3 min read

2011 Blogs in Review – The Role that IT Plays

By Prime Care Tech Marketing on Thu, Dec 22, 2011 @ 05:42 PM

Be nimble with Information Technology, Survive with ITOver the last several months, this blog has covered topics focusing on various aspects of IT and its impact on long term care. In our Thanksgiving Day blog, we observed how important IT has become to all of us – in how we work, how we communicate, how we entertain, how we educate, how we conduct business; IT is everywhere. Although slow in adopting technology, LTC providers have made significant progress in understanding, valuing, and embracing IT as a powerful tool to meet ever-changing challenges. For example, twice we demonstrated this fact as we momentarily digressed from IT-specific topics to alert readers about changes to billing therapy services to Medicare and avoiding workforce-related lawsuits.

These are trying and potentially dangerous times for the economy in general and long term care in particular. The vital role that IT can play in helping LTC providers survive reminds me of the African gazelle. The gazelle can reach a peak speed of 48-50 mph outpacing many of its predators. However, the cheetah can reach 0 to 60 mph in about 3.3 seconds with a top speed of 70 mph. You do the math. Since gazelles are a favorite meal for cheetahs, the difference between life and death is sustainability vs. spurts of brilliance. Cheetahs can only sustain such high speeds in bursts; gazelles on the other hand can maintain their top speed for miles. They can also make sharper turns and initiate quick changes of direction with minimal reduction in speed. Cheetahs cannot. Although slower, gazelles have the advantage if they are alert, sure-footed, and responsive to threats and opportunities.

Likewise, to survive and thrive, to outpace the “cheetah’s” of poor reputation, burdensome and sometimes conflicting regulation, competition, and reduced reimbursement, LTC providers must be on guard, quick to respond, and nimble. However, they also need vision. To blindly charge day-to-day into the fray without a clear understanding of what is going on around them and within their operations, can be suicidal. Data mining and business intelligence can help providers discover, discern, and act on the data they already have. In real time, digital dashboards can reveal business-critical information (Key Performance Indicators – KPIs) displayed in ways that easy to understand.

In 2011, we also discussed how important protection of your IT assets and data is and why disaster plans must include IT. “After the fact” is too late. Also, IT asset management (ITAM) can help providers to track and protect their IT assets, use, and storage.

Just over the horizon loom major changes in health care, ACOs being one of those changes. The significance of ACOs to IT in long term care can be found in the need for interoperability and IT infrastructure. Whether ACO’s pose a threat or an opportunity will depend on the specific market served and the provider’s willingness and ability to respond. Being uninformed and ill prepared is like a deer facing on-coming headlights. The prospect of becoming health care road kill is not appealing.

Question: IT is here to stay, are you on board? In what ways has IT helped your operation?

Topics: IT business intelligence dashboard ACOs disaster recovery IT asset management ITAM Part A Therapy Services
2 min read

Getting Paid for Part A Therapy Services

By Prime Care Tech Marketing on Tue, Nov 15, 2011 @ 06:19 PM

Billing Medicare Part A for Ancillary Therapy Services - a change in what units represent

Focusing on Medicare’s coverage and payment for ancillary therapy services,Proper Therapy Unit Codes Transmittal 2239 (CMS Manual, Pub 100-04 Medicare Claims Processing, issued June 14, 2011, Billing SNF PPS Services, 30.4 - Coding PPS Bills for Ancillary Services) states, effective August 1, 2011, “For therapy services, that is revenue codes 042x, 043x, and 044x, units represent the number of calendar days of therapy provided.  For example, if the beneficiary received physical therapy, occupational therapy and speech-language pathology on May 1, that would be considered one calendar day and would be billed as one unit.” (Italics added.)

In other words, for each day a Medicare patient receives a therapy service, providers must record that as one unit. In the past, the number of units reported on a claim reflected the number of treatments provided. That is no longer the case. The new policy stipulates that units of therapy should tie to the number of days the patient received therapy services, NOT the number of treatments. For codes 042x, 043x, and 044x, providers are to record the total number of days a resident received therapy treatments as one unit for each day. Providers can look at this as an “on/off switch,” “yes or no” answer. Did the resident receive PT today? If, “yes,” then record 1 unit. If a resident had 16 days of physical therapy treatments, for example, the 042x revenue code should indicate 16 units. The aggregate of the total units/days of therapy services received would be recorded on the claim. 

The transmittal further stipulates that “SNFs are required to report the actual charge for each line item, in Total Charges.” The total should reflect the charges for actual treatments received as determined by your facility’s/company’s charge master and recorded in the Total Charges field.


If you are using a clinical software application for documenting therapy services, does it automatically convert days of service to units to be recorded in aggregate on the claim while recording the charges based on the quantity of treatments?

What changes were necessary for you to comply with this regulatory change?

With the hiring of Ms. Becky Bos and Ms. Kimberly Kelly, PCT offers enhanced Revenue Management Consulting Services to long term care providers. Cuts in Medicare and Medicaid services have forced providers to effectively maximize and capture the revenue they are able generate. Becky and Kimberly have extensive experience and expertise in working with large multi-facility corporations and small regional providers to identify and collect the cash owed. This is the first in a series of articles in which Becky and Kimberly share their collective wisdom regarding sound billing and collection practices providers can employ.

Topics: Part A Therapy Services therapy units transmittal 2239 042x 043x 044x therapy codes Medicare Part A revenue cycle management


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