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Physical Therapy Software/EMR | Setting the Dials for Success

Physical Therapy Software/EMR | Settings
Setting up the Physical Therapy Software/EMR for success would require several configurations that taken together would ensure that the software delivers full value.

Get Things Going with Clinic Setup

Clinic setup would be a good place to begin.
  • This would include the tax id and NPI number for each facility along with other information on how claims are going to be filled out.
  • Next up would be adding employees and users to the EMR with only employees marked as therapists assigned to cases or appointments.
  • The number of possible appointments a therapist could take on if working for a full day would be a key metric that rolls into productivity reports.
  • Assigning an employee to a facility would enable them to appear in reports for that facility and on the scheduler if they are a therapist.
  • Facility access would also determine whether a user would be able to run reports for that location. User roles would grant the user certain permissions and securities in the system.
The licensed therapist insurance settings would affect billing.
  • Each employee would need the appropriate insurance group in the employee?s setup for their claim to successfully generate.
  • Other settings would include the NPI number for the therapist (rendering provider) and the organization and the tax id for the organization.
  • The rendering provider NPI number would go into the claim form and would be a required field for every insurance group that the therapist is credentialed with.
  • It should be possible to bill under different tax ids and NPI numbers for different payer groups, if the clinic were doing business as two different organizations under the same group.
  • Holding claims for a therapist for an insurance group would be necessary if the therapist is in the process of getting credentialed.

Get Insurances Squared Away

Adding new insurances would be a critical step, these could be coming in from the old billing system.
  • Marking if the insurance requires authorizations and Rx authorizations would be critical to stay on top of when scheduling visits.
  • Setting up a parent payer like a Blue Cross parent for different Blue Cross plans would help post the payment to the parent company.
  • Billing settings would include type of payer like commercial insurance or Medicare while the insurance type would denote the type of insurance policy.
  • The payer id would roll over from the clearing house if electronic submission for the payer through the clearing house is in place with a separate payer id to check eligibility and claim status.
  • The 8-minute rule calculation would automatically calculate the number of units based on time put in using the AMA or Medicare 8-minute rule.
  • Claim type could be professional claim or institutional claim or agency statement (for organizations or schools that the clinic provides therapy for).
  • Professional claims would be the default for submitting claims to insurances on a CMS 1500 form. The UB04 would be the claim form for institutional claims.
Selecting Medicare as the payer would control automatic Medicare settings in the system like automatically attaching KX modifiers.
  • Enforcing CCI Edit Rules would display the entire CCI rule set to identify charges that should not go together like a 97001 and 97002, that would call for a 59 modifier.
  • Also, specific Medicare warnings would be needed for Functional Limitation Codes and, for example, tenth visit reminders.
  • A visit-based contract would select a flat rate for every visit and would indicate at the time of posting the payment that it is a visit-based contract.

Fees and Other Money Matters

Another important item would be the master fee list for adding, editing, and updating all the fees to charge out, organized into groups like evaluations, therapeutic procedures, and so on.
  • It should be possible to add practice specific fees and add/modify/delete/activate/deactivate the fees list as needed.
  • Active fees could be charged in the EMR/selected inside a list. Fees that have been used in the past but are no longer valid could be marked as inactive.
  • It would be possible to make a visit count on a date of service without an appointment and charge the corresponding CPT code by marking the fee as a visit.
  • Marking the fee as a time-based fee would be ensure it uses the appropriate 8-minute rule to calculate the number of units.
  • Another setting would be if the fee counts in productivity in which case, it would be used in reports to calculate productivity measures.
  • Zero-dollar charges may need to be added to a Medicare claim, this would be a setting at the fee level in the EMR.
Fee classes are a group of fees that are allowed for a particular payer and would include billed and contracted amounts, whether the fee is active or not, and would be assigned at the patient case level.
  • It would be possible to edit the fees in the fee class, set default modifiers, and add new fees to the fee class. Some modifiers like the 59 and KX modifiers would be automatically set up.
  • Fee schedules would be set at the fee class level and pricing would be set up with billed amounts and contract amounts.
  • These would also be used to calculate Medicare thresholds and period of validity for pricing. Charges would get picked up based on the validity period for which fee schedules are applicable.

Other Items to Close Out the List

Some other settings to close out the list would include:
  • Adding attorneys (who could be guarantors on a case), referral practitioners, PCPs, case managers, and employers would be another step.
  • The referral NPI number would link to the CMS 1500 form. These would add into the patient case information.
  • Adding and editing appointment types would include whether the appointment is an eval appointment and if it would allow overbooking (for double booking on the scheduler).
  • Account types are a financial class that would be used to organize billing features in the application and typically mirror the fee class.
  • Account types could be used to organize claims at the time of billing and create batches of claims that are easier to work on.
  • They would also get correctly assigned to the right person for payments follow up with other tasks assigned to the account owner and show up when the task becomes due.
There are several such details that would affect workflow processes, reports, and other areas. Getting this right would ensure that the right foundation has been set for the Physical Therapy Software/EMR initiative.