Let's Help Each Other

Physical therapy is changing rapidly. As a PT with more than thirty years of experience, the changes observed in the last ten years triple those of the first twenty years. The pace of change is not slowing down. The Medigraph Blog will serve as a forum that will enable us to exchange ideas and assist each other. This blog will be used to share billing, documentation, and any other ideas to improve any aspects of our profession. If we share what we have learned, we can develop a resource that enables our collective understanding to advance our careers.

As profit margins grow smaller and expenses grow larger, we need to assist each other to survive and prosper. If we share our experiences we can help each other to grow professionally, administratively, and financially. Our professional lives, our livelihood, and our personal lives are intertwined. Our resources individually are limited. Together we can accomplish more than we can individually. Let's help each other


Tom Kane, PT
MediGraph Software

The ‘Disablement’ Model Progress Note: A RAC Auditor’s Nightmare
7/30/2011 11:47:00 AM

Dear Subscribers:

We at MediGraph continue to emphasize the importance of RAC sensitive documentation.  Our preventative approach is designed to protect you from the RAC auditors’ goal of extracting a refund from you.   RACs do not care if the patient got better!  RACs only care if your documentation meets their standards.  You could be the best therapist in the world and it would not matter to an auditor.  Unless we understand that the RACs purpose is to obtain a refund for past services rendered we are missing the boat.  Please consider these SOAP Note suggestions to emphasize disablement (loss of function):

Subjective:  When using the MediGraph Daily Note Editor, the third choice in the Subjective menu is ‘Functional Complaints’.  Functional complaints are also listed in the “Area Specific” drop down menu. The ‘Subjective’ entry of your progress notes should include personalized patient functional complaints.  For example: Mr. Smith states, “He has pain and weakness in his knee (impairments).  He also states that he cannot get up from a chair independently, and that he cannot walk more than 10 feet once standing (functional disablement).”   If Mr. Smith had pain and weakness, but did not have decreased function, the medically necessary component of your treatments will be challenged and you may be forced to refund the fees for Mr. Smith’s treatment (all of the fees).   

Objective:  Please Measure Something!   MediGraph is the only program available that integrates hundreds of standardized and peer reviewed measurements of impairment and function within the documentation program.  Use these objective tools to substantiate the patients impairments and  functional deficits.  For example, Mr Smith has knee complaints of weakness, pain, inability to transfer, inability to ambulate more than 10 feet.   Measure Mr. Smith’s loss of strength (an impairment), preferably with a hand held dynamometer (HHD).*    However, impairment measurements are not sufficient to satisfy the need for intervention.  To justify treatment, a functional deficit must be present (inability to transfer, inability to walk).  Use a functional test to reveal Mr. Smith''''s disablement-functional deficit.  Have Mr. Smith perform the Tinnetti (balance and initial gait testing), the TUG, or any functional test to demonstrate that his functional ability has been objectively assessed.   Also, employ the functional outcome questionnaires in MediGraph (OPTIMAL, Lysholm Knee Rating, Musculoskeletal Function Assessment, etc.).  

Assessment: Obviously, the assessment portion of the note will address the patient goals.  However, many therapists do not use the assessment portion of the SOAP to update the diagnosis, and to link the updated diagnosis to the patients’ functional improvements.   For example, “Mr. Smith HHD reveals strength gains of 20% (impairment improvement), which has translated into increased ambulation from 10 feet to 20 feet (functional improvement).  Mr Smiths performance on the TUG test reflects a functional improvement of 25%.”

Plan: The Plan portion of the SOAP note is primarily employed to alter the treatment plan.  The plan should be updated when new findings are discovered, expected, and to revise goals as the result of these findings.  The Plan portion of the note does not need to be completed on a daily basis. 

All the tools to outsmart the RACs are at your disposal in MediGraph.  All of the components mentioned above are included in your subscription.  Our goal is to assist you with using the software to protect you from those predators that are only rewarded by obtaining a refund from you.   Please call with any questions.

Be well,

Tom Kane, PT