you through that process on a monthly basis. It will cost you a little money up front, and in the interim get somebody on your staff RAC certified.

 

Q: Can you explain the in-house hybrid model in greater detail?

A: Sure. The in-house hybrid model works exactly like this: For all intents and purposes we bifurcate the issues. We say, "All right, what we need is we need staff therapists or we need access to staff therapists, and we can do that, but we don’t know how to do that as a facility." We’re not sure where to go, we’re not sure how to recruit, we don’t know how much they should be paid, job descriptions, all the rest of that other kind of stuff, and the one thing that we definitely don’t have expertise in maybe is managing a therapy department, is managing a therapy company. And we’ve heard horror stories about how hard it is to find good rehab directors, how much you pay, you know, all that kind of stuff.

What we do is essentially bifurcate the issues. We say, "All right, here’s the deal. Let’s go get a company who isn’t going to provide the therapy and has no interest in doing that or billing us for that, but is going to help us set up our program." So we’re going to go to one of the qualified companies that are out there that do this, and what they’re going to do is they’re going to come in, they’re going to do an assessment for us, which should be very low cost, to look at our operations, look at what we’re billing, look at our Medicare utilization, and give us a proposal that basically says, "Hey, here is what our department from our perspective would look like. Here’s how many PT hours you need, OT hours, speech therapy, staffing requirements, you know, rates of pay and all that other kind of stuff. We’re going to help you do that. We’re going to put this together and give you a pro forma, show you how this pays for itself and all this other kind of stuff.

"In the meantime, what we’re going to do as well is if you want to proceed down this path, we’re going to do that for you in concert with you. We will recruit, we will hire, we’ll give you job descriptions which we have. We have policies, we have procedures, we can give you a turn-key therapy company, and what we will do is we will be your therapy director fundamentally. We’ll be the folks who manage your therapists. We’ll watch those productivities. We’ll do the education. We’ll do all those kinds of things for you and in partnership with you, and the therapists that will be on site will be 100% your skilled nursing facility employees. They are your employees. You pay them. They’re your benefits. They’re subject to all your rules and regulations and all that kind of stuff, and we’ll just help you manage them. We’ll provide better oversight, and we’ll provide the infrastructure that’s necessary for a therapy department and a therapy program including ongoing education and RUG support and QA and all that kind of stuff. And we do that for a flat fee each month or a percentage of your ultimate therapy department revenue, etc."

HCPro.com – Billing Alert for Long-Term Care

Group Therapy substance abuse and Alcohol Abuse 90853

I m looking for additional information on billing 90853 group therapy charges. Not multiple-family group. Performed in office setting. Do you bill each patient at the group therapy. Documentation in each patients chart of group discussion. Can services be done by an MSW, LCSW and bill under a supervisory Psych and if so is modifier required.

Carla, Billing Manager
cacker@echochc.org

Medical Billing and Coding Forum – Behavioral Health

Massage Therapy School & Medical Billing and Coding Schools

For individuals who are curious about a Therapeutic Massage Education, comprehensive vocational massage schools and top massage therapy school took innovative steps to increase this excellent healing art to students everywhere. Within the United States alone, you will find 100s of healing schools that offer Therapeutic Massage Education inside a huge range of massage methods.

For inquisitive minds or career-oriented people who’re seriously considering a Therapeutic Massage Education to be able to begin a foundation for professional practice, you should evaluate all options just before using towards the massage school of preference. With several massage techniques that certain can explore, the choices are nearly limitless. In present day Therapeutic Massage Education, students can pick to earn certificates, diploma, or perhaps a degree in therapeutic massage. Additionally, curious folks can choose to take part in community training courses and workshops which offer informal Therapeutic Massage Education. Clearly, the area of practical learning is huge and filled with chance.

Therapeutic massage, you need to realize as soon as now, is really a dead-finish job-since advancement is restricted to learning new abilities and methods in supplying treatments. If you are employed by a massage company, you’ll obviously mature financially while you develop your craft, gain tenure, and expand your clientele. You may even get marketed when it comes to job level, or perhaps be given possibilities to do in the commercial side like controlling staffers and supervisory practitioners. If you are thinking of getting for freelance work, you might eventually establish your personal massage health spa, obtain a large clientele, and have the ability to secure a steady flow of earnings.

Medical Billing and Coding Schools

Individuals wanting to obtain a begin in the fields of medical billing or coding should attend an academic program from among the top medical billing and coding schools that are offered. You will find a number of different programs, varying from certificate programs that take under 2 yrs to 2 year affiliates degree programs to 4 year bachelor’s degree programs.

It is usually smart to select a course that’s accredited by among the organizations providing you with this particular service, because this guarantees become familiar with the abilities you’ll need to be able to start your job. For this kind of program, you need to search for AHIMA or CAHIM accreditation, with respect to the kind of program you select.

The precise courses you have to take to be able to earn certificates from medical billing and coding schools varies by school, but you will find some kinds of courses which are usually incorporated no matter this program. This training also usually include some kind of practicum or externship to be able to provide you with some real life experience of the area too.

Becoming an expert in these fields can provide you with a very rewarding professional life. Choosing the right top massage therapy school and top medical billing and coding schools is probably one of the most important decisions in your career.

Careers in Massage Therapy and Medical Billing and Coding

Have you been searching for work change and therefore are thinking about therapeutic massage just as one option? Therapeutic massage is a superb career selection for several reasons: It’s a financially rewarding career, you’ve got a flexible schedule, you meet interesting people, and also you help people feel good.

If you wish to be a professional massage counselor, you will in all probability must see top massage therapy school. What type of school put forth, and just how lengthy you need to choose, is dependent on your geographical area. I graduated from the 720 hour massage enter in Albuquerque, NM, although the minimum requirement of this condition is 650 hrs. New you are able to have more strict needs at 1000 hrs. Seek advice from the American Therapeutic Massage Association to discover exactly what the certification needs have been in your condition or county. In very couple of states, certification isn’t needed.

Massage practitioners are frequently self-employed, however they may also use other allied health care professionals in treatment centers and hospital configurations. They can have possibilities in resorts and luxury cruise ships. Within the public sector, a massage counselor will find are employed in a health spa, a hospital, any adverse health club, or perhaps a rehab center. Salaries differ with experience and particular fields, but to provide you with advisable of what to anticipate, the typical annual base purchase massage practitioners is calculated to fall between $ 34,857 and $ 53,967, with median ranges near $ 43,065. What you need to take more notice of, however, is the way forward for them.

Medical Billing and Coding

Medical billing and coding is a superb career choice. However, if you wish to have the ability to obtain a good position within this area you need the correct education first. The minimum training you need to get with this area is really a certificate, which does not usually take everything lengthy to accomplish. For top results, it is best to choose a certified program. There’s numerous American Health Information Management Association (AHIMA) accredited top medical billing and coding schools available to select from.

Two of the most basic careers within the medical area are medical billing and coding. Individuals experts who are responsible for billing and coding handle probably the most critical areas in this sort of profession. They’re usually responsible for office management and more importantly the processing of insurance claims.

The medical billing and coding salary ranges from around $ 25,000 for a beginner position and may achieve up to $ 50,000 for individuals who’ve a little more experience. The salaries medical billing and coding professionals earn can also be depending on their degree of training, skill, as well as on the place of the employment. So as you can tell, this career path can be quite lucrative should you play your cards right. And most of these wages are frantically necessary for these trying occasions filled with financial uncertainty.

Becoming an expert in these fields can provide you with a very rewarding professional life. Choosing the right top massage therapy school and top medical billing and coding schools is probably one of the most important decisions in your career.

Related Medical Coding Cpc Exam Articles

2015 new CPT Codes for RADIATION THERAPY


Radiation therapy codes underwent significant changes for 2015. Teletherapy isodose planning and brachytherapy codes now include the basic dosimetry calculation and IMRT codes now include guidance and tracking. Also radiation treatment delivery codes were deleted in 2015.

77306  Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)

77307  Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)

77316  Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)

77317  Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)

77318  Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)

77385  Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple

77386  Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex

77387  Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

See also complete list of 2015 CPT Changes


Coding Ahead