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
New MediGraph subscribers
often ask questions that are related to Medicare standards and the legality of
specific functions that relate to documentation. Three of the most frequently
asked questions are presented below.
Question: Can I edit my notes after the day of treatment?
Answer: Section 220.3 states, “Dictated Documentation. For
Medicare purposes, dictated therapy documentation is considered completed on the
day it was dictated. The qualified professional may edit and electronically sign
the documentation at a later date.
Question: Is it legal to write a progress note at a later date?
Answer: Section 220.3 states, “Dates for Documentation. The date
the documentation was made is important only to establish the date of the
initial plan of care because therapy cannot begin until the plan is established
unless treatment is performed or supervised by the same clinician who
establishes the plan. However, contractors may require that treatment notes and
progress reports be entered into the record within 1 week of the last date to
which the Progress Report or Treatment Note refers.”
Question: How do I prove that a skilled professional care was required?
Answer: "To determine whether a service is skilled, and therefore
coverable, the new regulations direct decision-makers to review accepted
standards of clinical practice and to consider whether a professional is needed
for the service to be safe and effective for the particular beneficiary.”
If we interpret this last answer with a most literal perspective, the ability to
improve the patient’s condition becomes secondary to proving that skilled care
was required. If we are honest, we will admit that these perfunctory tasks are
not designed to improve patient care or outcomes. They are designed to reduce
the care rendered in an attempt to save money. A few software vendors present
the documentation changes that are taking place in Medicare as though they are
desirable. If we were accountants, not therapist, I would agree. We at
MediGraph choose not to
sugar coat this issue. We comply with the documentation standards because we
are forced to comply. We address this matter openly, with the direct attention
that it deserves. In the near future, an upgrade of the program will take
evidence based medicine to the next level, automatically providing intervention
references that are diagnosis specific. For example, if you choose to provide
transverse friction massage for lateral epicondylitis, a peer reviewed reference
will accompany the intervention. We will guide through the Medicare requirement
maze so that you can do what you do best; treat the patient.
Tom Kane, PT