HIPAA Compliance: Protecting You and Your Patient
Speakers: Rhea Cohn, PT, DPT, Helene Fearon, PT, FAPTA and Steve Levine, PT, DPT, MSHA
Webinar Date:
5/14/2013
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
5/14/2013
Summary: This webinar will review the important aspects of HIPAA's privacy and security rules and the practice implications pertaining to HIPAA. Practice vulnerabilities will be identified and tips and strategies will be provided so that providers can update their current policies and procedures and internal processes related to HIPAA compliance.
[Additional Info About This Webinar]
Summary: Providers are increasingly transitioning to electronic medical records and use of mobile devices including laptops, cellphones, and tablets. Consequently, HIPAA compliance pertaining to protection of the patients' protected health information and the security of electronic devices is increasingly important. The government has released new, stricter rules and financial penalties related to HIPAA compliance. This webinar will review the important aspects of HIPAA's privacy and security rules and the practice implications pertaining to HIPAA. Practice vulnerabilities will be identified and tips and strategies will be provided so that providers can update their current policies and procedures and internal processes related to HIPAA compliance.
Objectives:
- Understand HIPAA's privacy and security rules as they relate to the provision of therapy services.
- Execute a review of practice vulnerabilities related to HIPAA compliance.
- Implement changes in policies and procedures to decrease financial risk related to HIPAA compliance.
- Establish an ongoing methodology to maintain currency with HIPAA regulations.
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ICD-10: Making a Successful Transition
Speakers: Rhea Cohn, PT, DPT, Helene Fearon, PT, FAPTA and Steve Levine, PT, DPT, MSHA
Webinar Date:
4/9/2013
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
4/9/2013
Summary: This webinar will describe ICD-10 and how it differs from ICD-9, and discuss practice strategies needed to be successful in preparations for implementation of ICD-10.
[Additional Info About This Webinar]
Summary: The implementation of ICD-10 for reporting of diagnosis codes is definitively scheduled for October 1, 2014. All industry stakeholders should be actively involved in activities needed to successfully launch ICD-10 on the expected implementation date. Pre-implementation activities include planning, reviewing current internal processes using ICD-9, educating staff, building a temporary financial buffer, testing, and assessing for gaps that increase vulnerabilities related to non-payment of claims. This webinar will describe ICD-10 and how it differs from ICD-9, and discuss practice strategies needed to be successful in preparations for implementation of ICD-10. This webinar will build on Fearon & Levine's previous ICD-10 webinar held in April 2011, which is currently available for viewing. Resources and references will be provided.
Objectives:
- Understand the purpose and structure of the ICD- 10 code set
- Identify internal processes that must be modified for the successful implementation of ICD-10
- Apply the ICD-10 code set to claims
- Prepare for practice vulnerabilities resulting from the implementation of the ICD-10 code set
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2013 Medicare Changes for Speech-Language Pathology: Billing, Coding, and Documentation
Speakers: Dee Adams Nikjeh, Ph.D., CCC-SLP, Helene Fearon, PT, FAPTA, and Steve Levine, PT, DPT, MSHA
Webinar Date:
3/13/2013
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
3/13/2013
Summary: The final rule for the 2013 Medicare Physician Fee Schedule (MPFS) released by the Centers for Medicare and Medicaid Services (CMS) contains critical information for speech-language pathologists who provide services to Medicare Part B beneficiaries. This webinar will address key issues as they relate to speech-language pathology.
[Additional Info About This Webinar]
Summary: The final rule for the 2013 Medicare Physician Fee Schedule (MPFS) released by the Centers for Medicare and Medicaid Services (CMS) contains critical information for speech-language pathologists who provide services to Medicare Part B beneficiaries. This webinar will address key issues as they relate to speech-language pathology. You will receive the latest information on the claims-based data collection requirements for speech therapy services including the newly required G-codes and severity modifiers as well as other changes that will impact your reimbursement such as the therapy cap and exceptions process, new and revised Current Procedure Terminology (CPT) codes and the impact of Multiple Procedure Payment Reductions (MPPR).
These new Medicare requirements impact how you document the services provided, how that documentation must be reflected on your claim form, and ultimately how you are paid for therapy services provided to the Medicare Beneficiary. Join nationally-renowned expert Dee Adams Nikjeh, PhD, CCC-SLP for an information-packed 90 minutes to sort out the policies and rules for engagement as a therapy provider in the Medicare program in 2013.
Objectives:
- Learn about the 2013 requirements involved in "Claims-based" reporting of the functional status of your Medicare patients
- Understand the latest Medicare coding and documentation changes to maximize the potential for success as a Medicare provider
- Participate in an active exchange of questions and answers related to coding and reimbursement issues as they relate to speech-language pathology services
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Policy Pandemonium: Medicare Part B and Therapy Services Reporting Functional Limitations
Speakers: Helene Fearon, PT, FAPTA and Steve Levine, PT, DPT, MSHA
Webinar Date:
12/18/2012
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
12/18/2012
Summary: On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule to inform providers regarding the 2013 Fee Schedule. This webinar will provide an overview of the key elements of the Final Rule and their impact on the provision, documentation, claims submission, and payment for therapy services under Medicare in 2013.
[Additional Info About This Webinar]
Summary: The Final Rule contains critical information on the Sustainable Growth Rate (SGR) update and other changes impacting payment, the therapy cap and exceptions process, claims based data collection of information regarding function - including new G codes that must be submitted, and updates to the Physician Quality Reporting System (PQRS).
Next year's Medicare Fee Schedule and associated payment policies continue to be under debate. These ongoing policy discussions will provide for an outcome one way or the other by January 1, 2013, and will directly impact payment of outpatient therapy provided to the Medicare beneficiary in all settings.
Regardless of further refinement, new Medicare requirements affecting the therapy benefit for 2013 will impact how you document, how that documentation must be reflected on your claim form, and ultimately how you are paid for therapy services provided to the Medicare Beneficiary.
In this critical webinar, Fearon & Levine will provide information on these and other changes under Medicare beginning January 1, 2013, how to best prepare, and what to continue to watch for as policies are considered during the last couple weeks of this year.
Join Helene Fearon and Steve Levine for an information packed 90 minutes sorting out the policies and rules for engagement as a therapy provider in the Medicare program in 2013.
Objectives:
- Learn about the 2013 requirements involved in "Claims-based" reporting of the functional status of your Medicare patients
- Learn about the impact on the fee schedule of the continued flaws in the formula to determine payment, as well as the potential scenarios related to the therapy cap as we head into 2013
- Provide an understanding of changes to be implemented January 1, 2013 to maximize the potential for success as a Medicare provider
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Part 2: Making PQRS Work Effectively For Your Private Practice: Beyond Implementation
Speakers: Heather Smith, PT, MPH, Program Director of Quality for the American Physical Therapy Association (APTA)
Webinar Date:
11/6/2012
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
11/6/2012
Summary: Part 2 in this webinar series will discuss important process considerations beyond the basics of participation, including the importance of auditing your success and accessing, understanding, and interpreting your annual feedback reports. Helpful tips including the most common provider pitfalls in failure to achieve reporting success will be provided, and the proposed changes to the PQRS system for CY2013 will be discussed.
[Additional Info About This Webinar]
Summary: Physical therapists and occupational therapists who bill Medicare for outpatient therapy services in private practice settings (using the 1500 claim form or 837-P) can obtain a 0.5% bonus payment in 2012 if they report on quality measures under the Physician Quality Reporting System. The Affordable Care Act made a number of changes to the Physician Quality Reporting System, including authorizing incentive payments through 2014 and requiring payment adjustments beginning in 2015 for professionals who do not satisfactorily report.
Last year, the Centers for Medicare and Medicaid Services finalized the use of the calendar year 2013 reporting period to inform the 2015 payment adjustment. Eligible professionals, including physical and occupational therapists, that do not satisfactorily report data on quality measures for the January 1, 2013-December 31, 2013 reporting period, will be subject to the negative 1.5% adjustment in their fee schedule amount in 2015.
This two part webinar series is aimed at assisting practice administrators and owners who are new to the PQRS as well as those who are looking to refine their reporting process and stay current with the annual PQRS program changes.
This Webinar has been approved by the Florida Physical Therapy Association for 1.5 continuing education hours.
Objectives: - Recognize the importance of auditing your practices performance in this reporting program.
- Understand how to access and interpret the data provided in the standard annual feedback reports that are provided by Quality Net (the PQRS program administrator).
- Appreciate the importance of the Physician Compare Website and public reporting of the PQRS data to your practice and your clients.
- Identify the most common pitfalls associated with unsuccessful reporting by physical and occupational therapists.
- Determine which proposed changes will impact your practice most with respect to PQRS in CY2013.
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Part 1: Making PQRS Work Effectively For Your Private Practice: Getting Started
Speakers: Heather Smith, PT, MPH, Program Director of Quality for the American Physical Therapy Association (APTA)
Webinar Date:
9/25/2012
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
9/25/2012
Summary: Part 1 of this series reviews the basics of the PQRS program, including the program's history and current reporting requirements, detailed review of the measure specifications and the current list of measures available to physical and occupational therapists, case studies will be utilized to provide examples to guide providers in reporting under this program.
[Additional Info About This Webinar]
Summary: Physical therapists and occupational therapists who bill Medicare for outpatient therapy services in private practice settings (using the 1500 claim form or 837-P) can obtain a 0.5% bonus payment in 2012 if they report on quality measures under the Physician Quality Reporting System. The Affordable Care Act made a number of changes to the Physician Quality Reporting System, including authorizing incentive payments through 2014 and requiring payment adjustments beginning in 2015 for professionals who do not satisfactorily report.
Last year, the Centers for Medicare and Medicaid Services finalized the use of the calendar year 2013 reporting period to inform the 2015 payment adjustment. Eligible professionals, including physical and occupational therapists, that do not satisfactorily report data on quality measures for the January 1, 2013-December 31, 2013 reporting period, will be subject to the negative 1.5% adjustment in their fee schedule amount in 2015.
This two part webinar series is aimed at assisting practice administrators and owners who are new to the PQRS as well as those who are looking to refine their reporting process and stay current with the annual PQRS program changes.
Initially, participation in the PQRS program can be daunting. Part 1 of this series reviews the basics of the PQRS program, including the program's history and current reporting requirements. Detailed review of the measure specifications and the current list of measures available to physical and occupational therapists will assist providers in understanding the specific reporting requirements for each measure. In addition, case studies will be utilized to provide examples to guide providers in reporting under this program. Lastly, implementation considerations will be discussed to assist administrators and clinicians in choosing or modifying the measures utilized in their practices.
This Webinar has been approved by the Florida Physical Therapy Association for 1.5 continuing education hours.
Objectives:
- Decide when your private practice should begin participation in the program.
- Identify the quality measures for 2012 and 2013 that apply to physical and occupational therapists in private practice settings.
- Recognize the distinction between reporting the individual measures and the group measures.
- Determine the changes to practice operations you need to make in order to participate successfully.
- Modify your billing to report the quality measurement codes successfully.
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Straight Talk -The Road Map for a Physical Therapy Practice Compliance Plan
Speakers: Katherine Karker-Jennings, Esquire, Steve Levine, PT, DPT, MSHA, and Helene Fearon, PT
Webinar Date:
5/8/2012
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
5/8/2012
Summary: An effective compliance plan is a sound investment on the part of any
Medicare enrolled or certified health care provider, and soon will
be mandatory for physical therapy providers. This webinar will take you step by step through the what, why and how of the
process in developing and implementing a compliance plan and
demonstrate the benefits achieved of getting your compliance plan in
place now!
[Additional Info About This Webinar]
Summary: The creation of compliance programs has become a major initiative of the Office of Inspector General (OIG) in its efforts to engage the health care community in combating fraud and abuse. The OIG has worked closely with the Centers for Medicare and Medicaid Services, the Department of Justice and various sectors of the health care industry to provide clear guidance to those segments of the industry that are interested in reducing fraud and abuse within their organizations. This includes you, the physical therapy provider. There remains much confusion among physical therapist practice owners as to what a compliance program actually is, who to turn to for help in preparing a workable plan, and most importantly how to most effectively implement its requirements.
A compliance plan, properly written and implemented, provides a road map for physical therapists to meet the requirements for proper billing under the Medicare program, and avoid violating the applicable laws, regulations, and policies that govern this heavily watch industry. It is a required tool for successful compliance in today's environment.
This webinar will help you learn the seven fundamental elements noted by the OIG, as of this writing, required to have an effective compliance program. These elements reflect the fact that it is incumbent upon all health care providers to assure that adequate systems are in place to facilitate ethical and legal conduct.
An effective compliance plan is a sound investment on the part of any Medicare enrolled or certified health care provider. Once a voluntary program, such plans are now mandatory for many providers, and soon will be mandatory for physical therapy providers. This presentation, by the experts, will take you step by step through the what, why and how of the process in developing and implementing a compliance plan and demonstrate the benefits achieved of getting your compliance plan in place now!
Helene Fearon & Steve Levine are joined by Medicare/Health Law expert Katherine Karker-Jennings for this critical topic. Ms. Karker-Jennings is the founding partner of the law firm of Katherine Karker-Jennings, P.A. and is responsible for all aspects of health care law for the firm. She has been a practicing Medicare attorney for over thirty years and is a national speaker covering such topics as Medicare Part A and B appeals, detecting fraud and abuse, analyzing relationships under the Stark Laws, interfacing with government investigatory agencies, and the importance and content of compliance plans for all types of providers and suppliers. She has acted as an expert witness in federal litigation involving Medicare issues, and served as special counsel in civil and criminal fraud and abuse Medicare trials. She is an expert in drafting and implementing corporate compliance plans for hospitals, home health agencies, durable medical equipment suppliers, and all forms of therapy practices. She has also served as the independent reviewer/auditor in Corporate Integrity Agreements.
Objectives:
- Understand the differences and the synergies between a compliance plan, corrective action plan, a corporate integrity agreement, and a policy and procedure manual
- Learn the most current areas of compliance concerns related to physical therapy outpatient practices
- Be informed of the new compliance requirements under the Patient Protection and Affordable Care Act (ACA)
- Be able to describe the content of a compliance plan that takes full advantage of the attorney/client privilege and reflect most recent OIG guidance
- Understand the keys to success in implementation of a compliance plan once developed
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A Bold Change: An Alternative Payment System for Therapy Services
Speakers: Helene M. Fearon, PT, and Steve Levine, PT, DPT, MSHA
Webinar Date:
3/1/2012
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
3/1/2012
Summary: Learn how the environment has
necessitated a transition from the current procedural and time-based
codes to a one in which the clinical judgment and decision-making of the
physical therapists is reflected in a coding structure, the current
options being discussed and developed related to payment for the future,
and how a transition to a new payment system will likely impact your
practice.
[Additional Info About This Webinar]
Summary: Since adoption of the Balanced Budget Act in 1997, The Centers for Medicare and Medicaid Services (CMS) has been engaged in reports and projects in an attempt to develop a new payment system for therapy services. These CMS contractor reports have generated significant data and will likely serve as a basis for new models of payment, but have not yet resulted in the implementation of a new payment system that would serve as an alternative to the present procedure-based fee schedule system and arbitrary therapy caps. Recent policy changes, including the multiple procedure payment reductions (MPPR) and continued regulations that inhibit the delivery of cost-effective and efficient physical therapist care, have created not only the opportunity, but the necessity to make bold moves forward with an alternative payment model for physical therapists.
APTA has also been developing a conceptual framework for a new payment system for a number of years. This concept is now moving to the next steps of modeling and implementation. Some of the key concepts that would be the basis for change include having at its core the clinical expertise and judgment of the physical therapist, reducing the oppressive administrative burdens, and dramatically changing the manner in which physical therapists services are communicated to third parties - specifically moving away from procedural, time-based coding. The desired impact of these and other characteristics of an alternative payment system would include:
- An improved reflection of the provision of consistent, quality, evidence-based care,
- The reduction of unwarranted variations in practice resulting in decreasing benefits and payment for physical therapy, and
- A manner in which to demonstrate value for physical therapists as key collaborators in the changing healthcare environment.
As APTA's advisors to the AMA's CPT Editorial Panel, where new codes will be developed reflecting the alternative payment system, and the Relative Value Update Committee (RUC), where the values for new codes that translate into payment are determined, Helene Fearon, PT and Steve Levine, PT, DPT, MSHA, have been involved in the discussions and development of the conceptual model and continue to work with APTA and other consultants to bring the model through the next phases of development and implementation as an alternative system to the current inadequate and burdensome methodology.
Join these recognized experts to understand the environment that has necessitated a transition from the current procedural and time-based codes to a one in which the clinical judgment and decision-making of the physical therapists is reflected in a coding structure, the current options being discussed and developed related to payment for the future, and how a transition to a new payment system will likely impact your practice.
Objectives: Overview of Content:
Review of why the current procedural based reporting and payment system is an unsustainable model in the third party pay environment.
- Objective:Gain an understanding of the critical timing of this effort
Describe the key components of the alternative payment system including the way in which clinical judgment and decision-making will be a prominent feature of its application to physical therapist practice.
- Objective: Learn how this model will require physical therapists use of a common nomenclature in describing patients presentation as well as the clinical services they deliver.
Outline of the timeline for further development, physical therapy professions feedback and external stakeholder communications and third party pay implications.
- Objective: Plan for participation in the review, and the provision of critical feedback as well as learn how to advocate for change as the process moves forward.
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Protecting Against Audits: Defending Medical Necessity for Physical Therapy
Speakers: Rhea Cohn, PT, DPT and Steve Levine, PT, DPT, MSHA
Webinar Date:
1/31/2012
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
1/31/2012
Summary: This webinar provides critical information to help you assess whether you are
appropriately justifying medical necessity in your documentation, the
steps to take in the event of an audit, and the importance of developing
a corrective action plan to address any insufficiencies that may be
identified through a self-assessment process.
[Additional Info About This Webinar]
Summary: There is no single industry-wide standard definition of "medical necessity", particularly as used by third-party payers for payment determinations, and yet the lack of medical necessity continues to be the most significant reason for denial of claims on review of documentation. The American Physical Therapy Association has adopted the position "Defining Medically Necessary Physical Therapy Services". This definition is intended to be utilized by physical therapists and payers in their ongoing efforts to find consensus related to medically necessary services.
The definition was modeled after the "Model Contractual Language for Medical Necessity", developed by the Center for Health Policy at Stanford University. The key pillars of the concept presented in this model are authority, purpose, scope, evidence, and value. The definition makes a clear statement that physical therapists are professionals and must be responsible for the clinical decisions they make.
The rate of audits and reviews of physical therapy services is skyrocketing, driven by multiple factors, including the OIG identifying outpatient physical therapy services as a key area of audit for the past 3 years. As a result, the number of physical therapy providers that have been targeted for medical necessity audits has begun to rise rapidly. New predictive modeling audits have generally focused on 3 key areas that can be identified on claim forms: use of the KX modifier, amount of billing under a single provider number, and number of time-based units billed per date of service. Typically, these audits happen without warning, and result in 100% prepayment review prior to any claims being approved for payment. Once documentation is submitted, denial rates are maintained due to determination of a lack of medical necessity supported in the documentation. The anxiety produced as a result of these audits, as well as the lack of cash flow resulting from this process, can be crippling to a practice.
It is critical that therapy providers understand how medical necessity is defined by Medicare and other third party payers, become familiar with how it is described by the professional association representing physical therapy, learn how to effectively communicate medical necessity in clinical documentation, and understand how to respond in the event of a negative or punitive audit. Join experts Helene Fearon, PT , Steve Levine, PT, DPT, MSHA, and Rhea Cohn, PT, DPT, as they provide critical information to help you assess whether you are appropriately justifying medical necessity in your documentation, the steps to take in the event of an audit, and the importance of developing a corrective action plan to address any insufficiencies that may be identified through a self-assessment process. Don't miss this important information!
Objectives: - Learn the profession's adopted definition of medical necessity
- Learn how Medicare defines medically necessary services for the purpose of payment of claims
- Understand the importance of justifying medical necessity in your documentation and how the federal False Claims Act may be used against you in an audit.
- Understand the requirements of skilled care under Medicare and ensure you have the information to justify compliance with these requirements.
- Learn what steps to take should you be audited or receive an Additional Documentation Request (ADR)
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Audit Alert! Keys To Protecting Yourself From New "Predictive Modeling" Audits
Speakers: Helene Fearon, PT, Steve Levine, PT, DPT, MSHA, and Katherine Karker-Jennings, Esq.
Webinar Date:
9/28/2011
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
9/28/2011
Summary: Learn critical information to help you assess your potential risk for these
new predictive modeling audits, understand key compliance issues related to these areas of
risk, how to respond these audits, including requests for information
that accompany them, and the benefits of obtaining legal representation
and expert advice under attorney/client privilege when appropriate.
[Additional Info About This Webinar]
Summary: The rate of audits and reviews of physical therapy services is skyrocketing, driven by multiple factors, including the OIG identifying outpatient physical therapy services as a key area of audit for the past 3 years and CMS' recent contract with Safeguard Services who recently released a second round of national provider Comparative Billing Report (CBR) centered on independent physical therapy providers who practice in the outpatient setting and bill Medicare with the KX Modifier.
Additionally, starting July 1, 2011, CMS began using innovative predictive modeling technology to fight Medicare fraud, and for the first time, has the ability to use real-time data to spot suspect claims and providers and take action to stop fraudulent payments before they are paid. Through the use of proven predictive models and other advanced analytics, Northrop Grumman, a global provider of advanced information solutions, has begun to deploy algorithms and an analytical process that looks at CMS claims - by beneficiary, provider, service origin or other patterns - to identify potential problems and assign an "alert" and assign "risk scores" for those claims. These problem alerts will be further reviewed to allow CMS to both prioritize claims for additional review and assess the need for investigative or other enforcement actions.
As a result, the number of physical therapy providers that have been targeted for these (and other) audits has begun to rise rapidly. These new audits have generally focused on 3 key areas that can be identified on claim forms: use of the KX modifier, amount of billing under a single provider number, and number of time-based units billed per date of service. Typically, these audits happen without warning, and result in 100% prepayment review prior to any claims being approved for payment. The anxiety produced as a result of these audits, as well as the lack of cash flow resulting from this process, can be crippling to a practice.
Join experts Helene Fearon, PT and Steve Levine, PT, DPT, MSHA, as well as nationally known Medicare attorney Katherine Karker-Jennings, Esq. as they provide critical information to help you assess your potential risk for these new audits, understand key compliance issues related to these areas of risk, how to respond these audits, including requests for information that accompany them, and the benefits of obtaining legal representation and expert advice under attorney/client privilege when appropriate. Don't miss this important information!
Objectives:
- Learn how to justify the use of the Therapy Cap Exceptions Process and the KX modifier
- Ensure services are being billed using the appropriate provider information
- Ensure documentation supports the number of units of timed services billed
- Learn what steps to take should you receive an Additional Documentation Request (ADR)
- Understand the benefits of attorney/client privilege and the necessary steps to establish the privilege.
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The Advanced Beneficiary Notice: How to Legally Collect Cash from Medicare Patients
Speakers: Helene M. Fearon, PT, and Steve Levine, PT, DPT, MSHA
Webinar Date:
8/18/2011
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
8/18/2011
Summary: This important webinar will review the instances in which Medicare will not cover
physical therapy services, identify when therapists can charge patients
directly for these services and collect payment directly from the
patient, and under what conditions this can occur.
[Additional Info About This Webinar]
Summary: Medicare coverage of physical therapy services is always subject to both national coverage decisions as well as local coverage decisions, which makes keeping up with services that are paid or not an interesting process! These various payment policies could be dependent on statutory limitations (such as exceeding the Therapy Cap or providing prevention and wellness services) or due to services not being deemed "medically necessary". A lack of documented medical necessity can be related to many issues, including situations in which the services are not considered skilled, or when local contractors determine that certain services (such as iontophoresis) are not covered, or when there are no longer any specific measurable functional goals to be achieved.
When informed of any limitation in their benefit, patients are often willing to pay cash for services if they perceive a value in the physical therapy being provided or recommended. Therapists may collect out of pocket (cash) from Medicare patients in many of the instances described above, provided it is done consistent with Medicare requirements. This could include providing the patient with an "Advanced Beneficiary Notice" (ABN) allowing the provider to charge for such services and collect payment directly, having determined the patient's decision to receive, and pay for, such interventions. However, there are also legal pitfalls that providers must be aware of related to collecting on a cash basis, or when considering providing free or reduced cost services to Medicare beneficiaries.
This webinar will review the instances in which Medicare will not cover physical therapy services, identify when therapists can charge patients directly for these services and collect payment directly from the patient, and under what conditions this can occur. Ensure that you and your therapists are appropriately identifying revenue opportunities that may exist beyond situations in which Medicare will provide payment, so that the full spectrum of physical therapist services can be provided to patients who wish to receive and pay for them! The uses of the Advanced Beneficiary Notice (ABN), including legal issues surrounding collecting cash from Medicare patients, are covered in this very practical webinar.
Objectives: - Understand what/when services are not considered skilled or medically necessary based on Medicare's rules and requirements.
- Learn when and what types of services may be billed directly to and paid by Medicare beneficiaries, and under what circumstances.
- Learn how to utilize the Advanced Beneficiary Notice (ABN) to inform patients that Medicare will likely deny payment and that the patient will be financially responsible should they wish to receive certain therapy services.
- Ensure services are not being given away for free (and potentially in violation of the federal ant kickback statue) when there is an opportunity to capture cash-based revenue for physical therapy, so that revenue opportunities are not being "left on the table".
- Become aware of some of the legal issues surrounding providing free or reduced fee services or offering in-network benefits when patients see out-of-network providers.
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Coding, Documentation, and Compliance Essentials At Your Finger Tips!!
Speakers: Helene M. Fearon, PT, and Steve Levine, PT, DPT, MSHA
Webinar Date:
7/26/2011
Time:
11:30 AM EDT
thru
1:00 PM EDT
Recorded On:
7/26/2011
Summary: This free informative Webinar highlights the resources available on
FearonLevine.com to facilitate your efficient and effective use of this
most valuable resource, providing an overview of the various
parts of the website to assist you with navigating to the information
you most need to know, to ensure you will have access to the information
you need, when you need it!!
[Additional Info About This Webinar]
Summary: The founding partners of Fearon & Levine, Ms. Helene M. Fearon and Dr. Stephen M. Levine, are nationally recognized experts who understand the economics of physical therapist practice as well as the need to balance the business side of rehabilitation with high standards of quality health care delivery. The Mission of Fearon & Levine is to facilitate a more strategic approach to the delivery of and payment for rehabilitation services, while maintaining compliance with coding, billing, documentation, and regulatory requirements in a business environment that respects and incorporates the most current professional standards and guidelines governing the provision of outpatient therapy services.
Objectives: FearonLevine.com is an online tool that utilizes Fearon & Levine's expertise to assist you in effectively interacting with today's healthcare environment. It has quickly become the "go to" web resource for physical therapists and their staff, as they face the challenges of being business owners and clinic managers who are striving to achieve and maintain effective compliance strategies for coding, billing and documentation, related to outpatient physical therapy.
Join Helene Fearon & Steve Levine for a free informative Webinar that highlights the resources available on FearonLevine.com to facilitate your efficient and effective use of this most valuable resource. The webinar provides an overview of the various parts of the website to assist you with navigating to the information you most need to know, to ensure you will have access to the information you need, when you need it!!
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Key to Private Practice Success: Knowing the Cost of Doing Business - Financial Essentials for Physical Therapists
Speakers: Helene Fearon, PT and Steve Levine, PT, DPT, MSHA
Webinar Date:
6/21/2011
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
6/21/2011
Summary: This webinar provides an overview of the basic financial statements
necessary for healthy practice management, and reviews the
concepts of fixed, variable, semi-fixed, and semi-variable costs as they relate to determining your clinic/facility cost per
visit and the opportunity to predict the financial impact of contracting
decisions made by therapists.
[Additional Info About This Webinar]
Summary: Due to the clinical focus of their professional curriculum, by the time physical therapists have graduated they most likely have had no formal training in financial management related to their professional practice. However, knowing the cost to provide physical therapy care is probably one of the most important pieces of information a therapist can have related to practice management, regardless of the setting where services are provided. Knowing your cost per visit (CPV) is vital when determining whether or not to contract with certain health insurance companies, determining your annual budget, negotiating salaries and other forms of compensation with staff, and predicting the opportunity for growth of your practice in the future. In light of the various payment models emerging from the pages of the recent health care reform legislation, it is more important than ever that physical therapists, especially those in private practice or in management positions, know their cost per visit, and use this information in managing their practice.
This webinar will provide an overview of the basic financial statements necessary for healthy practice management, including the balance sheet, income statement, and statement of cash flows. Additionally, the concepts of fixed, variable, semi-fixed, and semi-variable costs will be reviewed as they relate to determining your clinic/facility cost per visit and the opportunity to predict the financial impact of contracting decisions based not only on the CPV calculation, but on the opportunity and sunk costs that are critical parts of healthy financial decision-making. A commonly accepted method for calculating your CPV will be reviewed, and an opportunity to discuss the use of this calculation in determining contracting decisions will be provided.
Objectives: - Be able to describe basic financial statements necessary in physical therapist practice management, including the balance sheet, income statement, and statement of cash flows
- Be able to apply the various concepts related to calculating your cost per visit, including fixed, variable, semi-fixed, and semi-variable costs to your practice setting
- Learn how to calculate your cost per visit using both the "top-down" and "bottom-up" approaches
- Understand the variables necessary in determining the appropriateness of contracting with a health insurer when payment is likely to be less than your cost per visit
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Transitioning to ICD-10: Preparing for Implementation
Speakers: Helene Fearon, PT, and Rhea Cohn, PT, DPT
Webinar Date:
4/12/2011
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
4/12/2011
Summary: This webinar describes ICD-10 and how it differs from ICD-9,
specifics on ICD-10 code structure, practice implications for the use of
ICD-10, preparation for electronic billing using ICD-10, advice on
discussions with billing vendors, information on private payer
activities pertaining to ICD-10, staff education and other helpful
hints.
[Additional Info About This Webinar]
Summary: For many years, physical therapists and other medical professionals have been utilizing the ICD-9 code set for the purpose of reporting diagnoses on claims to third-party payers. Payers have already begun the transition to ICD-10, the next version of the HIPAA- approved code set. Therapists must also begin their transition activities to prepare for full implementation of ICD-10 by the industry on October 1, 2013. After that date, claims submitted to payers with ICD-9 codes will be denied. This webinar will describe ICD-10 and how it differs from ICD-9, specifics on ICD-10 code structure, practice implications for the use of ICD-10, preparation for electronic billing using ICD-10, advice on discussions with billing vendors, information on private payer activities pertaining to ICD-10, staff education and other helpful hints. Resources and references will be provided.
Objectives: - Understand the purpose and structure of the ICD- 10 code set
- Begin implementation of transition to ICD-10 including conversion to 5010
- Apply the ICD-10 code set to claims
- Understand the value of improved data capture for office efficiencies using the ICD-10 code set
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Therapy Cap Exceptions Process and Appropriate use of the KX Modifier
Speakers: Helene M. Fearon, PT, and Steve Levine, PT, DPT, MSHA
Webinar Date:
3/22/2011
Time:
2:00 PM EDT
thru
3:30 PM EDT
Recorded On:
3/22/2011
Summary: This Webinar reviews critical information related to the therapy
cap as well as use of the KX modifier, provides information about the Comparative Billing Reports (CPRs) that were distributed, and reviews utilization patterns that
therapists can use to compare their own use of the Exceptions Process.
[Additional Info About This Webinar]
Summary: Medicare limits its annual per-beneficiary outpatient therapy expenditures through a cap on payment for these services. Providers may exceed a beneficiary's therapy cap if the services are medically necessary and are supported by medical record documentation. With the "Exceptions Process", Medicare beneficiaries have ability to exceed the annual cap, however providers must indicate this when submitting the claim to Medicare by attaching the "KX" modifier to each service billed over the cap. However, there has been much abuse and inappropriate use of the Exceptions Process, and recently, CMS issued Comparative Billing Reports (CBR) to 5,000 physical therapists, which contain peer comparisons used to provide helpful insights into coding and billing practices related to use of the KX modifier. Although CBRs are designed to help the provider prevent improper billing and payment and are not intended to be punitive, recently the Office of Inspector General (OIG) published a report of questionable billing characteristics in outpatient therapy billing, in which it identified "services for which providers indicated that an annual cap would be exceeded" as a key area of potential fraud and abuse. The OIG has recommended that CMS target outpatient therapy claims in high-utilization areas for further review. This Webinar will review critical information related to the therapy cap as well as use of the KX modifier, provide information about the CPRs that were distributed, and review utilization patterns that therapists can use to compare their own use of the Exceptions Process.
Objectives: - Learn the circumstances under which use of the Therapy Cap Exceptions Process is appropriate.
- Learn how to appropriately use the KX modifier in reporting services under the Exceptions Process
- Understand the purpose of Comparative Billing Reports and the implication to outpatient therapist practice
- Assess your own outpatient therapy services for potential risk and vulnerability related to services provided using the KX modifier
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