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The Cycle Never Ends

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A big picture look at Revenue Cycle management and touches on the interconnected nature of the first point of patient contact through a paid claim.

By Eric Cardin, PT, MS

Revenue cycle management, a relatively mild term in the world of business jargon. It’s a simple yet important idea to look at the “management” of revenue. Physical therapy practice can be an emotionally and personally rewarding profession, but the obstacles between treatment and payment can be daunting. The term cycle implies a defined series of events or a routine that repeats itself, a cycle or pattern that is overtly and covertly tied together and the nature of which holds the key to successful management.

Visits x Charges x Accounts Receivable = Revenue (Income minus Expenses)
Simple, right? See a patient, charge for it, collect that money, pay the bills. Have something left over. Many businesses, including physical therapists in private practice, struggle or even fail by not digging deeper into what drives the factors in this basic equation for revenue cycle management.

Visits are revenue. No matter what metric you use, when you get to the bottom of the paper, visits drive the bus. Getting the patient in the door is an obvious first step but keeping them coming and growing the practice is the first and most important step. After all, there is no revenue cycle without revenue.

From the moment of first contact (phone intake, walk in, scheduling a neighbor for an evaluation on your phone—thank you, cloud-based electronic medical record (EMR)—while standing in line at the grocery store), the revenue cycle starts. So much of our ability to efficiently bill and collect revenue and manage cash flow is dependent on how well we collect information up front. “Clean” demographic information is the first obstacle we face in getting paid on time. Depending on the volume of your office, the ancillary staff you may or may not have, and the collection method, there are several “fail points.” Handwriting problems, typing errors, missed steps, and general lack of organization can and will delay a claim. It is very important to get the information from your client and get it into your billing/scheduling software in a quick and accurate manner. If you look at your turnaround time (time to get paid from the point you send out claim), you should be able to discern what the average is and also take note of what claims are rejected and why. Take note of the common errors and implement simple policy changes to reduce the rate of rejection. Your cash flow will thank you for it.

After you’ve efficiently and accurately collected demographic information and processed it without error, you still have some hurdles to overcome. Was there a referral in place? Was the patient authorized and/or do they have active insurance that will cover them during their entire episode of care? There are a few ways to go about this. One, you leave it to the consumer. It is their responsibility to know their coverage. Or two, you collect the necessary information at intake and you “trust, but verify.” There is usually a personal cost (doing it yourself) or actual payroll expense (paying someone to do it) in the time it takes to make sure all the referrals and authorizations are in order, but for a solo therapist with a full (30 to 40 hour) schedule of patients, for example, the effects on the bottom line are worth the up-front effort.

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Customer Service
The unifying theme in the first factor of “Visits = Revenue” is the ability to collect information. The tie that binds the components together is a positive customer service experience. A pleasant phone call or face-to-face encounter that leaves your client with the feeling that you are helping them get registered, authorized, referred, and ready for what is usually their first physical therapy experience will go a long way to establish your office as the destination of choice for physical therapy. It is wise to remember that the most important marketing opportunity you have is the patient who is already in front of you. Creating an environment that helps the client heal and doing so in a way that creates a feeling that everyone in the office is helping them on their journey will only serve to grow your patient base and your bottom line.

Payer Mix
Once you’ve seen the patient you’ve got more hurdles to jump through. What’s your payer mix, what are their coverage rules, what codes do they accept, and which ones pay well? The next factor in the equation for cycle management, “Charges,” is another important factor. Payer mix (what percentages of which insurers are paying you) should be a huge part of your due diligence prior to getting started. If you find yourself inundated with patients that have a low reimbursement rate, you might find it hard to stay in the black. Payer mix can be quite varied, and can change even from one town to the next. It is important to investigate who your patients may be, where they will come from, and who is insuring them before you decide where to practice. After you’ve made that decision, it is a good idea to routinely sample your payer mix and take note of where your bread is being buttered. Once you understand that, you can tailor your demographic collection and charge habits to maximize your revenue. As you understand payer mix, you will also find that it is important to stay on top of credentialing, continuing education (regarding coding/charges), and global changes to reimbursement. Visits x Charges = Revenue. If you have a multitherapist practice, get in the habit of sharing who pays what and what is well reimbursed and what is not. Even if they are not the practice owner, you will be surprised that they often do care that they are reimbursed appropriately. The cycle continues with or without you and your attention to detail is key. The only thing you stand to lose is money!

Accounts Receivable
Now that you’ve created a positive customer service environment and efficiently and accurately collected patient demographics while understanding insurance rules and gotten the client better without going over the allotted visits—it’s time to collect your revenue. Visits x Charges x Accounts Receivable. It is important to note that this equation we use to describe the revenue cycle uses multipliers, not addition. This is done with the intention of creating an understanding that success or failure will move exponentially. Small mistakes or small victories will carry over quickly. If you are seeing a hundred patients a week or a thousand, then that is your multiple. One mistake repeated 100 times. Or one success repeated over and over. It is all connected and all part of the revenue cycle.

Accounts Receivable (AR) is a basic component of any business that allows their “product” to be taken or used with a promise of payment. Physical therapists in private practice face the delightful challenge of having varied payment methods, contractual adjustments to our fees, and limited ability to make changes. Again, there are options. Cash-only payment at time of service sounds appealing when you delve deep into third-party reimbursement, but for those of us not ready for that option we must soldier on and get on our AR. Since we know we’ve already collected accurate demographics and used our expensive billing software to send out “clean” claims, we can just sit back and watch the bank account swell. Right? Think again. The struggle is real and the cycle waits for no one.

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Again, the tie that binds is customer service. Helping your client understand their benefit before they start physical therapy can seriously and positively affect your AR. Kindly let each patient know what their personal financial responsibility will be (copay) or could be (estimate their deductible) for their time in physical therapy and routinely remind them that their copayment, coinsurance, deductible, etc., is due, or will be due. Accept all forms of payment, remove all obstacles to “I forgot my [insert payment method here].” Create controls in the system to keep balances low and keep your consumer informed. Soft chasing them the same day in the front office is much easier and much more cost effective than bringing it up 90 to 120 days later. Start at the first point of contact with creating an understanding that you provide a service and that service has a cost. Too often we fall into the trap of the “helper/healer,” but have you ever tried to pay the utilities with good feelings?

Once the claims are out and awaiting payment, watch your rejections and Explanation of Benefits. Much of the payment process is automated and this has been to our benefit, but computers still can make errors and somewhere along the line someone is processing your claims who maybe—just maybe—isn’t having the best day and they just might let a charge slip through unpaid. If you are not managing this part of the cycle, there are plenty of ways to lose money. Pay attention to individual filing limits, coding rules, and coverage limitations. Bill your services as soon as you can, follow up as quickly as possible, and send out statements weekly (or more frequently if you can) to keep the cycle going and your cash flow strong. Bill the claim, correct the claim, rebill the claim. Keep the statements rolling.

Finally, you’ve collected demographics, charged appropriately, followed up on outstanding claims, and hopefully watched your bottom line grow. Revenue cycle management is constant. It begins with the first point of contact with every patient and ends with prompt and accurate payment. Tight controls, simple policies and procedures, and attention to detail should result in timely payment. Each practice should take a look at least quarterly at the components of the cycle. As time passes your data set grows, and you can see cause and effect and sharpen the parts of the cycle that lead to prompt, accurate payment.

Eric Cardin, PT, MS, is the executive director of South County Physical Therapy, Inc., which has six locations in western Massachusetts. He can be reached at ecardin@sc-pt.com.

Making the Most of Your Relationships

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Marketing in a revenue cycle management world.

By Sturdy McKee, PT, MPT

Most businesses generate the majority of their revenue from a few customers or clients. I prefer the term client, as it refers to a long-term, ongoing partnership, whereas customer is usually considered transactional. For most of us in physical therapy private practice, those clients are our referring providers. Of course our patients are our clients too, but for the purpose of this article we will stick with referring providers as our focus, and we’re going to look at reports and data about those referring providers to guide our decisions.

From your revenue cycle management (RCM) platform, pull your Referral Revenue Report, or whatever your system can create, that tracks the charges or collected amounts by referring providers. Notice I said revenue report and not number of new patients. By pulling both of these numbers on the same report, and comparing, you can start to ask more informed questions around your relationships and marketing efforts. Now, export your report to Excel. Sort it. Share it with your business partners and have a discussion. Is it what you expected? Did you find any surprises?

The providers at the top of this list obviously like you and your practice. From a business standpoint they have a certain worth. It’s typical to see the top 12 referring providers account for 30 percent or more of a practice’s revenue. And for the next 12 to account for another 10 percent. This is in a practice that has 300-400 referring providers in the course of a year. If you track this metric, what you may learn is that 10 percent of the providers who refer to you account for over 45 percent of your practice’s revenue. If that’s the case, where should you be spending your time? How do you take care of your top 10 percent? And why is that important?

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The numbers in the table (below) are “based on a true story.” They are “real” numbers. As you can see, not all are tracked effectively. Some patients don’t have a referring provider assigned. But this is the real world, and you can begin to see some numbers that may affect your future decisions.

Nearly 5 percent of patients do not have a referring provider assigned, which tells us there may be room for process improvement and training to have staff better track where referrals are coming from. But notice that the top doctor refers enough patients to represent over 7 percent of all charges generated by this practice, and the top 3 doctors account for nearly 19 percent. There are 328 referring providers or “doctors” on this list. The top 12 referring providers account for over 32 percent of this practice’s annual revenue. That’s 3.7 percent of the referring providers accounting for more than 30 percent of all charges generated in the course of a year.

If this is the case for your practice, when is the last time you talked to your top 12 referring providers? Did you talk with all of them? What did you talk about, you or them? Is everything okay in their practice and world? Are any of them moving offices? Are any hiring new people? Are they frustrated with their referrals? What are their current challenges? And how can you help?

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Oh wait, did you think this was going to be about postcards, seminars, and automation? It’s about relationships. It’s about conversations. It’s about prioritizing your high touch activities. Automated conversations are hard to have and at that point, do you really get to call them conversations? There’s a lot you can automate or create systems around and I urge you to do that. Creating this report is something you may be able to automate. Or you may be able to create a system so someone else can fetch the report, sort it, and share it. But the conversations are yours. Relationships are about people. And it’s our job as owners to take care of those who take care of us. So find out who they are and take care of them—and then find more like them that you can take care of.

Why is this all-important?
You are building relationships. When you spend the time to build those relationships, they know you care about them and their patients. You’re opening lines of communication. Having done this, you’re continuing to build trust over time, and this may in itself generate more patient referrals. It may help your biggest fans to talk about you more with their colleagues. On the flip side, it will also help when something goes wrong, like when you get a bad Yelp review, or a patient complains. It means they are more likely to engage you when you let a physical therapist go, or you decide to opt out of a lousy payer contract. This also puts you in a better position to have more meaningful conversations and further advance the relationship.

All of these things will happen if you stay in business long enough. The question is, how will your top referring providers react after you’ve invested time in the relationship?

Take note, all of these things will also happen with your competition. Are they investing in the relationships the way you are? If not, when one of these things happens in their world, what position will you and your practice be in? A position of trust and a solid reputation will help you build your practice, and weather the rough times and mishaps—perhaps better than your competition.

Sturdy McKee, PT, MPT, loves helping physical therapist practice owners achieve their goals. He is cofounder and CEO of ScheduleDoc.co and San Francisco Sport and Spine Physical Therapy. He can be reached at Sturdy@ScheduleDoc.co or @Sturdy on Twitter.

The Practical Coach

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Inspiring, encouraging, and challenging your team.

By Media Partners Corporation | Reviewed by Jean Darling, PT, LAT

As I was looking over old Impact journals, I saw an article analysis stating “millennials like to be coached.” This brought me back to a paperback book I received as a gift a long time ago, but felt appropriate to get out and read it again. The older I get, I think I have forgotten as much as I have remembered! In the busy world of today’s full-time therapist, owner, and parent, I enjoy quick reads that give me practical advice. This book is a working journal that you can take notes on as you proceed through the pages or simply take in its snippets of advice.

The very basic message of the book is in the title: As leaders in an organization, we are inspiring, coaching, and challenging team members every day. If we break it down to each area, coaching could mean that along the way in life, someone let us know that we matter. “From the day we were born, we all want to know that what we do affects our world, that we matter.” The people you lead are no different. They need to know that what they do matters to you.

Second, never assume your team is self-motivated. Most leaders are internally driven, but some of your team members may need extra help in the motivation department. Remember to get to know your team, as everyone buys in to your philosophy for a different reason. To really lead your team members to a new level of success, you want to know their styles so you can personalize your coaching for each of them. Coaching is the idea of selling hard work. You can only sell the idea of hard work if you are willing to work hard, too!

Next, try to encourage your team toward both individual and team success. “Never let great work go unnoticed.” Encouraging your team members means identifying specific actions or behaviors that are good, and then pointing them out. Remember that very similar to getting to know your team members for motivation, it is helpful to know if they are encouraged by applause, appreciation, or access to you or your time.

Finally, challenging your team members when things are not working or an individual is not doing his or her job correctly is every bit as important as encouraging them. A good coach gives feedback when there are great plays and when there are mistakes, because both have a tremendous impact on the vision of the success the team is working toward. Always remember to make it private and make it positive. Look at reasons for poor performance: Unclear communication? Do they have appropriate training to complete the task? Are there consequences for delivering poor performance?

To sum up this short working booklet, a reminder that adults learn by doing. A nice statistic they listed was that we remember 10 percent of information someone tells us, 60 percent when someone shows us, and 90 percent if we do it ourselves. This can be a take-home message for coaching our staff and our patients.

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Jean Darling, PT, LAT, is an Impact editorial board member and co-owner and vice president of Advanced Physical Therapy & Sports Medicine, Shawano, with six locations in Wisconsin. She can be reached at jean@advancedptsm.com.

Hiding in Plain Sight

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Therapy Coding Billing and Compliance Risk

By Nancy J. Beckley, MS, MBA, CHC

It all started out with a call from a health law attorney. He represented a small private practice that was under investigation. The therapy practice was in receipt of a civil investigative demand (CID); the U.S. Attorney’s office was involved as well as investigators representing federal health care programs. Is therapeutic exercise a one-on-one code? mused the attorney. If it is, how can a small practice stay in business if they have to treat patients individually? was the follow-up question.

Unfortunately, I have received many similar calls in the past year. Whistleblower cases, audits under the Office of Inspector General (OIG) Work Plan (Physical Therapists in Private Practice), Medicare Administrative Contractor (MAC) widespread probes and provider-specific probes, and unannounced visits by Zone Program Integrity Contractors (ZPICs). Outpatient physical therapy has been on the review radar with the OIG for over six years.

Reports under the OIG Work Plan are routinely published to the OIG’s website, and if nothing else they should serve as learning tools for all outpatient therapy providers, not just those in private practice. There have also been several settlement agreements and/or integrity agreements for small therapy providers in just the past several months. We have come a long way since the original OIG reports on Gem Physical Therapy and World Gym (both in South Florida) issued 16 years ago, and a long way from the “big news” corporate integrity agreements of 10 years ago with HealthSouth and Physio. All of these reports, Department of Justice (DOJ) press releases, corporate integrity agreements, and self-disclosures to the OIG all make for great case studies in compliance training and education. They make for even better case studies if you know both sides of the story.

So what do you need to do to mitigate compliance risk at your practice, and how can you use the posted settlement agreements, integrity agreements, DOJ press releases, OIG audit reports and crafting training programs, lunch and learns to mitigate compliance risk? A caveat: Just because your practice has been paid for submitted claims does not mean the claims would be considered payable if they were reviewed by a Centers for Medicare & Medicaid (CMS) contractor.

Group Code (CPT©97150)
Let’s start with the obvious. This is a current code that is valued and listed in the Medicare Physician Fee Schedule. CMS even provides alternative scenarios in using the group versus individual treatment codes. Do you use the group code at your practice? Should you use the group code at your practice? Do your groups have more than one patient? Do you bill the Medicare beneficiary for group, but other patients being treated at the same time for a 1:1 code? Would it surprise you to know that it doesn’t matter if the “other” patient is covered by commercial insurance?

The code descriptor for group is “therapeutic procedures(s), group (two or more individuals).” Group therapy procedures involve constant attendance, but by definition do not require one-on-one patient contact. So the definition of group includes more than two individuals. How is that to be documented in order to demonstrate that you complied with coding? A good example of documentation requirement for those providers with National Government Services (NGS) as their Medicare Administrative Contractor (MAC) is:

“The purpose of the group and the number of participants in the group. Description of the skilled activity provided in the group setting, such as instruction in proper form, or upgrading the difficulty of the activity for an individual.”

If you are using the group code, do you have more than one person in your group? Are you meeting the documentation requirements to support the use of the code?

Aquatic Therapy Code (CPT©97113)
Medicare coverage of aquatic therapy, as noted in the local coverage determinations (LCDs) of many CMS MACs, is contingent on demonstrating the need for aquatic-based exercises, including a transition to land-based exercises and therapy. Over the years there have been a number of cases involving aquatic therapy. In one case the therapy provider billed the state’s Medicare program for therapeutic exercise because aquatic therapy was not a covered service. In another case the practice owner instructed staff to conduct “group” aquatic therapy classes and bill as if individual aquatic therapy was provided.

First Coast Services (FCSO), the Florida MAC, indicates that aquatic therapy may be considered medically necessary if at least one of the following conditions is present and documented if the patient:

“has rheumatoid arthritis; has had a cast removed and requiring mobilization of limbs; has paraparesis or hemiparesis; has had a recent amputation; recovering from a paralytic condition; requires limb mobilization after a head trauma; or is unable to tolerate exercise for rehabilitation under gravity based weight bearing.” So if the patient is unable to tolerate exercise under gravity, is this documented in your evaluation and/or ongoing assessment?

Do you provide aquatic therapy at your clinic? Is the pool on site in the clinic? If the pool is not on site at your clinic, and you provide aquatic therapy at a community pool, do your policies conform to CMS requirements for the use of a community pool? (CMS policy differs for private practice and rehab agencies on the use of community pools.) Does your documentation include the medical necessity of aquatic-based exercises?

Self-Care Home Management Training Code (CPT©97535)
When you are developing a home exercise program (HEP) for a patient, how are you documenting the time, and ultimately coding and billing for the time spent in developing and progressing the HEP? If you are using the self-care management training code to instruct your patient and progress your patient in their HEP, you should review the code description to ensure meeting the code’s descriptor. Looking again to guidance from the NGS’s LCD:

“This code should not be used globally for all home instructions. When instructing the patient in a self-management program, use the code that best describes the focus of the self-management activity. For example, if the instruction given is for exercises to be done at home to improve ROM or strength, use 97110; if instructing the patient in balance or coordination activities at home, use 97112; if instructing the patient on using a sock aide for dressing, use 97535; if teaching the patient aquatic exercises to use as an independent program in the community pool, use 97113.”

Vasopneumatic Devices (CPT©97016)
If you are treating patients with lymphedema, you are most likely familiar with the vasopneumatic code.

There seems to be a trend with therapists using this code to describe (and bill for) the use of ice and compression. Some commercial payers have reportedly approved the use of this code to reduce swelling. With respect to Medicare, are you documenting the area of the body being treated, the location of edema along with objective edema measurements (1+, 2+ pitting, girth, etc.) and doing a comparison with the uninvolved side? Does your evaluation document the effects of edema on function? Do you describe the type of device used? This is what is expected in lymphedema treatment. In the absence of a lymphedema diagnosis, the use of this code for compression and ice may be considered upcoming.

If you are billing Medicare for this code, your documentation should include all the aforementioned details.

Next Steps
A few high-risk codes have been identified from recent audits and reviews. But any code can turn out to be a high-risk code depending on the circumstances and your MAC. For example, NGS continues to conduct a widespread probe review in Illinois on the use of whirlpool (97022) for all provider types including physician therapists. Hand therapists using this code to report and bill for fluidotherapy are finding that their claims are subject to review and often not paid, even if documented in accordance with the LCD.

Providers are reporting that Wisconsin Physicians Service (WPS) is requesting Additional Documentation Request ADRs on the use of group therapy code. The providers report little success in getting paid, even upon appeal.

To keep you on track and help mitigate compliance risk, two items move to the top of the list and should be considered a minimum starting point for your practice:

  1. Exclusions Monitoring and Sanctions Check. There is an expectation that your practice does not employ individuals who have been excluded from participation in federal health care programs. The OIG maintains a list of excluded individuals and entities that is updated monthly. Although not a requirement, it is an essential underlying element of compliance commitment.

    In addition to querying all your employees (https://exclusions.oig.hhs.gov/), you should check Medicare exclusions lists, keeping in mind that 37 states maintain their own exclusions list and at this time do not report to the OIG. The most frequent reason for exclusion? According to the folks at Provider Trust (http://providertrust.com), it is license infractions.

  2. Compliance Plan & Program. Compliance plans are required under the Affordable Care Act, but they are only applicable to skilled nursing facilities until CMS publishes further guidance. In light of that the OIG has suggested that providers use the OIG compliance guidances that are provided at their website (http://oig.hhs.gov/compliance/compliance-guidance/). The OIG guidance for individual and small-group physician practices specifically mentions the applicability to physical therapists in private practice and indicates that compliance plans can be scalable to the practice.

Please join me at the Private Practice Section’s annual conference in Las Vegas for my session on “Audits and Investigations: The True Hollywood Story.”

Nancy-Beckley

Nancy J. Beckley, MS, MBA, CHC, is certified in health care compliance by the Compliance Certification Board and is a frequent speaker and author on outpatient therapy compliance topics. She advises practices on compliance plan development and audit response. Questions and comments can be directed to nancy@nancybeckley.com.

Low Arrival Rate Is Lost Revenue

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By Michelle Collie, PT, DPT, MS, OCS

Most practices spend resources, time, and money on marketing to referral sources. The planned result is the physician, dentist, or office, referring patients to your practice. But how many of these referred patients actually arrive for their initial evaluation and become real, revenue-producing patients? This variable is most commonly referred to as arrival rate. And a low arrival rate is simply lost revenue and an added expense.

The goal of most practices’ marketing and public relations campaigns is to get new patients. This goal can be further defined and categorized based on the types of new patients; returning or new to the practice, payer type, referred or through direct access, social media, website, or word of mouth—the list goes on. The Healthcare Financial Management Association (HFMA) defines revenue cycle as “All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” Before any revenue can be captured, managed, or collected, these new patients must arrive for their first visit.

What is your practice’s arrival rate for patients scheduled for an initial evaluation that do not show? How many referrals does your practice receive via fax or electronically, but is unable to make contact with? Alternatively, after contact is made, how many patients decide not to come to physical therapy due to financial barriers, or they decide to go to another practice or seek an alternative type of provider? How many patients are referred but never contact a practice to make an appointment? All of these patients simply add to your marketing, administrative, and clinical expenses and result in lost revenue.

Establish best practices that ensure patients arrive for their first visit. There is a lot more to scheduling a patient than having a pleasant person offering convenient days and times for appointments. Scheduling staff need to understand their goal is not only to schedule a patient but also to ensure they arrive for the initial evaluation. The appropriate verbiage is required to proactively address any barriers or reasons why this patient may not arrive for their first appointment. For example: “Have you been to physical therapy before? Do you know what to expect? Would you like me to provide directions? Are there any reasons why you may not be able to come to your first appointment?” The scheduler is often the first person the new patient comes into contact with, so it is essential to have a person in this role who represents your practice well and has impeccable customer service. The scheduler must also be able to explain to the patient the value of physical therapy and address challenges from the patient who does not want to come to physical therapy despite being referred. Consider offering a free consult to the skeptical patient, or the opportunity to speak with a physical therapist. Be aware of the scheduler who describes physical therapy when asked as “exercise, massage, and dry needling.” This will drive away any patient who asks what physical therapy is! Equip schedulers with answers to questions on cost, what treatment will consist of, frequency and duration. Consider how the scheduler explains the cancellation policy. Finally, the scheduler can tell the patient who their physical therapist is and any additional information, establishing a personal connection between the patient and clinician before the first visit.

When appointments are made days in advance, consider additional reminders the day before the scheduled appointment; a text message, email reminder, or another phone call. There are many automated systems available that are separate or integrated into many EHRs (electronic health records). Alternatively, a welcome email that introduces the patient to the practice and the physical therapist they will see.

Establish what “unable to reach patient” means for your practice. One unanswered phone call to a referred patient should not result in a note being sent to the referral source stating “unable to reach patient.” What time are phone calls made and to which number? Can the referral source provide multiple ways to reach the patients? If contact cannot be made via a phone call, consider sending emails, postcards, or letters to patients’ homes.

How many patients receive a referral for physical therapy and never actually call to make an appointment? Or how often does a physician inform you they referred “lots of patients,” yet your records show one or two. Assess how every office makes their referrals and find solutions to the patient who leaves with a referral in hand but who never follows through with making an appointment. Online referral systems, faxes, and phone calls are all options to be considered. Additionally, consider the information the referral source gives to the patient. A professional and informative brochure representing your practice is more likely to result in a patient calling to schedule their initial evaluation.

Arrival rate is important to track as part of any practice’s revenue cycle management. Ongoing refinement in your practice’s processes including analyzing the data, training in best practices, and the communication of clear expectations and goals will ensure as many referrals as possible turn into real, revenue-generating patients.

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Michelle Collie, PT, DPT, MS, OCS, is the chair of the PPS PR and Marketing Committee and chief executive officer of Performance Physical Therapy in Rhode Island. She can be reached at mcollie@performanceptri.com.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.