While rehabilitative therapy providers who treat Medicare Part B patients know they must comply with regulations as part of their conditions of participation, some still run the risk of not being fully compliant when it comes to obtaining physician signatures of plans of care and recertifications. Why? The process for most is labor intensive, challenging to track and often frustrating. And the more Medicare patients you treat, the more the work – and possible audit risk – involved.
Forcura has worked with clients to develop solutions for every step of the complex and necessary compliance process to ensure continued cash flow without fines. In this post, we'll walk through the ins-and-outs of Medicare compliance and show you how to simplify this complex process with an intuitive care coordination software.
Are You Compliant?
Medicare covers outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology services only when clinically certified by a physician or non-physician practitioner. Getting stuck in a loop of requesting signatures can add to your administrative overhead and eat into your profits, a double hit when margins for most are still recovering from Covid’s impacts.
In an audit, Medicare can decide that all the care for these patients should not have been carried out thanks to improper documentation and can ask for all payments — plus interest and a penalty — to be returned to them. With so many possible errors, all issues of missing or incomplete documentation, the chances of being fined are quite high.
Providers of outpatient PT, OT, and SLP who work with more Medicare patients are the most at risk for these audits, so outpatient therapy providers in Senior Living Communities (such as CCRCs, ALs and ILs) and those outpatient therapists serving patients in their homes fall into this category. If your certified POC (Plan of Care) is not returned within 30 days from evaluation, you must at least be able to demonstrate reasonable efforts to obtain it (the rule of thumb is three attempts). Further, if your patient needs additional treatment beyond the first POC certification period, the recertification must be signed and returned before the original plan of care expires. Keeping up with this documentation manually is time-consuming and can easily turn frustrating because there is no compliance accountability on the part of the physician’s office.
Manual Tracking Will Slow You Down
In today’s environment, most therapy businesses fax their plans of care and recertifications to physicians, then manually track each subsequent contact attempt in spreadsheets. This approach is costly in terms of staff hours and overhead expenses, and many EHRs don’t provide an audit trail for all attempts made. And without a defined or standard process, each business office could be conducting these practices differently. It also leaves many therapy providers exposed to considerable financial risk.
A manual, decentralized process like a spreadsheet is undoubtedly better than nothing. Still, the tedium of updating and checking it can end up being a burden on your staff, whose precious time could be better used elsewhere.
Your Compliance Solution
Forcura can help optimize your outpatient therapy business with our streamlined and user-friendly care coordination software. CMS certified rehabilitation agencies or therapy practices that treat Medicare patients can protect their revenue streams while providing compliance oversight, using tools proven to get physician orders signed in seven days or less.
Using our Provider Dashboard with Follow-up Tracking feature, you can conduct bulk actions like auto-fax resends and follow-up on the physicians with the most or oldest volumes of POCs or recerts. Your staff can make notes on their contacts right in the system, with their actions logged with user name, date and time, removing the guesswork of what’s in flight and what’s resolved. Furthermore, with our transparent documentation flow, you’ll have a robust record of all the outreach your team is saving time and resources on, should you be audited.
Soon, our e-signature feature, Forcura Circle, will help you get even more done with less effort. With more patient documents reviewed more quickly by referring physicians, you’ll see the costs of follow-up drop and times between care and compliance-required sign-off shrink.
Medicare rehab therapy providers have a lot on the line, and manual solutions still leave them at risk for expensive penalties during audits. Forcura can help by providing centralized documentation, real-time communication, digital signatures, EHR integrations, audit trails and more.
Discover a better way to manage your compliance risk. Schedule a demo with Forcura to see our care coordination tools in action.
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As Chief Strategy Officer, Annie Erstling is responsible for driving growth at Forcura. She oversees the company's strategic planning, product innovation, marketing and strategic partnerships. She has experience launching new brands, products and companies across the healthcare and technology sectors. |
