Vol. 13 Issue 5
Successful PT: The Devil Is in the Details
I went to PT school about a million years ago. As my years advance, I remember less and less of the material that we covered. Nonetheless, I am confident that there was a tremendous amount of material we were responsible for knowingeven back then. Today, the amount of information a prospective PT must know is even more substantial. There are many new techniques, theories and a burgeoning body of literature being produced on our profession. Clearly, there is much for today's PT to master.
I am confident that my classmates and I did a pretty good job capturing all the information required of us as students. I continue to be comfortable with the level of mastery of the subject matter that today's students reach prior to graduation. I think that PTs are almost universally a pretty bright group of people (please don't send me a list of exceptions).
Given that we are well trained, often compassionate to a fault and are generally hard working industrious types who really try to do a good job, we do have some areas that I consistently find in need of further attention.
Here is an example. I routinely work as a consultant to a wide variety of clinics throughout the country. Part of what I do is review the clinical documentation and billing practices of the therapists to make sure they are appropriately documenting care and billing correctly for the work they do. Almost always, I am quite impressed by the level of compassion and quality of clinical care the therapists provide. But also, very frequently, the documentation is unclear, obscure and poorly written. There are often significant amounts of care that are not billed correctly or that go unbilled. It seems we provide wonderful care and then shoot ourselves in the foot to (almost) make sure we don't succeed financially.
I have often asked myself why this occurs. It is clearly not an isolated incident. I routinely see 50 percent of documentation that is not adequate for legal or reimbursement purposes and usually find at least 20 percent to 30 percent of what is documented is neither coded nor correctly billed. I almost always can find 15 percent of what is provided and documented that is not billed at all.
At a time when we spend so much time fighting for third party payers and government funding sources to recognize and adequately reimburse our services, I find it frustrating that we seem to be giving so much away and leaving such a significant amount on the table.
I also get calls weekly related to issues of productivity. "How do I increase the productivity in my staff?" "How come some therapists can see 15 patients a day comfortably while others, seeing the same type of patients, in the same clinics, struggle to see eight?" We've studied these questions and situations thoroughly and the answers are varied. Sometimes it is the people, sometimes it is the systems they work in and usually it is a combination of the two. But at least part of the productivity problem comes from therapists who do not adequately account for all the work they do.
I consistently see patients in therapy for 60 to 75 minutes being billed for 30 to 40 minutes of care. Do you want to increase your productivity? Bill and count all the work you do. You will be amazed at how much more productive you really are.
I see novice and even experienced therapists justify this underbilling with rationalizations such as "I'm just trying to avoid overbilling and fraud," and "Our prices are just too high." Personally, I think the payers have discounted our value enough. We are not only shooting ourselves in the financial foot, we are also loading the gun and buying the bullets out of our own or our employers' pockets.
We need to stop discounting our services. My care and the care of the great majority of therapists I work with is worth every cent we have coming to us. We must not, either intentionally or out of ignorance or apathy, give our care away when we should be rightfully paid for that care, excepting purposeful pro bono situations.
Here are some things to consider:
1. Check your work. Document what you do. Bill for what you document. Repeat.
2. Set up a system to audit and verify that you and everyone in your clinic are following the same rules consistently.
3. Talk to your payers when there is a problem. Learn their perspective and figure out how to meet the rules.
4. Learn the rules about billing and coding. They are not that hard. Find someone who teaches courses on billing and coding who can help you get this part right (if even I can teach these courses, anyone can learn the material).
5. Figure out how to pay attention to all the little details that may not be the most interesting to you. Use support personnel or support systems to help you.
I'd love to hear your opinion on this topic. Call or e-mail me with your comments.
Peter Kovacek is the president of Kovacek Management Services, Inc. and the president of APTA's Section on Administration. You can reach Peter at www.PTManager.com or Pkovacek@PTManager.com