Unit 2: Guiding questions 3 Flashcards
What do you need to remember about the patients medical record?
- legal document that is evidence
- record is presumed true
- documentation should reflect scope of practice thats within the legal description provided by the state
- any questions that surfaces in a legal proceeding can be answered based on context of documentation
- single most important evidence of the PTs judgement, actions, skills, decision making
- overseeing health care professional for the patient is responsible to keep health information accurate, timely, relevant, secure
Documentation Supports or Refutes Medical Malpractice
- prove that the health care provider was negligent
- nonverbally explain how the provider met the professional standard of care (duty)
- if its not documented, it didn’t happen
Legal Document Problems and Pitfalls
- parrot documentation
- technical omissions
- illegible entries
- undefined abbreviations
- lack of substance
- lack of information to support if standard of care has been met
Components of informed consent and how to document it
- a clear explanation of the RISKS associated with the therapy
- expected BENEFITS from therapy
- anticipated COSTS
- reasonable ALTERNATIVES to the rec. therapy
Confidentiality
all information regarding the patients care must be kept confidential and in a secure area
Incident report is NOT part of pts medical records and CAN be used in litigation…
what are some do’s and don’ts about incident reporting
- notify referring physician immediately bc S&S is may develop or worsen
- ensure pt receives appropriate care after the incident
- record only factual information for supervisor
- DONT discuss relative guilt or innocence
- DONT make inferences related to cause in the report
- DONT discuss with pt after event
What governs how long medical records are to be retained?
HIPPA requires a covered entity to retain required docs for ____ yrs from the date of its creation or the date when it was last in effect
- STATE LAWS
- 6 yrs
Statute of Limitations
time limit after an incident by which an individual must file a lawsuit
retention periods must exceed statutes of limitations
Purpose of the State Boards of PT Practice
- review complaints!! brought against pts, ptas, and students for violation of the PRACTICE ACT
- disseminates rules and regs governing the progession of PT
- oversee the state licensure of pts and ptas
General Supervision:
PT is NOT required to be on site for direction and supervision but MUST BE AVAILABLE by telecommunication
Direct Supervision:
PT is PHYSICALLY PRESENT and immediately available for direction and supervision. PT will have DIRECT contact with pt during each visit
Direct Personal Supervision
PT or PTA (if allowable), is physically present immediately available to continuously direct and supervise tasks that are related to pt
If there are conflicts in the regulatory hierarchy, which rule should you follow?
the most restrictive law
Effects of fraud, waste, and abuse in PT Practice
- over utilization of services
- increased costs for payers
- corruption of medical decision making
- unfair competition
- harm to the patient
- reduced reputation of PT practice
Fraud:
INTENTIONAL deception or misrepresntaion that a person does to gain a benefit which they are not entitled to
(knowingly billing for services not furnished, altering claims forms to increase payment, falsifying documentation
Abuse:
payment for items or services that the provider isnt entitled to and for which the providor has NOT INTENTIONALLY misrepresented facts to obtain payment
(billing services that arent medically necessary and/or do not meet professionally recognized standards, unbundling services/billing)
Waste
incurring unnecessary costs as a result of deficient management practices, systems, or controls
duplication of services already provided elsewhere
(spending on services that lack evidence of producing better outcomes compared with less expensive alternatives
Ways to ensure compliance in PT practice
- internal monitoring/auditing
- having compliance and practice standards
- training and edu
- written standards of conduct, policies, and procedures
- have a compliance officer
APTA code of Ethics #3
PTs shall be accountable for making sound professional judgements
Assets
Liabilities
Net worth
Assets: Property like goods, equipt, investments, earnings (+)
Liabilities: debts (-)
Net Worth: assets - liabilities
Importance of Cost of doing business
- to know the cost per pt
- to determine cost to deliver services and increase profit
Direct Costs
Expenses for delivering services, salaries, equiptment (loans or leases), clinical supplies
Indirect Costs
Overhead costs: necessary regardless of the number of patients, rent/mortgage payments, utilities, janitorial services, equipt maintenance, office supplies, telephone, internet services, medical records
Examples of different cost classifications :
Fixed cost
variable cost
semi-variable cost
- Fixed: rent, loan payments, salaries, equiptment, insurance, FICA
- Variable: laundry services, staff, supplies, advertising/marketing
- Semi-variable: hourly wages: overtime, decreased work hours, patient census fluctuations, utilities
Expenditure:
Routine/Operating vs Capital
Routine/Operating: expenses needed for day-to-day costs needed to run a business
Capital: Major purchases that will be used for >1yr
Revenue
- total $ received for services provided or goods sold
Expectable Revenue
- amt that SHOULD be paid for services
- based on insurance contracts, fee schedules
Net Income
measure of a companies earnings after accounting for expenses
Revenue - Variable Costs - fixed costs
Profit Margin Ratio
Comparison of profit to sales
- 20% GOOD
- 10% AVG
- 5% LOW
Net Income / Revenue
Productivity Expectations
- revenue only generated when pts are being treated
- standard: 75-80%
- different settings/pts have different productivity
- non productive time: meetings, documentation, submitting charges education
Practice calculating productivity
Lifecycle of a Claim
- Prelim: scheduling, insurance varification, auths
- Treatment
- Documentation
- Coding
- Billing
- Accounts receivable: claim returned, denied, paid
- Collections/Management: appeals, explanation of benefits, write offs
- Corporate Compliance: post payment review & corrective action
How to control costs
- monitor indirect expenses
- eliminating waste and inefficiency: make sure pts show up
- Become productive PTs
- address lifecycle of a claim issues
Value of PTS work calculation
(# of pts seen) x (avg reimbursement)
Greatest expense for any business
LABOR COSTS
- salary, wages, benefits, payroll taxes, owners salaries
Direct Cost per Session
total direct costs (labor costs + equipment loans + clinic supplies)/ avg number of tx sessions
Indirect Cost per Sesson
add all indirect costs (rent, utilities, office supplies, phone, internet) / estimated total # of tx sessions
What is the Profit Margin Ratio
- Revenue: 1,000,000
- Variable Costs: 500,000
- Fixed Costs: 200, 000
Net Income= revenue - variable - fixed = 300,000
300,000/1,000,000 = .3 = 30%
What is FTE
full time equivalent
- hrs worked by one employee on a full time bases
- annually 2080 hrs
Break Even Point
- when revenue equals expenses
