Just What the Physical Therapist Ordered
How EMRs conquer compliance, boost bottom lines, and promote patient-focused care.
By Heidi Jannenga, PT, DPT, ATC/L
For most physical therapists, compliance regulations (namely, the ones handed down from Medicare) are a bit like a foreign language. You might know a few key phrases and vocab words—therapy cap, multiple procedure payment reduction (MPPR), the 8-minute rule, functional limitation reporting, physician quality reporting system (PQRS), and the like—but you are far from fluent. While you might be able to get by with your pocket Spanish dictionary when you are sightseeing in Madrid, a stumbling, fumbling approach to Medicare rules is not going to cut it—especially if you are ever faced with an audit. However, digesting all that jargon-laden government speak requires a lot of time and effort—something most private practice owners and therapists simply do not have.
Still, the financial health and stability of any clinic hinges on following the rules; even a single penalty could be enough to close a practice’s doors for good. Sounds pretty awful, but it is happening across the country. Luckily, there is a silver lining: Most electronic medical records (EMRs) have built-in compliance features to ensure your patient records are always audit-ready, no matter how many curveballs the Centers for Medicare & Medicaid Services (CMS) throw your way. It is like a “Rosetta Stone” for Medicare regulations, and if you want to put all that compliance-related worry to bed so you can get back to focusing on what you do best—treating and healing your patients—then it might be just the ticket.
Here is why:
1. An EMR has an infallible memory. Even if you are able to decode and understand Medicare’s legalese, you still have to remember how and when to do the things it mandates—and that is an exercise in memory skills that even genius Jeopardy contestant Ken Jennings would find challenging. The right EMR will sort that out for you, providing reminders and alerts at all the right times to ensure you complete each step correctly for every requirement.
EMRs with integrated functional limitation reporting solutions, for example, will prompt you to record a patient’s primary functional limitation, the severity of that limitation, and the patient’s therapy goal at all of the necessary intervals (e.g., initial evaluation, reevaluation, progress note, and discharge). The system can also help you choose the appropriate G-codes and modifiers based on the information you have already entered into the patient record and will then carry that data forward to future notes. It is not only a huge time-saver, but also a big bottom-line booster, considering that Medicare will deny any claims lacking functional limitation data.
Speaking of G-codes—things can get even more confusing when you throw PQRS into the mix. Therapists often mix up PQRS and functional limitation reporting, but even though both of these reporting initiatives involve G-codes, they are totally separate. You are responsible for completing both. Sure, PQRS is technically “optional,” but financial repercussions for eligible providers exist—including physical, occupational, and speech therapists—who either choose not to report or do not meet the requirements for satisfactory reporting. How much are these financial penalties? In 2014—and for all subsequent years unless otherwise directed by CMS—the penalty is a 2 percent payment adjustment. Therefore, it might be best not to take on the intricacies of PQRS on your own. With an EMR system that offers registry-based PQRS reporting, you know that everyone in your clinic will remember to submit the proper data at all of the required times during normal documentation. On top of that, the system will compile all of your data for you and electronically submit it to CMS on your behalf.
EMRs also help you with Medicare Plan of Care tracking reports and alerts, certification and recertification reminders, and 8-minute rule alerts. Plus, a physical therapy–specific EMR can streamline your documentation process and reduce double data-entry and human error—both of which have the potential to cause compliance issues. Storing documentation digitally creates neat, organized, legible, and easily accessible records should you ever need to review past notes.
2. Pleading ignorance does not work with Medicare. Unless you are confident in your understanding of Medicare’s demands of you, at some point you are bound to miss something. And if that happens, Medicare is not going to cut you any slack—even if you had absolutely no idea the rule you broke even existed. They do not care how busy you are treating patients and running your practice; they expect you to comply, no matter what.
3. EMRs are always up to date. In a physical therapy clinic, time is money, and staying on top of Medicare’s ever-evolving rule book could cost you hours and dollars if you try to go it alone. The people working behind the scenes of your EMR are totally immersed in the world of compliance. Although that does not give you a free pass to ignore new legislation and regulations completely, it does mean that you will have some help. After all, cloud-based EMRs update their systems to account for regulatory changes when they occur, as well as introduce new features and functionalities. These updates happen automatically and seamlessly.
4. Electronic documentation is cheaper than paper. In the long run, documenting on paper is actually more expensive than using an EMR—and I am not just talking in terms of penalties and fines. In fact, according to Medical Economics (December 1997), it costs about $8 per year to maintain a single paper record, compared to $2 to maintain a single electronic record.1 Multiply that by hundreds of patients, and the case for EMR as a profit-preserver becomes pretty clear. Plus, when you devote fewer precious minutes to digging around for patient files, you will save in labor costs and have more time to see patients.
5. You get more than just software. When you implement a compliance-focused EMR, you not only get a system that is equipped to handle all things compliance—you also get a team of experts who help you understand the rules and provide answers to your toughest compliance questions in the form of educational content like blog posts, webinars, user guides, and one-on-one support calls. Things can get rough in the compliance jungle, and simply knowing that you are not alone can be a stress reliever.
6. EMR is better for your patients. As I alluded to in the item above, taking some of the compliance responsibility off of your plate gives you more time—and energy—to devote to your patients. At the end of the day, that is really what it is all about, right? The patient benefits of EMR do not end there; EMRs also enhance your patients’ safety by ensuring their records are always complete, organized, secure, and error-free. (To elaborate on that error-free benefit: The best EMRs provide clinical decision support to identify documentation mistakes, pinpoint compliance issues, and alert you to potential red flags.) Additionally, electronic systems allow therapists to easily view a patient’s entire history, thus enabling them to make better clinical decisions. On the interoperability front, EMRs foster care coordination among different providers and specialists, which is extremely beneficial to patients who see multiple doctors.
The list of reasons to implement a cloud-based EMR in your rehab therapy practice is a long one—and compliance is definitely near the top. In addition to lifting some of the Medicare burden off of your shoulders, the right EMR can help you increase your profit and enhance your patient care.
Medical Economics, December 1997.
Heidi Jannenga, PT, DPT, ATC/L, is a PPS member and the founder and chief operating officer of WebPT. She can be reached at firstname.lastname@example.org.