The Medicare Compliance Breaking Point

In 2019, “Therapist Burnout” was described as “an industry-wide crisis”. COVID-19 has geometrically increased the stress.

MUCH more is expected from therapists than ever before. Amidst all of today’s distractions, Medicare documentation rules are just as onerous and time consuming as ever.

Therapist bandwidth is over-stretched and is at its absolute limit

It’s time for your EMR to step up

Five Medicare compliance requirements are listed below. Systems4PT calculates the eight associated algorithms and recommends the 250 to 400 words of required evidence-based documentation, all in the blink of an eye.

You’ve Taken On Significantly More Stress

It’s Time for Your EMR to Step Up and Offload the Pressure

We’re here to help.

Five Burdensome Medicare Requirements: How is your compliance?

Do all Medicare Cases Include a Functional Outcome Test?

Medicare requires an outcome test for all evals, re-evals and discharge visits.

Patients complete the integrated outcome test with Sytems4PT’s patient portal. The tests are scored and documented, touch free.

Is Progression of the Identified Functional Deficit(s) Tracked?

No, G-codes are no longer required. . . But YES, Medicare still requires therapists to specify relevant functional deficit(s) including initial severity and forecasted ending severity. Re-evals and Discharge notes must include evidence-based progression of each deficit.

With two clicks from the therapist, Sytsems4PT recommends functional progression when required.

Does the Plan of Care Defend Each CPT Code’s Role in Restoring Function?

Systems4PT recommends clinical rationale, explaining how each exercise, treatment and modality will restore the specified functional deficit(s).

Does each Medicare evaluation contain 150 – 300 words defending the eval code severity?

The requirement began 1/1/2017. Defensive documentation must include analysis of body regions, body systems and body structures, relevant history, comorbidities, standardized tests, cognitive status, social history, living environment, and clinical presentation.

The CMS protocol requires segregating the above topics into the four categories shown below:

# of personal factors
# of body structure, body system, activity limitations
Complexity of Clinical presentation
Complexity of Clinical decision making

Each category has a unique scoring algorithm and is scored separately. The category with the lowest score is the defendable level of complexity. All pertinent details from each category must be documented in the “eval code defense” section of the evaluation.

Sytems 4PT data mines the clinical record, adds points of complexity in their appropriate category, scores each category and recommends the defendable level of severity along with 150 – 300 words of defensive documentation. All of this is completed in a nanosecond.

Are you Compliant with Medicare’s 10% Deminimis rule?

2020 CMS Assistant Modifiers are yet another audit trap that our industry is glossing over. ‘True, the 15% assistant discounts don’t hit until 2022, but the 2020 final rule is crystal clear about what’s required today. From the 2020 CMS final rule:

“Correct billing requires sufficient documentation in the medical record to support the codes and units reported on the claim, including those reported with and without an assistant modifier… the documentation in the medical record must be sufficient to know whether a specific service was furnished independently by a therapist or a therapist assistant, or was furnished “in part” by a therapist assistant in sufficient detail to permit the determination of whether the 10 percent standard was exceeded.”

Assistant participation needs to be timed and documented separately from the therapist content. The 10% calculation, documentation and modifier apply to each CPT code for every Medicare date of service.

Systems4PT automates the 10% De Minimis Rule and recommends defensive documentation. This is touch-free for the therapist.

You need to focus on your family, your patients, your staff, and your practice.

Systems 4PT will help you out with Medicare compliance.