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PRESENTED BY:
Aaron Sorensen, MBA, CPO, LPO
O and P Billing Solutions, Inc.
Importance of Physical Therapist & Your Practice Today
P T & Your Practice
O Obvious reasons
O Increase referrals
O Marketing opportunity
O But why today more important than ever?
O PT vs Physician
O Functional level pre-delivery
O Functional level post-delivery
O Reassessment/follow-up/check out
O Pre-cert info
O Appeal info
P T & Your Practice
O Why develop
relationship with PT
group: Obvious
reasons
O Increase referrals
O O and P lifeblood is
referrals
O Can be significant
referral source
P T & Your Practice
O Reimbursement dependent on “objective” data
O Pre-certification
O BCBS Illinois
O Hanger functional assessment test PAVET
O UHC asking info
O BCBS TN form
P T & Your Practice
O Data weighted heavier if not driven by provider of device receiving payment
O What data is needed vs preferred?
O PT data vs Physician?
P T & Your Practice
O Physician
O Assessments & appointments have become highly dependent upon EMR program
O Will often miss substantial info required
O NO TIME for detailed functional assessment
P T & Your Practice
O Physician
O Focused on:
O Surgery outcome
O Goals met?
O Healing progress
O Diagnostic readings; x-ray, blood work, etc.
O General health issues like weight and blood pressure
O Issues that relate to their (physician) reimbursement
P T & Your Practice O Physical Therapist
O Physical assessment well within scope of practice/ expertise
O Medicare allows payment for one assessment before physician referral required!
O Some commercial payers allow # visits without Physician referral
O Some Rehab companies grade DOR on # of these
O Higher #; better grade
P T & Your Practice O Physical Therapist
O Functional assessment fits into the category of visit allowed without Rx
O PT will set enough time for proper pt assessment
O Use this to our (O and P) Advantage
O direct referral
O Builds relationship with Rehab group as now you are a direct referral source not just physician
O Both O and P patients!
P T & Your Practice O Physical Therapist
O Develop a “program” with your Rehab partner/DOR
O Maybe AmpPro
O Take an existing prosthetic and orthotic pt for therapists’ training
O Choose 1-2 therapist(s) per rehab facility to work with for continuity
O Do the first few assessments with the chosen therapist(s)
O what are we looking for in O and P for payment?
P T & Your Practice O Many, if not most, PTs
unfamiliar with the differences in o and p components O Especially Prosthetics
O Knowledge needed for pt’s best chance at progress O OR think this way: YOUR best
chance for positive outcomes being documented for reimbursement
O Audits
O Appeals
O So a “program” relationship with one/few group(s) will better your clinical outcomes and documentation
P T & Your Practice
O Physical Therapist
O They understand the changes in CMS and reimbursement needs
O Send copies of YOUR assessment with pt for PT visit
O Get a repeat model assessment pre and post delivery of device!
P T & Your Practice O Additional info helps for
payment approval vs just functional assessment
O Complete orthosis or prosthesis assessment
O Pt stated activities
O Age of device
O Date of onset, injury or surgery
O Vocational plan/change
O Pt stated changes in their health/activities
P T & Your Practice
O Physical Therapist
O Post delivery
O As important or more important as pre-delivery assessment
O What is functional level with device vs without?
O Patient wearing the device?
O Ambulatory?!
O KEY: Outcomes measurement!
P T & Your Practice O Post delivery Therapy
O Gait training
O Documented distances
O Documented progress toward no assistive device
O Document time vs distance traveled
O BUT for this to be positive, pt needs cooperation between orthotist/prosthetist and PT
P T & Your Practice
O PT education
O i.e.; Plie’
O Adjustments and features
O Will determine how therapy sessions conducted
O i.e.; Kintera
O Heel strike stability
O Ascending and descending stairs/ramps/hills
P T & Your Practice O Post-delivery (Conclusion)
O Data needed for appeals and audits
O Illustrates device assists with maintaining or improving pt functional level
O This is at the heart of the argument for O and P reimbursement!
O Difficult to deny/recoup payment with positive outcomes!
O Very important at ALJ level
THANK YOU
Aaron Sorensen, CPO, LPO
President , OPBS
Ph. 877-907-4180
Rob Cripe
VP Global Marketing
Ph. 949-544-7916
O Freedom Innovations thanks you for your continued support and hopes this series of webinars helps you make decisions to be successful in today’s unforgiving O and P industry.
O Please provide
feedback to your
Freedom sales
representative of
future topics to cover
and if you find these
webinars helpful.
