Direct Access
List the 3 major rules for direct access
1. Send the IE note to HCP of choice within 5 days of eval
2. Re-Assess Progress every 10 visits or 15 business days (Whichever comes first) – refer to MD if no progress shown
3. Cannot evaluate/treat patient for same injury beyond 30 days of DC
Percent goal to collect each week for TOS
45%
Fixed dollar amount due at the time of service
Copay
The proper frequency that every patient should take FOTO
1st visit
4th visit
Every 10th visit (Medicare)
Every 2 weeks (All Other Insurance Plans)
Graduation Day
Patient calls today (Which is a Monday) to schedule an appointment because they sprained their ankle over the weekend.
Demonstrate how this phone conversation should sound between an OC & Patient with 2 people on your team.
3 key items to be collected at the phone screen for direct access patient or free assessment
1. Name of HCP/PCP/MD of choice
2. Insurance information
3. If there is a script
Defines the total patient revenue divided by the total number of visits. It is impacted by the payer mix and coding
NRPV - Net Revenue Per Visit
Describe what a Deductible (Ded) is
The dollar amount a patient must meet for insurance to begin covering
The point difference between intake score & risk adjusted score that should be a red flag?
5 points and higher
Choose 2 people to role play a conversation regarding providing a patient their current balance
At phone screen, what is the best practice for a Medicare DA Patient?
Obtain PCP/HCP information at phone screen.
Call HCP prior to patient coming in & inquire if they will sign off on a POC.
If yes, chart note (include name of who you spoke to) & then you are okay to Eval and treat
Continue to follow up to obtain POC in writing
What does the Adj/Refund column mean in the financial tab?
The dollar amount that is adjusted off due to the contracted rate with the insurance company
When does 100% coverage by insurance occur?
Once the Out of Pocket (OOP) is met
Scale of 0-10 rating we receive from patients
Net Promoter Score (NPS)
Explain FOTO to a new patient
Functional Questionnaire that will be taken periodically throughout therapy to gauge your progress.
Answer how you are currently feeling regarding your injured body part, and without using any assistance (Cane, walker, etc.)
Some questions may not be relevant currently, but answer as if you were to try to complete them.
Name 2 conditions in PT that we currently cannot see without a script
1. TMJ/TMD
2. Wound Care
Patient calls to schedule an IE and you see that they have a bad debt balance from 2014. What do you do?
Prior to patient being seen, explain to patient that they have an outstanding balance from 2014.
Inquire if they are aware of this.
Inform patient that payments need to be made toward this and that we can set up a payment schedule in clinic to pay it off.
Also, reach out to your RSM
When payment made, enter receipt description as "POA - Bad Debt"
How can we properly track a dollar amount max of $3000?
What 3 things are necessary to DC someone in FOTO?
Total number of visits
Last DOS
2 statuses
Choose 2 people to role play reading insurance benefits to a new patient - we are looking for some key phrases
“Have you had a Chance to verify benefits?”
“As a complimentary service we verify your benefits, but suggest you call as well, as this is a quote NOT a guarantee”
“We will continue to keep you updated on your balance as claims process”
The date that Direct Access passed as law in Illinois
August 16th, 2018
Patient calls complaining about service and does not want to pay bill - what 3 key items help us determine accuracy of complaint
1. Insurance Verification
2. Financial Tab
3. FOTO Feedback
4. Chart Notes
A. How should this image be utilized?
B. Who should be utilizing this?
A. Found on the insurance verification, checked off once benefits have been read to a patient.
B. OC’s & Aides, but also all clinicians should review this to ensure benefits have been read, and follow up with patient if they have any questions
For effectiveness, how can we get our clinics to rank greater than 50th percentile?
Functional status change score needs to be above predicted
You are completing your copay reports this morning and notice we missed 3 copays for yesterday. How do you look further into this?
Discuss with aide who closed previous evening regarding closing email, and why the copays were missed.