How to Ensure Your Rehab Therapy Practice Comes Out of COVID-19 Even Stronger than Before

This is the second blog post in my series on working on your business, when you can’t work in your business. My intention is to help providers improve sustainability and efficiency within their practices, so they can come out of this pandemic with a renewed spirit and the ability to provide maximum benefits to patients.

If you’re like me, you may be starting to lose track of time. This seems to be a common problem right now—as we are all adjusting to a new normal and learning new patterns of living and working. Most of us are somewhere between week four and week six of social distancing and non-essential school and business closures. It’s safe to say that we’re in uncharted waters here; yet, some tried-and-true business best practices remain the same. 

In the first article of this series, I shared some best practices for ensuring you have a strong foundation for financial viability. Today, I want to focus on specific clinical and billing improvements—as well as general business improvements—you can implement during this time.

Clinical Improvements

Documentation

As a clinic leader, you’ve likely heard every excuse in the book as to why a therapist’s documentation is incomplete. Perhaps you’ve even been guilty of getting behind on your own SOAP notes. Well, you probably haven’t billed for any of those unfinished notes, which means you’re leaving money on the table—money that is critical during this time. With that in mind, be sure to:

1. Complete all outstanding documentation for billable visits that occurred within the last 90 days (and ensure that all of your therapists do the same). 

If you have a web-based EMR, you—and your therapists—can document securely from any location. In other words, there is no need to have your providers risk contracting or transmitting the virus to come into the clinic and complete their documentation. Keeping up to date in each 90-day period is important, as many insurance companies have 90-day timely filing limitations—and if you don’t file in time, you may not get paid. Other insurances, like Medicare, have longer timely filing limits, but letting things linger beyond 90 days may lead to documentation and billing errors—plus, it delays payment for your practice.

2. Finish up those discharge notes. 

I know this non-billable piece of documentation is the bane of many a therapist’s existence, but it’s still an essential part of completing a patient’s episode of care. I know you’ve heard the phrase “flatten the curve,” but I propose an additional mantra for PTs: flatten the stack. There’s never been a better time for therapists to complete all outstanding discharge paperwork on their patients!

3. Streamline documentation templates in your EMR.

This is another area where you can improve future efficiency in your practice. While we don’t know how long the current stay-at-home orders will remain in effect, we do know that they won’t last forever, and people will continue to need rehab therapists. Now is the time to plan for when patient volumes return to—or possibly even exceed—what they once were. For example, in WebPT, you can create: 

• physician protocols; 
• universally uniform evaluation templates; and/or 
• home exercise program templates.

Compliance

1. Plan for MIPS in order to maximize incentives. 

For those of you who are participating in the Merit-Based Incentive Payment System (MIPS) this year, now is the time to dig into the requirements, so you can understand exactly how to maximize your incentive payment. The area that many outpatient practices are having the most trouble with is improvement activities. So, I would recommend focusing there: make sure your practice is addressing this requirement fully. Be sure to consult our comprehensive MIPS guide for more advice.

2. Catch up on continuing education opportunities. 

There are many platforms that offer online courses, and most states now accept these courses for all or most of the CEUs required for therapists to maintain licensure. What better time than now to catch up—or get ahead—on those requirements?

Billing Improvements

Ensuring your documentation is up to date is a great first step, but it’s also crucial to see that all outstanding claims are sent out as well. That way, you can generate as much cash flow as possible to get you through the remainder of this crisis. 

1. Clean up your A/R.

If you handle billing in-house, use your front office staff to support your billing team in ensuring that your A/R is squeaky clean and current. Staff should be:

• Reviewing and correcting all denied claims;
• Following up on liens (and documenting their progress); and
• Posting all payments received. 

If you outsource your billing, be sure to check in with your service provider to make sure it has the same expectation of keeping your A/R current and as close to $0 outstanding as possible. This may require some decision-making on your part as to whether or not you write off some long-overdue payments.

2. Pursue outstanding patient balances delicately. 

Crises like this are just one more reason to collect patient balances at the time of service. However, you can still use this time to collect past-due balances from patients you have seen in the last 30 days. That said, doing so in the current economic climate requires a very gentle touch, as you definitely do not want to be too aggressive and risk losing a patient forever. I also would not recommend going back more than 30 days.

3. Audit your charts. 

Sure, chart audits aren’t anyone’s favorite way to pass the time. But, completing this task now could help you surface unbilled—or underbilled—dates of service, which may afford you the opportunity to collect additional money. It's also an opportunity to identify clinicians who may not be meeting your documentation standards in terms of clarity and timing. If this appears to be a clinic-wide issue, you can use this time to clarify those standards and, if necessary, provide additional guidelines or training. 

4. Review insurance contracts.

We’ve talked about this a lot over the past few years, but insurance contract reviews still seem to get put on the back burner consistently. Well, now is the perfect time to review all of your contracts and assess the following for each:

• Is this current? 
• Is this accurate? 
• Am I maximizing the fee schedule? 
• Have I been getting paid the correct amount per the contract terms? 
• Is this contract meeting my financial needs (i.e., is it paying more than my cost per visit)?

If the answer to any of these questions is “no,” then now is the time to remedy the issue. In fact, many insurance companies are taking meetings with providers to discuss contracts. Ultimately, you have nothing to lose by booking a meeting and asking for improvements to your reimbursement rates. (For tips on how to do so effectively, check out our free guide to negotiating payer contracts.)

Business Improvements

1. Review and update policies and procedures. 

Now’s a perfect time to pull out that dusty policy and procedures manual and update any and all policies that are outdated. There are probably quite a few changes you’ll need to make based on the current situation—for example, adding a work-from-home policy or disaster recovery plan.  

2. Complete all pending annual training.

Although you may have your annual HIPAA, sexual harassment, or other HR-related training scheduled for later in the year, make it a point to get it done now, while your team has downtime. That is assuming, of course, that your staff is still on payroll. You’ll have to pay them for any training time, so this might not be an option for team members who are furloughed. 

3. Review vendor contracts. 

Now is a great time to review your contracts with vendors, including credit card merchants and clinic consumables providers. Then, negotiate for lower rates or make the switch to another vendor (those that are integrated with your EMR provide further efficiency in collections). You should also review your suppliers to ensure you’re paying a fair price. In fact, compare your current costs to what’s available in the WebPT Marketplace, as we offer steep discounts. Otherwise, contact your vendors directly to negotiate new pricing that will help reduce your expenses—and to learn about new offerings and updates that might be more effective for your practice.

4. Review your patient experience data and workflows. 

The patient experience is going to be even more instrumental on the other side of this crisis, as  patients will want to feel even more connected with, and supported by, their providers. Your patient experience data is a gold mine of valuable information that can help you identify areas to improve across every aspect of your operations—including billing, A/R, collections, new patient paperwork, appointment reminders, waste, and wait times. Now may also be the right time to decide whether to keep your billing in-house or outsource it to a reputable vendor that can help you maximize the patient experience as well as your clinic’s cash flow. 

5. Create a metrics dashboard.

Take some time to review the specific key performance indicators (KPIs) that you are using to run your business. Data is critical to understanding how your practice is currently faring—and where there is room for improvement. Plus, being able to access a dashboard with your metrics all in one place allows you to make intelligent decisions more efficiently. Furthermore, this sort of data will help you establish a better business continuity plan for the next crisis.

There are countless decisions that go into starting a practice—and for your practice to continue operating at its maximum potential, you must periodically review and update those decisions. Well, now is that time! For practice owners, directors, or managers, this is also a great opportunity to solicit help from clinicians or team members who want to learn more about the business side of your practice’s operations. Delegating some of these tasks as projects can be a great way for the team to come together and collectively benefit from everyone’s input and hard work.

Want more best practices for working on your business when you can’t work in your business? Stay tuned, because my next blog post in this series will focus on marketing and communication opportunities during these unprecedented times. I’m confident that we will make it through this—so, let’s make sure your practice is even spiffier on the other side. You’ve got this!