In the land of Medicare, certified POCs are golden. Follow the appropriate billing guidelines. For Medicare—and any other insurances that follow Medicare rules—you should use the 8-minute rule to determine how many units to bill for each service. WebPT helps with this requirement. Complete your documentation in a timely fashion. Make sure your documentation accurately reflects the skill you as a therapist demonstrate when providing treatment.
Be sure to identify and objectively measure all impairments treated. Stay on top of the latest rehab therapy tips, trends, and best practices with our weekly blog digest.
Your email is required. Your email must be formatted correctly. Thank you for signing up! Tom Ambury. Illustrations By: Marc Collins. Tags: audit business best practices claims CMS guest post insurance Medicare physical therapy regulations reimbursements. See More Related Posts. March 31, It may be worthwhile to do a literature review to help you define your measures or consult measures used by insurers or accrediting bodies; adopting measures that have been used successfully in the past will make your work easier.
A literature review may also help you identify benchmarks for comparison. Once you've chosen measures that seem workable, it can be helpful to conduct a pilot audit. Just going through a few charts will help to identify issues that need to be clarified before starting a full audit. Example : For your audit on breast cancer screening, the group considers several measures, including the following:.
Time since last mammogram. This provides the most specific information but would require more analysis. Mammogram completed within last year. This measure attempts to assess compliance with clinical guidelines. The U. Preventive Services Task Force recommends screening mammography every one to two years for women age 40 and older.
Mammogram ordered within last year. Do you want to measure only whether the study was done, or whether it was recommended or ordered by the provider? Should providers be held accountable when patients decline to have the test?
After considerable discussion, the group decides to measure whether a mammogram was completed or recommended within the last 24 months. Step 3: Identify the patient population.
To determine which records to review, you need to define the population you want to assess. Characteristics to consider may include age, gender, disease status and treatment status. In many cases, the focus of the audit and even the measure itself will help to define the population. You'll also need to develop specific inclusion or exclusion criteria. Example : In keeping with the HEDIS breast cancer screening measure that your group decided to follow, your patient population will be women age 40 to Because you'll be looking for evidence of a mammogram in the past 24 months, the lower age limit for the sample will be Only those patients with at least three visits in the last two years and one in the last 13 months will be included.
You decide to exclude women who have had bilateral mastectomies or are terminally ill. Step 4: Determine sample size.
A manual audit of all charts meeting your inclusion criteria will not be feasible in most situations. That's where sampling comes in. For better results, a common rule of thumb is to try for 10 percent of the eligible charts. Or you may choose to use a convenience sample: the patients from a single day or all the charts on a single shelf in the records room. If you want to track a measure over time, or if you want your results to be statistically valid, your sample size is critical.
If the sample is too small, the random variability will be too large, and the results will be limited in their applicability. Example : Using the process outlined below , your group determines that its sample should total 81 charts. Calculating a statistically valid sample size for a chart review follows steps adapted from statistical techniques used for descriptive studies.
The process uses a nomogram, or table, to identify the desired number:. Estimate the expected proportion within the population that will have the measure of interest. If you have a benchmark from literature or prior studies, use it. Otherwise, consult with colleagues or experts in the field to determine an estimate. The tables generally require this proportion to be 50 percent or less.
If more than 50 percent of the population is expected to have the characteristic, then base your sample size calculation on the proportion without the characteristic. All empirical estimates based on a sample have a certain degree of uncertainty associated with them. It is necessary, therefore, to specify the desired width of the confidence interval W. This gives a range of values that you can be confident contains the true value. In most cases, an appropriate width is 0. This is a measure of the precision or level of uncertainty.
Typically 95 percent is used, meaning that we are 95 percent certain that the interval includes the true value. This is arbitrary, however, and other levels of confidence can be used. The table shown below is for a percent confidence level. The narrower the width of the confidence interval and the higher the confidence level, the larger the sample size.
Adapted with permission from Hulley SB, et al. Designing Clinical Research , 3rd ed. Philadelphia: Wolters Kluwer Health; This makes the expected proportion of those without screening We choose a width of the confidence interval of 0. This means that we want to be 95 percent confident that the result falls between Using the nomogram to determine the sample size, we read down the left column of figures for the expected proportion without the characteristic 0. When we follow the column down, we find the required sample size If the number required is too large to be completed, we can recalculate with a lower confidence level or wider interval; this will produce a smaller sample size.
Step 5: Create audit tools. To complete your chart audit, you will need instruments on which to record your findings. How they are structured and the details they include will affect the analysis you can do and the eventual usability of your findings.
Data should be collected in a format that keeps all individual records separate but allows for easy compiling. Many chart audits involve the calculation of a rate, percentage, mean or other statistical measurement. An electronic spreadsheet format can be customized to do these calculations for you. For those more comfortable with paper-based systems, a preprinted form that lists the specific items to check in each chart serves well as an audit tool.
One form is completed for each chart, and the forms can then be sorted and counted as desired. A separate form can be used to tabulate results.
Creating clear, simple audit tools will make it possible for nonclinical staff to perform many audits effectively. Once you've developed the forms, if someone other than you will be doing the actual chart reviews, go over a few examples together to be sure the reviewer understands the criteria exactly as you intend.
The audit group selects and agrees on the objectives of the audit, with a clear sense of purpose. This form of data collection can be time-consuming, data collected is not always complete and accuracy must be assured e. If there were no limitation on resources the whole workforce could be audited; however, if the number of patients in your population is over you will most probably want to look at taking a smaller sample. The degree of confidence wanted in the findings and resources available time, staff, access to data, costs.
Proper records should be maintained of the project so that progress against objectives can be monitored and changes to methodology recorded.
Data analysis should be as simple as possible. Pen, paper and a calculator are often enough for comparisons of frequencies and percentages. A problem-solving tool for identifying the cause of a problem with the problem or effect written in the head of the fish. Asking the question why something has happened five times — each time drilling down further to get to the root cause of the problem. By identifying the root causes, you can then move towards identifying the changes needed to improve.
After the collection and analysis of data, an audit report sets out the practice compared with the standard. All audits should have a quality improvement plan with identified priorities so that you can set out the plan and allocate responsibilities.
Some simple quality improvement tools such as the Plan- Do—Check-Act cycle could be used to implement quality improvement. Sustaining improvement all audits and quality improvement plan should be subject to on-going monitoring and evaluation. You need to evaluate to see if these changes have effectively raised the standards.
This is your re-audit. A rapid re-audit is advised to assess the effectiveness of the changes using the same audit tool and protocol. For more free templates and policies go to free templates download here. My site may contain affiliate links. Meaning, I get a commission if you purchase through my links, at no cost to you. However, I do not recommend lightly — if I like it I want you to know about it.
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