Hear from Office Manager Kelly Latini as she explains why outsourcing to PGM was “one of the best decisions the practice has ever made.”

To view the case study, click here (pdf).

Hear from Brian August, founder of A2 Medical Group, who explains how outsourcing to PGM provided an immediate return on the investment in the form of a significant decline of days in A/R, increased benchmarking opportunities and improved patient satisfaction.

To view the case study, click here (pdf).

While this change may be specific to Medicare payments, commercial payors often set their fees at a percentage of Medicare. As such, they may desire to adjust their fee schedule and align it with Medicare’s schedule, which could result in their attempting to cut your physical therapy reimbursement.

Changes in a practice’s fee schedule are not uncommon, which is why the fee schedule should be reviewed on at least a semi-annual or annual basis and routinely undergo a payor mix and fee schedule examination from medical billing and coding service companies. Medical billing companies with experience in fee schedule reviews can provide assistance in establishing the appropriate fee schedule for your practice.

For practices that have not yet started the transition to ICD-10, here is a checklist of eight steps that will assist with preliminary planning.

1. Identify your current systems and work processes that use ICD-9 codes. This could include your clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.

2. Talk with your practice management system vendor about accommodations for ICD-10 codes. Confirm with your vendor that your system has been upgraded to Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes.

3. Discuss implementation plans with all your clearinghouses, medical billing companies, and payers to ensure a smooth transition. Be proactive, don’t wait. Contact organizations you conduct business with such as your payers, clearinghouse or medical billing service. Ask about their plans for ICD-10 compliance and when they will be ready to test their systems for the transition.

4. Talk with your payers about how ICD-10 implementation might affect your contracts. Since ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, payment schedules or reimbursement.

5. Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms and quality and public health reporting.

6. Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars and onsite training. If you have a small practice, think about teaming up with other local providers. For example, you might be able to provide training for a staff person from one practice, who can in turn train staff members in other practices. Coding professionals recommend that training take place approximately six months prior to the ICD-10 compliance deadline.

7. Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials and training. Assess the costs of any necessary software updates, reprinting of superbills, trainings and related expenses.

8. Conduct test transactions using ICD-10 codes with your payers and clearinghouses. Testing is critical. You will need to test claims containing ICD-10 codes to make sure they are being successfully transmitted and received by your payers and physician billing service or clearinghouse. Check to see when they will begin testing, and the test days they have scheduled.

CMS provides some assistance in the form of step-by-step plans and relevant templates for small, medium and large practices that are impacted by the transition:

- Large Practices Handbook | Templates

- Small/Medium Provider Practices Handbook | Templates

CMS also provides free large practice and small practice implementation timelines for download.