May your new year be all you hope it will be!  Happy New Year!

Alzheimer's patients can still feel emotion long after memories have vanished

Date:

September 24, 2014

Source:

University of Iowa Health Care

Summary:

A new study further supports an inescapable message: caregivers have a profound influence -- good or bad -- on the emotional state of individuals with Alzheimer's disease. Patients may not remember a recent visit by a loved one or having been neglected by staff at a nursing home, but those actions can have a lasting impact on how they feel.

http://www.sciencedaily.com/releases/2014/09/140924135018.htm

Evaluating Physical Therapy Billing

Therapy services have unique billing guidelines.  To prepare for reviewing the therapy bills obtain a copy of your physician’s prescription for service.  When attending therapy keep a daily log of your attendance and the services provided.  These two documents will allow you to evaluate your therapy bills.

The most common errors that we find when reviewing physical therapy bills are:

• Services billed, but not provided
• Duplicate billing for services
• Services billed that are not separate services, but rather a part of the parent code (unbundling).
• Billing for individual service when group service was provided
• Services provided that were not ordered
• Time based services not documented as to the amount of time the therapist work with the patient.

Physical therapy evaluations (97001) and re-evaluations (97002) include assessment and documentation of the patient’s history, level of function, systems review, specific tests and measures, diagnosis, and prognosis.

A lot of physical therapy treatment is described as a modality.  A modality is any physical agent applied to produce therapeutic changes to biologic tissue.  These include, but are not limited to thermal, acoustic, light, mechanical, or electric energy.”

Some modalities, such as traction, unattended electrical stimulation, and whirlpool treatment, are “supervised” by the therapy provider, but don’t require one-on-one contact during the treatment.  Supervision in this case would mean that the physical therapist is available within the treatment area to intervene one-to-one if necessary.  As defined by CPT, supervised modalities are not timed services (CPT codes 97010–97028).

Other modalities, including manual electrical stimulation, ultrasound, and iontophoresis (using an electrical charge to deliver medication to inflamed tissue), are defined as “constant attendance” services that require one-on-one contact with the physical therapist or therapy provider. These codes (CPT codes 97032–97039) are timed and billable in 15-minute increments.

Therapeutic procedures (CPT codes 97110–97546) are another type of physical therapy service.  These services are also timed and require direct, one-on-one patient contact. Examples include therapeutic exercises and activities, neuromuscular re-education, aquatic therapy, gait training, and manual therapy. Therapeutic exercises and activities typically involve the use of gym-style equipment, stairs, or therabands (TheraBand™ are latex exercise bands utilized for resistive exercise).

Active wound care management (CPT codes 97597–97606)—Wound care services promote healing by removing devitalized and necrotic tissue from the patient’s body. The provider has direct contact with the patient, and codes are determined by the type of debridement and wound surface size.

Tests and measurements (CPT codes 97750–97755)—Although tests and measurements are a component of evaluation and re-evaluation, employers or insurance carriers may request specialized testing or assessment, which are reported using these codes.

Orthotic and prosthetic management (CPT codes 97760–97762)—therapists may provide specialized training in the use of orthotics and prosthetics, which is reported as a unique service.

Physical Therapy billing codes are either timed or untimed codes for billing purposes. Untimed codes are reported as one unit per day regardless of how many body parts are treated with the modality.  It does not matter if you spend one hour or two hours with this type of treatment.

The following are untimed codes:

• 97001 – Physical Therapy Evaluation
• 97002 – Physical Therapy Re-Evaluation
• 97010 – Hot or cold packs
• 97012 – Traction, Mechanical
• 97014 (G0283) – Electrical Stimulation
• 97024 – Diathermy
• 97028 – Ultraviolet

Timed codes are reported using the Medicare 8 Minute Rule.  When billing more than one timed CPT code on a calendar day, the total number of units that provider may bill may not exceed the total treatment time the therapist and the patient spent one-to-one time together.

Timed codes are billed using Medicare’s 8 Minute Rule to determine how many units a day a particular CPT code can be charged.  The following codes are timed codes:

• 97032 – Electrical Stimulation (Manual)
• 97033 – Iontophoresis
• 97035 – Ultrasound
• 97039 – Unlisted
• 97110 – Therapeutic Exercise
• 97112 – Neuromuscular Reeducation
• 97116 – Gait Training
• 97124 – Massage
• 97139 – Unlisted
• 97140- Manual Therapy
• 97530 – Therapeutic Activity

Below is the 8 Minute Rule chart to help you determine the total number of minutes that service was provided and the total number of units you can bill during one therapy session:

Units	Number of Minutes
0 Units	< 8 Minutes
1 Unit	>= 8 Minutes and <= 22 minutes
2 Units	>= 23 Minutes and <= 37 minutes
3 Units	>= 38 Minutes and <= 52 minutes
4 Units	>= 53 Minutes and <= 67 minutes
5 Units	>= 68 Minutes and <= 82 minutes
6 Units	>= 83 Minutes and <= 97 minutes
7 Units	>= 98 Minutes and <= 112 minutes
8 Units	>= 113 Minutes and <= 127 minutes

First, add up the total treatment time for timed codes (do not include the time spent treating for untimed codes). You then take the total treatment time for timed codes and look up the maximum number of units you can bill for on the 8 Minute Rule Chart.

If a service represented by a 15 minute timed code is performed in a single day for at least 15 minutes that service shall be billed for one unit. If the service is performed in a single day for at least 30 minutes, the service shall be billed for at least two units, etc. You cannot count all minutes of treatment in a day toward the units for one code if other services were performed for more than 15 minutes.

When more than one service represented by 15 minute timed codes is performed in a single day, the total number of minutes of service determines the number of timed units billed.

If any 15 minute timed service is performed for 7 minutes or less on the same day as another 15 minute timed service that was also performed for 7 minutes or less and the total time of the two services is 8 minutes or greater, then you bill one unit for the service performed for the most minutes. This is because the total time is greater than the minimum time for one unit. The same logic applies when three or more different services are provided for 7 minutes or less. The expectation is that a provider’s direct patient contact time for each unit will average 15 minutes in length. If a provider has a consistent practice of billing less than 15 minutes for a unit, this should be highlighted for review.

If more than one 15 minute timed code is billed during a single calendar day, then the total number of timed units can be billed up to the maximum number of units allowed based on the total treatment time for that day.  The total number of timed minutes must be documented!

There is one exception to the timed codes for codes 97545 and 97546. These specialized codes are used for rehabilitating a worker to return to the job and the expectation is that the entire time period specified for 97545 and 97546 would be the treatment period. The code 97545 is for the time period included in the first 2 hours, the code 97546 includes the time period for each additional hour (after the first 2 hours).

Telephone Tips

Making numerous telephone calls in a day can be daunting.  We have compiled few telephone tips that we thought may help others make the most of their time.

• Call the right day:  Monday & Tuesday seems to be the busiest.  Thursday & Friday are best for quick responses.  Marketing call recipients are the most receptive on Tuesday & Wednesday.  
• Call at the right time:  avoid the busiest times (10 a.m. to 2p.m & 5:30 p.m. to 7:30 p.m.) for service industries. 
• Ask yourself how much the call is worth:  establish the length of your call in your mind before you call & keep the clock handy.  Prepare talking points prior to dialing.  Get to the point fast: but remember to be friendly.
• Batch calls:  schedule a time to make calls. Control the work; don’t allow it to control you.  Will your workload will allow for one time of day in which you take calls?
• Eliminate phone tag:  if you must leave a phone message leave a detailed message with your name, number, why you called, and when you can be reached.
• If you meet with resistance on the initial call:  ask when would be the best time to call back at the time that would be more convenient for the recipient.   
• Avoid being placed on hold:  it is ok to say “no”.  Explore other options with the person who answers the phone.  Call early in the day.  Avoid procrastination
• Start the phone call:  brief introduction & specific question will move conversation forward.  Compensate for not being able to see the body language:  listen carefully & be clear in your communication.  Just listen:  don’t do something else.  Taking notes helps keep you on focus
• If you are confronted with negativity in initial conversation:  analyze the reason for the “push back” and ask questions such as:  “How can we remedy this situation?  Would it be more convenient to discuss this at another time?” 
• Use oral feedback:  to let the other person know you are interested. Cut incoming solicitation calls short.  “thank you, I am not interested”
• Count to 3 before you respond: helps to keep you from judging or emotionally reacting and it will avoid you from interrupting the other person.
• Get calls on your terms:  screen calls with caller ID or through your staff.
• Learn the value of returning calls & calling again if you don’t get what you need on the first call. Set a time to return the call and return the call at the stated time.

Phone Power...last, but not least. If all else fails draw upon your inner strength—it will serve you well!

• Breathe deeply- lowers the voice and enlists control
• Mirror the style of the person with whom you are talking as we all like to visit with someone with our style of conversation.  If they talk slowly, slow down, if the person on the other end of the line seems rushed, speed up your verbiage...you get the jest.
• Stand while talking:  sounds crazy, but it empowers you
• The mirror trick...I have a mirror at my desk.  Not because I like to see how I look, but rather to monitor my tone.  If I am smiling during the conversation, my conversation is friendly and upbeat.

 Please feel free to share what works for you.  In both our personal and professional telephone calls look forward to learning what works for you! 

Successful Case Management

A Thought for the Day

A thought for the day: “Talent wins games, but teamwork and intelligence wins championships.” By Michael Jordan

LBDA Clarifies Autopsy Report on Comedian, Robin Williams | Lewy Body Dementia Association

Found this piece that reinforced my thoughts that Alzheimer's affects us way before the diagnosis is made.

LBDA Clarifies Autopsy Report on Comedian, Robin Williams | Lewy Body Dementia Association

Medical Coding-why hire a nurse?

Many times we are asked if a nurse with a coding certification is really necessary. NurseValue believes the answer is a definitive yes as medical coding is a complicated, multifaceted process. A nurse is familiar with the medical procedures and services, but is not always aware of the financial piece of the process (coding). We are not the only ones that feel this way! The Department of Labor’s occupational handbook (www.stats.bls.gov/oco/ocos103.htm) recognizes only AHIMA and AAPC certifications. The Office of Inspector General (OIG) requires independent review organizations to have AHIMA or AAPX certified coder for claims review. The state of Hawaii requires certified coding for medical claims review, again recognizing only the CCS and CPC credentials.

Barbara King, Co-Founder of NurseValue,Inc.

Please meet Barbara King, co-founder and president of NurseValue, Inc. She is a Registered Nurse, Certified Professional Coder, Medicare Set-aside Consultant Certified, and is a Qualified Mental Retardation Professional. Barbara has over 29 years nursing experience in hospital and managed care case management services and possesses in-depth knowledge and experience in the managed care arena involving workers’ compensation case management and federal, state, and contractual commercial billing requirements. When Barb is not visiting with a client, you can find her in the office in Mount Carroll handling the day to day operations and client requests for NurseValue.

 

Words & Phrases that Facilitate Communication

We recently published the words that we encourage our staff to avoid.  So here are the words that facilitate communication which in turn improves customer relations:

 

Are you willing?	How can I help?	I apologize for (specific)
Will you?	What do you want me to do?	How can it be corrected?
What have you considered?	Here are some options.	However
What are the options?	I made a mistake	Will/willing
Which do you prefer?	I understand	Able
What are the alternatives?	I understand your concern	Unable

 Are there phrases that have worked for you? 

Sometimes it is what you Don't say

Words to avoid for extraordinary customer relations: 

Have to	I need (want) you to...	What’s your problem?
I can’t/you can’t	Would you mind...?	I’ll try
I’m sorry	It’s just a...	Best
Worst	But	Required, necessary
Should...	Ought to...	Must
Policy	Jargon

What words do you find cause you to become defensive? 

A Thought For the Day--Community

Wild geese always fly in a V formation and travel as a community. As each goose flaps its wings, it creates an 'up-lift' for the birds that follow.

People who share a common direction reach their destination more quickly and with less effort than those who travel alone. That's because they are traveling on the thrust of one another.

When a goose falls out of formation, it feels the drag and resistance of flying alone and promptly moves back into formation to take advantage of the lifting power of the bird immediately in front of it.

Bilingual Nurse Advantage

Many times patients gravitate to a healthcare provider that speaks their language.  This makes a lot of sense as it makes it less difficult  to describe symptoms and feelings to someone that understands. 

The bilingual nurse does not replace the provider’s interpreting staff.  They are invaluable in their own right. 

There is a huge advantage for the patient with the opportunity to interact with a bilingual nurse, specially when they are involved in a complicated medical condition or a workers compensation case that has rules and regulations they must abide by over and beyond the medical treatment plan.  When trying to communicate with a patient via a translator there is the tendency to forget to ask certain questions or you can miss the minute clues that may lead to a clearer understanding of the patient’s needs and concerns thus facilitating a good medical outcome.  Often patients will express their concerns to a bilingual nurse that they would not feel comfortable asking through a translator.  The relationship is built on mutual understanding of both the language and the culture. 

Herlinda Rodriguez joined NurseValue in 2011 with background in orthopedics  and  workers' compensation nurse case management.  She was an integral participant in Liberty Mutual's telephonic  case management program; 2004-2005,was a translator for Princeville Medical center, and was a community outreach worker for a year with the Hispanic Outreach Partnership.  We knew she was a team player with a penchant to pay it forward.  Today, we find that our injured workers depend upon her for calm understanding, careful direction and comforting demeanor to move their recovery forward.  NurseValue depends upon Herlinda's never ending optimism!

 

 

Nancy Davis Pays it Forward

 

Nancy Davis, a co-founder of NurseValue finds the time to "pay it forward".  Nancy is the co-founder

of Love Repeated, a 501(c)3 charitable organization This organization benefits the children of Tanzania, East Africa. Their primary focus is education of the orphans. Less than 5% of orphan children in Tanzania receive even an elementary education. Their goal is to sponsor 50 students in 2015. They also support an emergency medical fund at Biharomulo District Hospital that is designated for children whose parents can not afford life sustaining medications. In 2015 the organization is also focusing on shipping a container of $100,000.00 of donated medical supplies to Tanzania. Visit them at: www.loverepeated.org to find out more and see how you can help.

 

 Nancy Davis  is one of our founding partners of NurseValue. She is a Registered Nurse, a Certified Medicare Set-Aside Consultant, a Certified Case Manager, and a Certified Life Care Planner. With over 29 y...ears of nursing experience involving obstetrics & gynecology, colon & rectal surgery, orthopedics and extensive experience in field, telephonic and catastrophic case management, as well as workers’ compensation, liability and accidental health claims she is an asset to our client's complicated cases. NurseValue couldn't function without her!