Year End Jeopardy Review

Patient Access

100

Primary metric affected by referral delays

DTA

200

When a patient is seen by a PT without a physician referral in certain states, this is the term used to describe their ability to legally start care.

Direct Access

300

A referral is received but not contacted same day. Explain at least 3 downstream risks.

Increased DTA. Patient's health continues declining. Patient dissatisfaction. Reduced conversions. Lost Referrals. 

400

A patient has exhausted their PT benefits. What are three things you should offer the patient?

Charity Care, ANNC or ABN form, Self-Pay with a GFE form for costs. 

500

What do you have to do before sending a Patient Dismissal Letter due to attendance non-compliance?

Partner with the treating therapist first because it is their decision. 

Insurance Terminology

100

Patient is responsible for this payment before coverage starts

Deductible

200

Maximum amount a patient is responsible for each year.

Out-of-pocket max

300

Approval required before treatment

Authorization

400

Proof that services are justified

Medical Necessity

500

What is the new Smarthealth Plan called?

Health Alliance

All About Medicare

100

Modifier added to show medical necessity after a patient has reached their threshold amount

KX Modifier

200

Form used when the patient receives a letter stating their PT benefits will no longer be covered.

ABN form 

300

What is the 2026 Deductible for MCR patients?

$283

400

What is the 2026 threshold amount for MCR patients?

$2480

500

DAILY DOUBLE

When a patient has an ACTIVE GHP from an employer with 20 patients or more with MCR based on age. OR When a patient has an ACTIVE GHP from an employer with 100 patients or more with MCR based on disability. 

Know Your Metrics

100

What does DTA have to be within?

5 days

200

What does CX rate have to be below to be passing?

15%

300

Capture Rate Goal

70% or above

400

Hours to response includes what 3 categories added together in Leading Reach?

New, Received, and Pretext Sent

500

What is the Utilization Goal for therapists to be considered passing? (Percent or amount of patients)

80 patients or 90% to scheduled

Master Class

100

Explain the different between budget and schedule target.

Budget is the actual amount of evals/visits we have to end up with to make goal. Schedule Target is the amount we need to schedule beforehand to hit the budget. (Budget=after cx rate, schedule rate= before cx rate)

200

This document outlines the patient’s plan of care, including frequency and duration, and often determines how many visits insurance will approve.

Plan of Care

300

What is the CPT code for Manual Therapy

97140

400

A patient switches insurance mid–plan of care. Walk through the required operational steps in Soarian to update the insurance.  

Ask what the effective date is. Wait until the patients first visit has charges dropped in Soarian AFTER the effective date. Create a new policy under the insurance tab. Click on Manage List and "Copy to treatment series" going forward in order to apply new insurance for future visits but not past visits. 

500

What is the new visit limit for a Caresource HIP patient who is 25 years old?

75 visits