Starting Your Own Practice From Scratch
Starting Your Own Practice From Scratch , Course Content
CHAPTER 1: DEFINING YOUR PRACTICE
- Hubbard’s Story
- Naming Your Health Facility
- Choosing the Right Business Structure
- Location
- STUDY YOUR COMPETITION
- Office Hours
- Payment Options
- Business Plan
- BUILDING YOUR IDENTITY
- INSURANCE AND NECESSARY LEGAL CONCERNS
- PAYMENT
- Setting Up Your Billing System
- WebPT
- Kareo Integrated Billing
- Clinicient
- OptimisPT
- Theraoffice
- Therabill
- Free PT
- Intouch EMR
- Collection
Chapter 2: Basics of Medicare
- Medicare Part B
- Private Insurances
- Medicare Skilled Guidelines
- Medical Necessity
- Expressing Medical Necessity and Skilled Care
- Advance Beneficiary Notice
- Maintenance Programs
- Evaluation and Maintenance Plan without Rehabilitative Treatment
- Skilled Maintenance Therapy for Safety
- Individual Activities Concurrent with Rehabilitative Treatment
- Evaluation and Maintenance Program without Rehabilitation Therapy
- Maintenance Therapy Lawsuit
- Medicare Appeal Deadlines
- Medicare Audit Recovery
- Appealing Recoupment
- Sample Letters of Appeal
Chapter 3: Effective Documentation
- Basics of Documentation
- Evaluation
- Treatment
- Late Entries and Supplemental Notes
- Documentation Requirements
- Documentation Required upon Request
- Limits on Requirements
- Certifications and Recertifications
- Dictated Documentation
- Dates for Documentation
- Evaluation/Re-Evaluation and Plan of Care
- Additional Components of Evaluation/Reevaluation
- When the Evaluation Serves as the Plan of Care
- Re-Evaluations
- Progress Reports
- Objective Evidence
- Absences
- Delayed Reports
- Early Reports
- Progress Reports for Services Billed Incident to a Physician’s Service
- Documenting Clinician Participation in Treatment in the Progress Report
- Assistant’s Participation in the Progress Report
- Discharge Notes
- Treatment Notes
- Describing Pain
- Justification for Skilled Services
- Risk Factors
- Documenting a Patient’s Potential for Rehabilitation
- Creating Goals
- Plan of Care
- Treatment under a Plan
- Two Plans
- Contents of Plan
- Changes to the Therapy Plan
Chapter 4: ICD-9-CM/ICD-10-CM and CPT Codes
- Basic Guidelines in Using ICD-9 codes
- Coding Guidelines
- Transitioning to the ICD-10 Codes
- General Coding Guidelines
- Steps in Coding
- General Equivalence Mappings
- History of CPT Codes
- In Depth Look at CPT Codes
- Coding for Procedures
- Examples of CPT codes:
- Untimed CPT Codes
- Timed CPT Codes
- Utilization Guidelines and Maximum Billable Units per Date of Service
- 0183T: Low Frequency, Non-Contact, Non-Thermal Ultrasound (MIST Therapy)
- 29065: Application of Casts and Strapping Codes
- G0283: Electrical Stimulation (CPT G0283 or 97032)
- 90911: Biofeedback Therapy
- 95851: Range of Motion Tests
- 97001: Physical Therapy Evaluation
- 97002: Physical Therapy Re-Evaluation
- 97010: Hot/Cold Packs
- 97012: Traction, Mechanical (to one or more areas)
- 97016: Vasopneumatic Devices (to one or more areas)
- 97018: Hot Wax/ Paraffin Treatment
- 97022: Whirlpool
- 97024: Diathermy (i.e. microwave)
- 97026: Infrared Therapy
- 97028: Ultraviolet (to one or more areas)
- 97033: Iontophoresis
- 97034: Contrast Baths (to one or more areas)
- 97035: Ultrasound (to one or more areas)
- 97036: Hubbard Tank (to one or more areas)
- 97110: Therapeutic Exercises
- 97112: Neuromuscular Re-education
- 97113: Aquatic Therapy with Therapeutic Exercise
- 97116: Gait Training
- 97124: Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) (one or more areas, each 15 minutes)
- 97140: Manual Therapy
- 97150: Group Therapy Services
- 97545: Work Hardening (97545, 97546)
- 97530: Therapeutic Activities
- 97532: Development Of Cognitive Skills To Improve Attention, Memory, Problem Solving, (includes compensatory training) direct (one on one) patient contact by the provider, each 15 minutes
- 97535: Self–Care/Home Management Training
- 97537: Community/Work Reintegration Training (e.g., shopping, transportation, money management, avocational activities and/or work environment (modification analysis, work task analysis) direct one on one contact by provider, each 15 minutes)
- 97542: Wheelchair Management
- 97597: Selective Debridement
- 97750: Physical Performance Testing
- 97755: Assistive Technology Assessment (e.g., to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one on one contact by provider, with written report, each 15 minutes
- 97760: Orthotic Management & Training
- 97761: Prosthetic Training, upper and/or lower extremity(s), each 15 minutes
- 97762: Checkout For Orthotic/Prosthetic Use, established patient, each 15 minutes
- 97799: Unlisted Physical Medicine/Rehabilitation Service Or Procedure, not timed (97799, 97139 or 97039)
- Miscellaneous Services (Non-covered)
- Modifiers
- CCI 20.1 Correct Coding Initiative (CCI) Edits
Chapter 5: Service Units and Therapy Certifications
- Timed and Untimed Codes
- Counting Minutes for Timed Codes in 15-Minute Units
- Student Supervision
- Billing Scenarios for Medicare Part B
- CPT Codes Clarification
- Therapy Certifications
- Initial Certification
- Timing of Initial Certification
- Review of Plan and Recertification
- Physician/Non-physician Practitioner Options for Certification
- Restrictions on Certification
- Delayed Certification
- Denials Due to Certification
- Exceptions for Medically Necessary Services
- Appeals Related to Disapproval of Cap Exceptions
- Appeals
- Application of New Coding Requirements
- Services Affected
- Providers and Practitioners Affected
Chapter 6: Functional Limitation Reporting, G-Codes and PQRS
- Functional Reporting Codes — G-codes
- Functional Reporting Codes — Severity/Complexity Modifiers
- Function-related G-codes
- Mobility G-code Set:
- Changing & Maintaining Body Position G-code set:
- Carrying, Moving & Handling Objects G-code Set
- Self-Care G-code Set
- Other PT/OT Primary G-code Set:
- Other PT/OT Subsequent G-code Set:
- Documentation Requirements
- G-Codes Examples and Clarification
- Required Tracking and Documentation of Functional G-codes and Severity Modifiers
- Remittance Advice Messages
- Physician Quality Reporting System (PQRS)
- Eligible professionals
- 2015 Changes to PQRS
- Claims-based Reporting
- Registry Reporting
- Group Practice Reporting Option (GRPO)
- Value-Based Modifier
- New Medicare Legislation
Chapter 7: Therapy Cap, Manual Medical Review, & Physician Fee Schedule
- General Information on the Therapy Cap
- 2015 Therapy Cap Limitations and Exceptions
- Automatic Exceptions Process
- Manual Medical Review
- Multiple Procedure Payment Reduction (MPPR)
- 2015 Medicare Copays and Deductibles
- Outpatient Prospective Payment System (OPPS)
- Medicare Physician Fee Schedule
- Additional Cap Facts for 2015
Chapter 8: Administrative Matters
- Common Billing Errors and How to Avoid Them
- Coordination of Benefits
- Medicare Payments First
- Medicare Payments in Event that the Primary Payer Denies Payment Claims
- Claiming for Payments when Patients’ GHP is Fully Consumed
- Plan of Care Document and Medicare
- Standard Document Requirements for Claiming Medicare Payments as Secondary Benefits
- Therapy Caps for Medicare Claims on Secondary Payment Scheme
- Medicare Audits on Payment Claims
- Denials, Audits and Appeals
- Coverage Issues
- LCDs or Local Coverage Determination
- Provider-Supplier Enrollment
- Supervision: Use of Students, Aides and PTAs
- Supervision of Students
- Acceptable Billing Practices
- Physical Therapy Assistants
- CMS: Medicare Coverage Database
- Durable Medical Equipment, Prosthetic, Orthotic and Supplies (DMEPOS)
- Medicare Advantage
- Medicare Claims Audits
- Health Care Reform
- Payment Reforms Under Practice Administration
- Documentation
- Initial Certification of Treatment Plans
- The Process of Recertification
- Billing Procedures and Associated Modality Units
- Ensuring Documents are Error Free on CERT
- HIPAA POLICIES
CHAPTER 9: PURCHASING CLINICAL EQUIPMENT
- THE FACILITY
- New Patient Area
- Patient Care Area
- Point of Sale Area
- Billing Area
- Office and Furniture Supplies
CHAPTER 10: MARKETING PLAN
- Creating a Website for Added Promotion and Public Accessibility
- PRE-OPEN ADVERTISING
- SETTING UP YOUR ONLINE APPOINTMENT SCHEDULER
- Schedulicity
- Appointy
- GETTING REFERRAL SOURCES
- Join Trade Associations
CHAPTER 11: KEEPING TRACK
- EMPLOYEES
- START-UP EXPENSES
- YOUR ACCOUNTING SYSTEM
CHAPTER 12: GRAND OPENING
- DAY PLANNING