Physical Therapy Software | Putting the Patient at the Center
From a high level, the patient record would have demographic information at the top and individual case records at the next tier:
- Each patient would have one or more cases associated with their record. Each specialty like PT, OT, or Speech would be a separate case.
- What would bring everything together in a detailed summary would be the Patient Information Card with context sensitive information at the demographic level or case level.
Appointments would typically be a point of entry into the patient record and associated documentation. Any list of appointments would include the date, time, facility, and the therapist under whom the appointment was scheduled, with links to the flowsheet and SOAP note for the appointment:
- It would be possible to expand the appointment selection to see what types of notes were done on the day like a daily note or initial evaluation and edit the appointment from the summary page.
- Accessing documentation to print it should also be possible. A case report should allow printing all notes or notes for a selected date range.
Constructing the patient record would be akin to putting together all its building blocks:
- Demographic information
- Clinical information
- Financial information
Diving into the EMR Patient Record
First, the demographic information
Adding demographic information to the physical therapy software would provide a starting point:
- A key item would be the patient referral source that is how did the patient discover the physical therapy practice: from the physician, word of mouth, and so on.
- Patient contact details and contact preferences like email or text would flow over into automated appointment reminders that would periodically go out.
- Additional items like the patient memo and precautions would show up on the patient information card, in the clinical documentation, and in the appointment scheduler.
Next, the clinical updates
Patient cases would be an essential part of the patient record:
- Each case would include detailed information about the case and injury: both clinical information like body part and insurance/financial classifiers like account type and fee class.
- Other information would include names of referring physician, PCP, treating provider, responsible payment party, discharge date and type, and service type like PT/OT/Speech.
- Diagnosis codes would be added to a patients case after searching from all available ICD 9 / ICD 10 codes. Notes of various types like appointment notes could be added to the case.
- The patient record would include both scanned images as well as other case related documents that could be added to the record as e-files.
- Some documents like an insurance card would be applicable across cases whereas others would be case specific and would need to be marked as such.
- Case documents could be transmitted via e-fax to the referring physician, primary care physician, other physicians, and the insurance payer on file.
- Follow ups tasks would get updated in the patients record by updating the patient case/patient information card, these could be clinical related, or billing/claims related.
Finally, the financial information
Payments would be a significant component of the patient record:
- Payments that are collected in advance like co-pays would form part of patient information along with outstanding payments not yet been allocated to charges.
- From the payment summary, it should be possible to navigate to payment details that would be the domain of EMR billing functionality.
Adding patient insurance would be an important step at the time of registration:
- A major checkpoint would be whether the patients plan requires authorization. So would be the patients relationship to the insured person (self/other).
- Insurance information like co-pays would show up on the scheduler directly. Medicare caps and ceiling amounts could also be entered and tracked.
- Insurance information would feed into the billing system and insurance master settings. It would show default settings and information like policy number and co-pay amounts.
- Insurance coverage would include the designation of primary and secondary payers along with effective date ranges.
Authorizations would be an important item to track and would comprise:
- Insurance authorizations from the payer for the patients treatment including the total number of allowed visits/total dollar amount and start and end dates.
- Rx authorizations from the referring practitioner for the prescribed number and frequency (number of visits per week) of physical therapy visits.
- CPT code level authorization that some payers could include. This would all flow into the patient information card: number of authorized visits/arrived visits/allowed visits remaining.
Viewing charge balances for a patients case would show where the primary payer has a balance and where the secondary payer has a balance:
- Information would include billed amounts, contract amounts, if claim has been created, patient responsible amounts, primary/insurance balances and paid amounts, write-off amounts, the licensed provider under whom the claim would go out, and the treating provider.
- It would be possible to drill down to edit charges at any time. Also, payments that were allocated toward the charges could be seen. The history of transactions on a particular line item would be accessible to get into details and investigate any discrepancies.
- Viewing payments as part of case information would show the list of checks allocated to charges on the patients case. This would include the list of all individual transactions underlying the payment. It would also be possible to drill into check details and view or modify it as necessary.
Last, but not least, would be claims:
- This would include patient statements and insurance claims along with the charges associated with each claim. Navigating to all claims associated with the batch should be a click away.
- Denial or appeal forms would be generated from the claim line item using preexisting templates. Appeal forms would use payer specific templates for appealing the denial of the claim.
Getting the patient record right including the demographic information, clinical information, and financial information would provide a solid foundation for the physical therapy software. That would truly put the patient at the center and lay the pathway for a successful implementation and beyond.