Tips on how to easily incorporate G-coding into your practice

Here is a video that I put together providing you will tools on how to streamline your documentation to easily incorporate G-coding into practice.

10 Important Facts about Medicare G Codes

Check out this video, its part of a class designed to decipher medicare's new G Code Billing system.

RAC's are a smack in the head for Therapists and Seniors

Unfortunately it was no joke that on April Fool's Day the Manual Medical Review went into process.

This means that there will be pre-payment review (therapists will not be paid for services until after the patient has been seen) for patients who have exceeded the combined $3700 allowed per year for PT and Speech therapy combined in the following states: Florida  California, Michigan, Texas, New York, Illinois, Louisiana, North Carolina, Pennsylvania, Ohio and Missouri. 

For those who practice in states that are not affected by the pre-payment review, Medicare can take your money back in a post-payment audit. 

It is likely that pre-payment review will become a national policy in the near future. 

I watched an informative webinar on this topic that can be found at http://www.clinicient.com/4307-2/ It goes into what is happening and how to document best way possible to defend your services to an auditor.

One of the comments made by the instructor during this presentation that really stuck with me was "CMS (Center for Medicare and Medicaid Services) has designed a system to limit therapy services to Medicare recipients."

They have managed to do this in the following ways:

1. Monetary rewards for auditors. Auditors get paid on a percentage of the money that is recovered, so they are biased.

2. Making the process of review painstaking and lengthy. Reviewers claim it is 10 days, but in reality by the time delivery of documentation and approval and or denial is received (approvals and denials are sent by mail)  it is double that time.

3. Documentation of additional codes: Developing difficult systems like G-codes, PQRS codes, KX modifiers etc... that easily allow for screw ups on a claim and cause a denial to occur. To ensure compliance check out these courses on G-codes found at http://www.sigproed.com/online_courses.html

4. Forcing the Therapist into a difficult moral and ethical circumstance. The therapist now has to decide if they can monetarily afford to provide services to a patient, knowing that they will likely be denied or have to waste time and energy to fight for their money.

I wonder if congressman would have the same rules for Medicare if that was the health insurance that they had to rely on?

Simplifying Medicare G-Codes

Everyone in the therapy community has been buzzing about this topic.  It is the latest form of documentation torture mandated by Medicare.

If you bill Medicare in any way as a provider or non-participating provider it affects you. It also affects  MD's, DO's, and Chiropractors who bill therapy codes, in ALL settings.

The only way to avoid it is to become a provider of a Medicare HMO. Not, in my opinion a great option.

It is vital to all practices that they understand and comply with this information for the following reasons:

• You will not get paid for services after July 1, 2013.
• It will be a part of the mandatory audit that affects therapists when services are provided after the therapy cap has been met. 

Trying to learn this system is not easy and resources are few.

The following are 2 videos that I posted on you-tube:

Top Ten Facts about Medicare G-code Billing and Documentation:

http://www.youtube.com/watch?v=N1CD1fijeHo

and

How to Streamline your Practice while remaining compliant with Medicare G-code Requirements:

http://www.youtube.com/watch?v=gYpv-3z_0pk

The videos are excepts from 2 new online classes:

1. Keeping it Simple: Documenting and Billing to comply with Medicare G-codes

2. Strategies to Streamline your Practice while being compliant with Medicare G-codes.

These courses are are available with a variable fee to allowing you the option to take the class for credit or just for your own information at http://www.sigproed.com/online_courses.html 

The Rules for Rehab

I will never forget my Professor's words of wisdom that were taught to me over 15 years ago.

I use them on every patient that I see and go back to them when a patient is not responding to my treatment.

Thanks Roz

They are:

1. Alignment Dictates Function: If the alignment is off the structure will not work. From the tube like structures in viscera to the bones in a joint, if they are even a millimeter off they will not function optimally.
In muscles this is substantiated by the principle of the Length Tension Ratio which states that a muscle will contract with greatest vigor when it is at a particular length.

2. You need to have Stability in order to Have Mobility: This comes into play with our core muscles. If our core muscles are not firing there is no fix point from which are muscles can move.  It also explains why joint inflammation is such a problem. For every cubic centimeter of inflammation,  a muscle shuts down by 1 percent. The muscles that are closest to the joints are our core muscles. Therefore, people who are inflamed are unstable and will lack flexibility. This rule directly contributed to my developing the ARMS release technique as well as the Position of Manual Stability.

3.  Release, Re-position, and Re-Educate or  just Re-position and Re-educate: If there is a non-structure dysfunction, meaning that if a limitation in motion is not being caused by an anatomical structure, then you would just put the body part where you want it to be (re-position) and re-educate. If however, a structural dysfunction is occurring, meaning that motion is being blocked or limited by an anatomical structure, you need to release it first, then tell the body where it needs to be (re-position) and re-educate.

If you are not having great success with your patients you may want to refer back to "The Rules".

Battling the Enemy to Health

I mentioned in my previous post that the true enemy to health is inflammation.

In order to battle this enemy effectively one really needs to figure out the things that trigger the inflammatory process in their bodies. 

How do you do this?

1. Have a general blood test done to note vitamin/mineral deficiencies as well having you blood inflammatory levels checked.  
2. Test for food allergies.
3. I had mentioned that inflammation can cause pain. If you are having pain, keep a journal and record your pain intensity, what you ate and your activities. See if there is a cause/effect relationship. 
4. Eat foods and take supplements that have anti inflammatory properties and avoid those that are know to cause inflammation. A good list for both can be found at:

http://www.chicagonow.com/clean-convenient-cuisine/2010/09/best-and-worst-top-10-most-inflammatory-and-anti-inflammatory-foods/

New research is showing benefits with taking Tart Cherry Juice. One study found it as effective as the prescription version of aleve.(naproxen)

In her book "Taming Pain", Cheryl Wardlaw, PT recommends purchasing Tart Cherry Juice Concentrate from a health food store and take 2 tbsps 30-45 minutes before bed. 

Note that if you are taking blood thinners you should consult your doctor before taking. 

One of my former patients began taking it last week and felt results immediately. He reported that he was able playing paddle ball without negative effects,  he had not been able to do this in months.

The True Enemy to Health

The true enemy to health is not: a sedentary lifestyle  gluten, soy, peanuts, high cholesterol, fats, or carbs or even sugar but the manifestation these things in the body, especially in certain individuals.

The true enemy to health is Inflammation.

Here are some interesting facts about inflammation:

1. There is a link to heart disease with increased inflammation
2. Inflammation is a direct cause of pain. Pain leads to immobility. 
3. In spinal cord injured patients, paralysis is caused by inflammation due the injury rather than direct damage to the spinal cord.
4. Stroke caused by bleeds and Spinal cord injured patients have greater return of function when steroids are given early to decrease the effects of inflammation.
5. Traumatic brain injured patient’s in the military are kept in a cold room to decrease inflammation.
6. People with autoimmune diseases have higher levels of systemic inflammation. 
7. Allergies cause inflammation.
8. For every cubic centimeter of inflammation a muscle shuts down by 1 percent.

Since the muscles that are closest to the joint where inflammation typically occurs, core muscles will shut down. Instability causes irritation and further inflammation. 

Inflammation causes Instability

We know that a person needs to have Stability in order to have mobility therefore, patients will lack range of motion secondary to instability caused by inflammation.

Inflammation causes decreased Range of Motion

Both Instability and a lack of Range of Motion Lead to Falls,

Therefore, Inflammation Leads to Falling

It is imperative that all health care professionals understand the direct and indirect effects of inflammation as well as the direct and indirect causes of it. In addition to other helpful diagnostic tests, we should request information about inflammation that can be detected by testing ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) in the blood. 

Also realize that whenever a patient sustains a trauma, undergoes surgery, has a poor diet and/or food allergies, they will become inflamed.  We need to not only need address the inflammation but also restore range of motion and stability in the system.