Rehab Essentials
Convenient, affordable online education to health professionals
Documentation, Coding, Payment, and Compliance: Managing for Success in the Outpatient Physical Therapy Environment
Robbie B. Leonard, PT, DPT
Course Description
This module will present to the physical therapy clinical doctoral learner methods to remain current in issues related to the documentation, coding, billing, and payment, for physical therapy services in all outpatient settings. Compliance issues are also covered throughout the course materials either specifically or in context with the topic being covered during each module. This information is critical to being successful in the administrative aspect of providing physical therapy as well as the delivery of clinical services. Understanding and being able to apply this information is vital in order to thrive in today’s healthcare environment due to the transition in payment methodologies and the focus moving away from a procedure based reporting and payment mechanism to payment and service delivery models that are emphasizing not only the reporting of services reflecting the severity of the patient’s condition(s) but also the outcomes of your clinical decision making. The content covered in this course includes information that will assist the physical therapist in their day to day practice operations, from an administrative perspective and provide resources for them as informed physical therapy professionals.
This is the most up-to-date information to improve your clinic and allow you the abilty to maximize your reimbursement while maintaining complete compliance with all current laws and regulations.
Objectives
- Explain the process involved in the development and maintenance of AMA’s CPT codes, including the use of modifiers, as applied to physical medicine and rehabilitation services.
- Describe the appropriate application of current CPT code to clinical services, coding challenges, and possible reimbursement implications.
- Critically assess the developmental process of the Resource Based Relative Value Scale (RBRVS) and its impact on payers outside of the Medicare program.
- Understand the components of RBRVS and how they impact the payment for services.
- Understand the methodology and calculation of the Medicare Fee schedule and its impact on fee schedules developed by private payers.
- Understand the current use of diagnosis codes both current (ICD-9) and future (ICD-10) and their impact on the reimbursement process and ability to support medical necessity.
- Understand the various aspects of payment policy that apply to the Medicare program and how they influence policies of private payers, including mechanics and importance of reporting on quality measures and functional limitations.
- Understand the current legislative initiatives and regulatory environment and the impact on payment for outpatient rehab services both now and in the future.
- Recognize the concepts of fraud and abuse and understand health care environmental factors that influence the occurrence of fraudulent and abusive.
- Understand the federal False Claims Act and its importance determining what constitutes fraud and abuse violations in health care practices.
- Apply clinical reasoning and quality assurance strategies to documentation supporting medical necessity of physical therapy and avoid potential fraud and abuse situations.
- Be able to use an understanding of the health care environment from the perspective of the provider and the third-party payer to effectively manage in the outpatient rehab setting in the areas of coding, billing, documentation for medical necessity and compliance.
- Understand the importance of physical therapist involvement in peer review and utilization management strategies.
- Understand audit review flags and assess how these flags alert reviewers to potential problems with the provision or billing of physical therapy services.
- Describe the proposed structure and underlying premise of the alternative payment methodology being considered for physical therapy services in the future.
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The University of Montana (UMT)/ Rehab Essentials tDPT Program has greatly influenced my career as a physical therapist and educator. I selected this program due to the amazing access it provides to the top academicians and clinicians in the profession. The added bonus was the reasonable cost and the ability to receive credit for my preparedness at the post-graduate Master’s level.
The University of Montana (UMT)/ Rehab Essentials tDPT Program is a fantastic education for which I am most grateful!
The experience I had with the tDPT program through The University of Montana exceeded my expectations in all ways. The courses were in a logical manner and were easy to follow. I enjoyed the “learn as you go” format that allowed me to study at my own pace and review material as needed. The CD lectures followed the syllabus and were easy to understand. Most sections had a textbook and/or reading material well defined. There were no surprises once the academic calendar was released if you followed the syllabus.
I enjoyed the ability to confer with my cohort in the discussion board and meet most of them at the Professional conference. The conference was a highlight of my experience as the material discussed was thought provoking and covered a wide range of topics. The faculty for the Professional conference was filled with leaders in the physical therapy field.
My highest recommendation for anyone wishing to further their education in an organized, interesting and thought provoking manner.
In my program, we use Rehab Essentials as a cost-effective means of bringing expert instructors in pharmacology, imaging, and medical screening into our courses. My faculty are then able to focus on getting students to apply this knowledge to physical therapist practice. Rather than spending time creating lectures in those areas, my faculty develop activities and assignments aligned with the instruction that help engage and apply information in a way students will do so in clinical practice. This shift gives us the best of both worlds- expert instruction and core faculty who focus on designing and assessing learning experiences.
We have begun threading the Rehab Essentials modules across the curriculum in variety of formats. Associations between select areas of physical therapy practice and pharmacology principles have been integrated within courses that focus on certain practice patterns or settings. The Differential Diagnosis and Imaging modules are being used to replace some face-to-face class time or prepare students for a more advanced discussion in a flipped classroom format. In addition, the service and support provided by the Rehab Essentials team has been excellent.
What drew us most to the Rehab Essentials modules was the versatility of the delivery method and the ease with which it supported and integrated into our curriculum. The reallocation of faculty instructional time away from introductory and foundational concepts has allowed for a more dynamic classroom, one that is rich with higher order critical thinking activities that drive student clinical reasoning to the top of our licensure.
Rehab Essentials did a stellar job teaching our entry-level DPT students cardiopulmonary physical therapy. All instructors demonstrated competence, professionalism and great enthusiasm for the class. I highly recommend this organization to assist DPT programs with supplemental instruction in high-need areas.
1. I love this curriculum.
2. I would not have a chance to ever go back to school if online programs like ours did not exist.
3. The point you make about "you get out of this curriculum what you put into it" is immeasurably true.
4. I love that each course has very different assessment tools...I got alot out of Business and Mkt..this was the course I expected the least out of and was enriched the most by...those writing assignments got me creatively thinking.
5. It is wonderful how Jonathan, and you Steve, convey a message of "we are all in this together and we want to help you" on every interaction. You guys rock.
I just want to extend my sincerest appreciation, Dr. DeRosa, for the valuable lessons I learned from you and this course. It was amazing to have the chance to put in writing a lot of thoughts and ideas that I have from several years ago that became relevant and resurfaced through this course. The resource books are truly a great read as well. I have been using some of the terms like "disruptive innovation" at work.
Your course and the discussion that you did on the lectures have been really helpful for me. Before this subject, I have looked at health care and business/marketing as two entities at the extreme ends of the arrow. I mean, I'm one of those practitioners, who, lets say, are kind of ginger in involving profit with actual facilitation of client care. This course made me better understand the importance of looking at the business aspect of the profession in order to sustain a practice, and in turn, continue helping patients. For all these, thank you so much.
I wanted to follow up and say thank you to Rehab Essentials and the University of Montana. I completed my DPT there in 2013 and then a Certificate of Rehabilitation Administration in 2017. All of this additional training that built upon my original bachelor’s degree in PT enabled me to recently obtain an Assistant Professor appointment in the Department of Physical Therapy and Human Movement Sciences at Northwestern University Feinberg School of Medicine. This is made possible through the partnership between Northwestern and Shirley Ryan AbilityLab where I am currently a Therapy Manager.
If I had not gone on to get my DPT, my qualifications would not have been at the appropriate level to be reviewed for a faculty appointment. I am very thankful to the faculty in the Rehab Essentials program.