Rehabilitation Outcomes Review-Teach staff how to count units billed per HCFA change

Develop competency program for reimbursement

One of the more important quality issues a rehab facility will face in the current environment has to do with staff's understanding of billing issues and reimbursement.

That's not to say staff should be entirely fluent in prospective payment system (PPS) terminology and methods, but it will improve a rehab facility's efficiency and outcomes if therapists and other staff understand how their services translate into reimbursement dollars.

After the Health Care Financing Administration (HCFA) implemented changes in how rehab facilities count billed units of therapy, Ingham Regional Medical Center rehab department in Lansing, MI, began an extensive staff education program on the subject. "We went to ground zero to teach staff how CPT [current procedural terminology] codes work, the Medicare fee schedule, how things are defined, such as what is 'whirlpool' and what are 'therapeutic exercises,' and we turned it into a competency," says Teresa Vinson, MPA, PT, rehab supervisor for the 20-bed rehab facility, which is part of a 241-bed acute care hospital.

The rehab services department gave staff therapeutic procedure guidelines and modalities along with the CPT codes for the various therapy procedures. Here's how the educational and competency program works:

Assess the need for a competency program. Rehab supervisors initially thought they could update staff about reimbursement changes through a staff memo. "Then, as we started learning more about how charging and reimbursement works, we realized that our staff as a whole doesn't have an understanding of the intricacies of billing," Vinson says. So they decided to create a complete competency program about billing and reimbursement.

Give staff a handout with guidelines. Supervisors gave the staff a three-page handout that included some of the HCFA requirements and definitions for terms such as "unit." It also included examples of how to calculate minutes and charges, and it broke down some of the guidelines, offering examples of what is and is not reimbursed by Medicare.  They also gave staff a chart that explains what billable time is. 

Explain why a competency program is needed. Supervisors explained how the recent changes in Medicare billing created the need for staff to learn more details about how to calculate billable hours. To communicate that need, supervisors told staff, "This isn't just making life more difficult for you as a therapist, this is protecting your license and protecting the hospital to make sure we follow these guidelines," Vinson recalls.

Create a competency tool. Using a fee schedule form, a CPT code book, and other information, Vinson and outpatient supervisor Heidi French, PT, spent six weeks developing the competency tool. "We had turned it into a worksheet, and there were 18 different treatment scenarios," Vinson says. "We tried to encompass outpatient medical rehab scenarios that would apply to all staff."

The result was a five-page tool, which the supervisors gave out at a quarterly rehab meeting, asking staff to complete the worksheet by the next staff meeting.  It takes about 30 minutes to complete. After the staff finished the competency tool, supervisors reviewed it and answered questions at a staff meeting.