Independent and comprehensive therapy billing and regulatory compliance audits for skilled nursing facilities, assisted living facilities, and adult day health facilities. Ensure therapy services are delivered with an individualized plan of care, consistent with the nature and severity of the resident’s individual illness or injury, in compliance with accepted standards of medical practice, and are reasonable and necessary. This assessment includes:
- Therapy clinical documentation review
- Analysis of billing practices and systems
- Ensure compliance with state and federal regulations
- Assess proper CPT code utilization
- Benchmarks RUG percentages
- PEPPER Report data Review
- Optional – Contract review to ensure your contracted therapy company is fulfilling the terms of their contract
Terapia offers three low cost options :
- One time comprehensive assessment. One day on site review and written report with finding, recommendations, and detailed action plan.
- Ongoing monthly review and monitoring. Initial on site assessment and report followed my monthly on site visits to continually ensure ongoing compliance. This includes subscription for all therapy related compliance emails and blogs published by Terapia.
- Quarterly or Annual compliance audits. Comprehensive audit and report conducted at intervals which align with your corporate compliance program. Plus inclusion in all compliance communications.
Trouble keeping up with all of the recent rules and regulations changes? Struggling to stay compliant while maximizing reimbursement?
We work closely with your clinical team to assess current compliance then help you devise a plan to stay up to date.
PQRS, MIPS, MPPR, MMR, CJR, IMPACT, - no problem!
- PEPPER Report Analysis
- Audit Preparedness and Response
- Survey Preparedness
- Documentation Review
- IMPACT Review and Analysis
- 5 Star Rating and Rehab’s Role
- Rehab/MDS Coordination
- PPS Overage
- Managed Care Compliance
- Section GG Compliance
- Maximize Therapy Reimbursement
- Monthly Financial Reporting
- Financial Efficiency
- Strategic and Operational Planning
- Budgeting and Revenue Projections
- Policy Review
- Space and Equipment Review
- Outpatient Business Plan Development
Ongoing guidance and oversight to your rehab staff. Best for independent facilities, non-profit organizations, and small chain companies who want the same level of "regional" support as the larger chain companies and the advantages that brings.
- Guidance and Support
- Regulatory Compliance
- Monthly Financial Reporting
- Part B Programming
- Staffing Levels and Efficiency
- Clinical Documentation
- Strategic and Operational Planning
- Marketing and Community Promotion
The two best reasons for an OP clinic are financial gain and expansion along the care continuum.
Successful OP clinics find the right combination of these and ensure that it is an integral part of their mission and vision. When done correctly, OP clinics can add some real dollars to your bottom line and can expand your care provider footprint in the community.
First, set realistic expectations: When OP clinics usually fail , it is most often due to unrealistic financial expectations or an inability to incorporate it into everyday operations. Outpatient therapy is a high volume/low margin business. Since most patients have either Medicare (which pays OP therapy with the MPFS – the same one that pays your Part B) or managed care insurance, expect similar reimbursement rates.
Second, a good OP program relies on a good referral stream. Realistically about a third of your active patients will come from your discharged short stay population, which leaves about two-thirds coming from other referral sources. These include local orthopedic, neurologic, family practice, or primary care groups. Referral development must be constant and ongoing.
Finally, the two biggest hurdles to get over is licensure and reimbursement contracts.
Each state has its own variation on the licensure process, but essentially, you add OP to your existing SNF license. Most want to ensure that: OP operations does not interfere with your inpatient care or restrict activities of your long-term residents and that you have the proper physical plant modifications like; separate entryway, public bathrooms, changing facilities, etc.
Reimbursement contracts are often overlooked until too late in the development process. Your FI will need to add OP to your existing SNF Medicare billing portfolio and some contracts will need to be renegotiated and include staff credentialing.
When developed correctly and with realistic expectations a SNF based OP therapy clinic can be a rewarding addition to the already great services you provide. Contact us to see if OP therapy is right for you.
Best three reasons to finally bring your therapy program in house:
Culture: You work hard to develop a culture which is unique to your facility, Your contract therapy company has its own culture, ways of treating residents, and priorities. Contract therapy staff often rotate too quickly to be truly integrated. An in-house therapy team means your employees, your policies, your priorities.
Compliance: Over the past few years, many contract companies have gotten into compliance trouble with CMS and their related agencies and that has spilled over to the facilities that they serve (remember, since the facility is the entity that actually bills for therapy services, they are the ones ultimately responsible for accuracy). Take control over how, when, and how much therapy is provided to your residents.
Cost: Let's face it, contract therapy services are much more expensive then ever before. You are often paying for a bloated infrastructure and costly overhead. (not to mention that they are passing the costs of the recent multi-million dollar fines on to their customers). Most average size SNFs can save between $150,000-$200,000 annually by bringing therapy in house.
There are 3 major steps:
Secure staff. Terapia can help you determine how many FTEs you will need of each discipline based on actual facility volume. We will work with your outgoing vendor to “buy-out” as many of staff you already know (and love), and help recruit and hire any additional staff needed. We can help determine market based wage and benefits, and set schedules.
Put systems into place. Terapia can help you select and implement a rehab computer billing and documentation software system. We have done dozens of installations and this can be done seamlessly with your outgoing system. In addition, we can help put policies and procedures into place, and train any new staff.
Ongoing compliance and survey readiness. Terapia can provide ongoing support with billing and documentation audits, compliance updates, and maintaining your therapy team to always be survey ready. This service includes monthly onsite visits with operational and performance reports, 24/7 access by email or phone to troubleshoot specific patient or system issues, and subscriptions to ongoing compliance newsletters and blogs.
- Adult Day Health - Occupational Therapy Consultation
- Assisted Living Facilities
- LTAC Hospitals
- Operational Assessments
- Mock Surveys