Physical Therapy EHR & Billing Software

In Kareo, therapists can easily track the patient's visit count to know when to report FLR data. Therapists can easily pick from a list of their favorite G-codes, severity modifiers, and therapy modifiers into Kareo Clinical's Superbill. Therapists can even copy forward G-codes and modifiers from previous visits to the current visit's Superbill.

As of July 1, 2013, CMS requires physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) to complete functional limitation reporting (FLR) on all Medicare Part B patients. CMS automatically will deny claims lacking FLR data.

G-codes are quality data codes that rehab therapy providers—including eligible physical therapists, occupational therapists, and speech-language pathologists—include on their Medicare claim forms to fulfill requirements for Physician Quality Reporting System (PQRS) and Functional Limitation Reporting (FLR).

FLR G-codes are always reported with corresponding severity modifiers. The modifier represents the functional impairment on a 7-point severity/complexity scale. For a full list of FLR G-codes and severity modifiers to use for your Physical Therapy demo, visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/G-Codes-Chart-908924.pdf

PQRS QDC G-codes are reported depending on the PQRS measure selected by the practice to report on. For a full list of PQRS QDC G-codes and modifiers to use for your Physical Therapy demo, visit: https://www.westongroupinc.com/westime/ops_docs/PQRS/13-Physical%20Therapy%20PQRS%20Paper%20Billing%20Log%20Addendum.pdf

In Kareo, therapists can easily pick from a list of their favorite G-codes, severity modifiers, and therapy modifiers into Kareo Clinical's Superbill. Therapists can even copy forward G-codes and modifiers from previous visits to the current visit's Superbill.

MACRA is the Medicare Access and CHIP Reauthorization Act, which is legislation that replaced the Sustainable Growth Rate (SGR). It outlines a new program for physician reimbursement that replaces fee-for-service with value-based payments under the Quality Payment Program (QPP). For the 2017 and 2018 reporting years, PT/OT/SLP providers are not considered eligible clinicians under MACRA, but they may be added in 2019. View Kareo's MACRA resource center to lean more.

LEARN MORE: http://www.kareo.com/macra

Medicare policy is ever-evolving. To ensure our members stay current with the constant stream of new rules, regulations, and initiatives—and to help keep them compliant—we constantly update our application to reflect Medicare changes and provide educational materials in digestible formats.

LEARN MORE: http://www.kareo.com/search/gss/MEDICARE

Modifier 59 is used to identify procedures/services that are commonly bundled together but are appropriate to report separately under some circumstances. A health care provider may need to use modifier 59 to indicate that a procedure or service was distinct or independent from other services performed on the same day. This commonly means a different location, different anatomical site, and/or a different session.

Kareo's billing application runs a set of coding checks based on CMS Correct Coding Initiative (CCI) edits and warns users when trying to submit charges that are not separately payable except under certain circumstances. Users can decide whether adding Modifier 59 is applicable or not.

Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. Example measures applicable to Physical Therapy and Occupational Therapy:

• Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan
• Functional Deficit: Change in Risk-Adjusted Functional Status for Patients with Knee Impairments
• Functional Deficit: Change in Risk-Adjusted Functional Status for Patients with Hip Impairments

Starting January 1, 2017, PQRS has been rolled into the Merit-Based Incentive Payment System (MIPS) track of MACRA's Quality Payment Program (QPP). For the 2017 and 2018 reporting years, PT/OT/SLP providers are not considered eligible clinicians under MACRA, but they may be added in 2019. View Kareo's MACRA resource center to learn more.

LEARN MORE: http://www.kareo.com/macra

Kareo's billing application runs a set of coding checks based on CMS Correct Coding Initiative (CCI) edits and warns users when trying to submit charges that are not separately payable except under certain circumstances. Users can decide whether adding Modifier 59 is applicable or not.

Patient privacy is serious business. Even one HIPAA slip-up could cost your practice thousands of dollars. That’s a lot of pressure. But with a secure, cloud-based EMR like Kareo, you can rest easy knowing your patient data is safe.

LEARN MORE: http://gopractice.kareo.com/article/hipaa-compliance-facts-vs-myths

As of October 1, 2015, virtually all healthcare professionals must use ICD-10 diagnosis codes in order to get paid. The switch from ICD-9 to ICD-10 represents one of the healthcare industry's biggest changes, but Kareo makes selecting and using ICD-10 codes easy with our optimized diagnosis code search and favorites.

LEARN MORE: http://www.kareo.com/icd-10

Kareo retrieves the Therapy Amount Used per patient from the Eligibility Report returned from Medicare, which is displayed during scheduling and patient check-in.

The user can re-run the eligibility check to receive the latest Therapy Amount Used for the patient and manually apply the KX modifier to charges to justify exception to the therapy cap.

The limit on incurred expenses (therapy cap) is $1,940 for physical therapy (PT) and speech-language pathology services (SLP) combined and $1,940 for occupational therapy (OT) services.

If the therapist believe that continuing therapy with a patient is medically necessary—thus qualifying the patient for an exception to the cap—all the provider has to do is attach the KX Modifier (or Modifier KX) and clearly document reasons for continuing treatment.

When patients reach the $3700 Manual Medical Review threshold, they may be subject to a targeted review process.