A Day In The Life With Physical Therapy EMR, Not Exactly Groundhog Day
Patients Get On The Schedule
Front desk gets patients scheduled
When patients call in, the front desk logs into the EMR, quickly adds (quick add) key patient information, and secures their spot on the schedule. Later, they can follow up with the patient for any additional missing information. The Google Maps integration helps ensure accurate patient addresses. Patients are digitally onboarded by sending patient forms, customizable clinical questionnaires, e-sign, and other documents through the patient portal.
Appointments get scheduled across the one or more locations of the clinic (with independent or shared clinicians). Each location could have the same or different billing setups including multiple tax IDs, and practices could have single or multiple disciplines. With different colors used to display appointment statuses like arrived, rescheduled, canceled vs canceled under 24 hours, the front desk knows exactly where to look.
Front desk checks all warnings
A layered approach to presenting patient information and warnings is in place. Warnings are first presented to the front desk, then to clinicians, and then to billing where it gets flagged in the claim. Specific warnings include number of visits/units remaining in the authorization, progress notes that are due, and missing certifications, among others.
Patients access the patient portal
Patients log into the patient portal and fill in their clinical questionnaires (like functional scales and outcome tests) so that certain questions in clinical templates like past medical history, allergies, medications, and pain levels are pre-answered before they arrive in the clinic. This saves valuable time for the therapist at the time of evaluation. Time to completion of a note is an important metric and KPI. Prefilling documentation helps improves the metric, making the patient portal a win-win for all including admin, scheduling, and clinical teams.
Patients Arrive At The Front Desk
Front desk collects patient payments
With online bill pay, the front desk team knows precisely what to collect for each visit. Credit card integration makes payment collection straightforward. Payments are posted to the merchant account and to the EMR simultaneously.
Front desk confirms that patients are all set
A Patient Information Card at the top of each EMR screen summarizes demographic information, diagnosis information, timelines for clinical/billing compliance, total visits, authorized visits, remaining visits, appointment history and more for each patient. That way, the front desk can see immediately if something is off right when they are talking to the patient. Files that were earlier uploaded by the patient to the patient portal can be readily accessed by the front desk via the patient information card along with other common patient related features. Insurance verification kicks in automatically through the integration with the clearinghouse. The verification gets retrieved from the clearinghouse and is populated on the screen.
Patients Get The Therapy They Need
Therapists check their to-dos
When clinicians login, the first thing they see is their follow-up task list and their appointments for the day that includes type of appointment, number of visits, number of visits since last eval, status of documentation, and arrived appointments that lack finalized documentation. Assistants mark notes as ready to review, which passes it to their supervising therapists.
Therapists document visits
The flowsheet is a key part of daily documentation. The flowsheet documents each patient encounter and specifically what interventions were performed. Therapists can opt to copy forward their previous daily notes. Exercises, the SOAP note, and charges are all on the same page of the flowsheet. Easy to navigate, the flowsheet makes the solution audit proof by generating all charges directly based on documentation. Units are automatically calculated. Billing rules and modifiers are applied at the backend. All clinicians need to do is to roll forward and edit their notes, update meeting times, and the billing system handles the rest.
Patient Visits Get Billed
Billing reviews and submits claims
The billing team gets into action. Claims generation is broken into stages. First off, all charges are reviewed before claims are created. Charge review highlights items that could cause a rejection like missing authorizations, unlocked notes, charges entered with no appointments, evaluations that are missing eval charges, and so on. Billing issues are fixed at the backend right from the charge review screen. Billers assign tasks to therapists to correct charges, when needed. Claims are created in batches. Through the use of application filters, claims are validated and then transmitted to the clearinghouse. Collection follow up tasks are added.
Billing assigns follow-up tasks
Follow-ups are a flexible, inter-departmental task management system built into the core of the EMR that can be accessed from a number of places in the application. Follow-ups can be created during patient workflows, thus gaining the appropriate patient context. Follow-ups roll up into management level reports for example all tasks for a particular reason that are still outstanding. The follow-up system is a vital element of revenue cycle management and provides full transparency into the billing process with a constant back-and-forth on tasks and denied claims.
Billing completes remittances and patient statements
Next remittances are imported into the EMR through EOBs and ERAs, directly from the clearinghouse. Adjustments are read and remaining balances are automatically allocated across patients, secondary/tertiary insurers, and write off. Billers can intervene by overriding ERAs and changing the auto allocation of balances. Patient statements are sent to patients for collection of patient balances through the patient portal, via integration to print-services in the EMR, or manually printed and mailed.
Compliance is constantly checked
Managing the certification lifecycle is another important process. For Medicare, it is not possible to get reimbursed for a patient until the referring doctor sends back the signed plan of care document. Faxing the plan of care directly from the EMR to the referring doctors office makes the process trackable. A dashboard shows when it was sent and if the signed document was returned from the referring doctor, with automatic alerts if delays become excessive.
If the EMR provider is a certified registry with the CMS, data is submitted to Medicare and CMS for MIPS reporting. If there are any missing certifications or MIPS measures or progress notes, controls in the EMR prevent clinicians from moving forward until they add the missing compliance items based on insurance and configuration rules that are constantly running in the backend.
KPIs And Goals Gets Tracked
Reports and dashboards close the loop
There are operations reports, productivity tracking reports, authorization reports, and financial reports (broken down by department). As workflow tools, reports are very useful for clinic teams with their links to the relevant parts of the EMR for exploring data and taking remedial actions.
KPI and goal performance is checked
KPI dashboards organize metrics into dashboards alongside KPIs and goals. Bringing in data from all parts of the EMR including scheduling, billing, appointments, documentation, metrics like arrival rates, appointment reschedule rates, cancellation rates, units per visit are calculated and displayed in a consolidated summary. Users can dive deeper into metrics, drill down, and see metrics broken down by dimensions like locations. Goals can be customized at the facility and user levels and viewed alongside metrics and KPIs. Clinicians and other users can also have their own personal dashboards. Clinic owners and leadership can review the reports and dashboards for tracking clinic performance.
Security provides additional reassurance
User security provides the critical controls and checks and balances that ensures there are no unexpected surprises. Each page has add, delete, edit, and view permissions making for a robust security. Customizing user roles in the system and overlapping roles if needed enables unique templating for security. Audit logs with audit tracking at the user level and time stamp level show who changed an appointment, charge, claim etc. The same level of specificity is added to reports security in the system where certain reports can be restricted to specific users.
And so there you have it. A busy day comes to an end. Everyone gets to leave on time with no work or documentation carried home. And then the next day arrives. Not exactly Groundhog Day, as patients are likely to come in with unique problems making every new day one of discovery, learning, and caring.