Eli's Rehab Report

Published on Thu Jul 08, 2010 PDF

You'll want to keep records of more than goals and patient progress.

You can't afford to miss out on workers' comp reimbursement. You read about managing workers' comp patients a few issues ago, so now it's time to explore one of the finer details --documentation. Small holes in your documentation can start adding up against you, so check out these valuable tips to ensure you're raking in every bit of payment you deserve.

One of therapist's biggest mistakes in their workers' comp documentation is their lack of specificity, says Bubba Klostermann OT, CVE/R, CEAS, with West Texas Rehab in Abilene, Texas. Here's where you need to dig a little deeper:

• Details about the employee's job. "Be clear on the requirements the patient must meet to return to work," states Ann Kresl, director of rehab & occupational health at Bay Area Medical Center in Marinette, Wis. To ensure this clarity, establish an open line of communication between the physician and employer, she adds. "If the therapist has no clue what the job demands are for the injured worker, she cannot establish a thorough, goal-specific plan of care and return to work process," Klosternann says.

Even worse: If you try to meet goals that have no functional basis, 1) therapy is less meaningful to the injured worker, thus his compliance and participation may lessen, and 2) you're at a higher risk of over-utilizing therapy services and fraudulent billing, Klostermann adds.

• Job functions affected. Once you state what the employee must do at work, explain what he can't do. "Cite functions that matter to the job site, such lifting, reaching, sitting time, standing time, etc.," says Jim Dagostino, DPT, PT, PTPN board member and co-owner of Dagostino/Gaspar Physical Therapy, a PTPN member office in Oceanside, Calif.

"Therapists often don't connect in their documentation how the patient's pain affects his ability to push, pull, lift, reach, or climb, etc," Klostermann points out.

• Your clinical conclusion. After establishing functional limitations, use your skills as a therapist to draw a direct conclusion and treatment plan for the problem -- "without shot-gunning the patient and treating them with multiple modalities," says Barry G. Inglett, PT,CHT, Cert. MDT, with Wayne Physical Therapy & Spine Center and Mailly & Inglett Consulting in Wayne, N.J.

The more direct you are, the less confused your payer will be. "Goals should be functional and revolve around the range of motion, strength, and endurance needed to return to work safely," Kresl says.

While workers' comp insurance can reimburse well, it can also take you for a spin. That said, the first thing to do is not to assume you will be reimbursed by workers' comp, Kresl says. "At our clinic, we regularly obtain private insurance information so if we receive a denial we can turn around and bill the private insurance." Doing this also prevents issues with timely filing while scrambling for the private insurance information, she adds.

Meanwhile, be familiar with the workers' comp fee schedules in your state, Kresl recommends. "This allows you to look at your reimbursement and compare it to what the fee schedule indicates."

Critical: Keep communication lines open. If the therapist feels that the patient is not capable of returning to her previous job duties, alert not only the referring physician but also the individual handling the claim, Inglett stresses. And of course, document these correspondences.

Along the same lines, inform the right sources if the patient is noncompliant with the home exercise program or not attending physical therapy appointments, Inglett adds.

Tip: Inglett's practice asks patients to sign a document that emphasizes the importance of working with the therapist as a team. "Patients that expect passive physical therapy intervention and do not take an active roll in resolving their problem, typically are not successful in returning to work."