Bulletproof Physical Therapy Decisions
Decision making tools and techniques for physical therapists
Get Better Physical Therapy!

Get evidence based physical therapy with these resources.  

Also, check out the extensive reference list in the Bibliography to see how evidence based physical therapy can contribute to Bulletproof Physical Therapist Decision making for your Medicare compliance program.


Bulletproof Templates

Chart templates are 'process measures' that help you make decisions by scripting the clinical thought process along evidence based lines based on measured variables, taken at specific time points (eg: Re-evaluations, Progress note periods, etc.).

Chart templates specify specific types of data, tests, measures and even suggest specific diagnoses.  Chart templates are often specific to the type of practice you have and to your patient population.  

You may download these templates and use them in your clinic - they are copyrighted so change them to fit your clinic.  Use what you think will help your patients - and help you make better decisions.

TBC Templates!

Use standardized templates to document your skilled decisions using Treatment Based Predictor (TBC)  variables.

Most TBC decision rules will fit on one or two templates - easing your paperwork and improving your documentation.

High volume conditions like spinal stenosis get their own template.

Use these templates to document your findings quickly and easily and make physical therapy decisions like doctors! 

Get Treatment Based Classification (TBC) templates that you can use to show the shift in probability favoring a particular diagnosis or treatment.  You will distinguish your physical therapy decision-making with a quick, simple checklist that demonstrates why you chose a treatment or diagnosis.

Why TBC is not 'cookbook' or 'protocols'

You must apply these checklists to your own patient population to understand the probability shift favoring the treatment or diagnosis.

While the steps are easy and the templates improve your documentation you must still possess the skills of a physical therapist to apply TBC correctly. 

Nothing else demonstrates this sophisticated level of understanding of your patients and of your physical therapy practice and skills than TBC.

Your patient population has a pretest probability of a diagnosis or outcome (eg: manipulation) that your can measure for patient-centered TBC.

Use the Global Rating of Change (GROC) as an outcome measure - many new derivation studies are using this powerful clinical tool to capture meaningful change in their patients.

Download the Bibliography for an extensive reference list of TBC as it relates to skilled physical therapy and Federal payment policy.


Sample Justification Statement Template

Use this template of a justification statement to show why you believe your patient needs and will benefit from additional physical therapy.

Use any validated, reliable measurement (self-report, performance, impairment-level or classification measures) to show a broad range of improvement.

You want this to be a separate document for those "outlier" patients that could show up as an unusual billing pattern in Medicare's computers.

This statement will reference the data you have already gathered in your daily sessions and is not hard to generate - besides, you don't want too many "outlier" patients, do you?


Functional Activity Chart Template

Use this new physical therapy graph with your progress or discharge note.

Use any validated, reliable measurement (self-report, performance or impairment) that generates a number and chart that number.

Show Need (Medical Necessity) with this chart format.

Do you need to append the -KX modifier?

Demonstrate graphical evidence of Progress (Expected Significant Improvement in a Reasonable time frame). 

 PT Progress Note Template

Our outpatient PT Progress note is designed to also be used as a re-certification note (if needed).  

We used evidence-based principles with an eye towards Federal payment policy.  

All the requirements are met for a successful Progress Note.

Been Audited?

Get the most useful physical therapy predictor for outpatient care!

Gait Velocity has been demonstrated to predict Falls, Hospitalization, Ambulatory Status, Discharge Status from Hospital and Dependence.

 Stacy Fritz, PhD, PT has given physical therapists a powerful new tool to create your plan of care and be accountable for your decisions.  Measure Gait Velocity over 10 feet using Dr. Fritz' new tool.

Why are predictions important?

In February 2009 I bought and paid for a Medicare auditor to come and assess my charts.  He asked, "Why do you recommend TIW x 4 weeks for most of your patients?" 

I said, "Because that's what the doctor ordered."

He said, "No, you have to justify your decisions - the physical therapist needs to show why the patient needs physical therapy - you can't rely on the doctor!"

This new tool is the best of the performance measures that I have found for showing why the patient needs (medical necessity) physical therapy.

NEW!

My Experience with Medicare RACs in Florida

Get my loss experience data from 2006-2008 that shows my Medicare RAC audit re-payments from the Demonstration audits in Florida. 

California and New York were also in the demonstration audits.

My clinic is a Physical Therapist in Private Practice (PTPP) and our experience was limited to automated audits that 'dinged' me for multiple untimed codes (eg: traction, e-stim, parafin, etc) in one day.

Untimed codes are again a RAC target.  Untimed codes are...

"CPT Codes (excluding modifiers KX, and 59) where the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one (1) in the units billed column per date of service.
Provider Types Affected: Outpatient Hospital and Physician
States Affected: Alabama, Florida, Georgia, South Carolina
Additional information can be found in the following manuals/publications:
CMS Pub 100-04, Transmittal 1019, dated 8.3.06, pages 7-11
CMS Pub 100-04, Ch. 5, § 20.2"


Untimed codes are: 

traction parafin electric stim
infrared vasopneumatic devices whirlpool/Hubbard
Fluidotherapy diathermy microwave
ultraviolet    


I've also included comparisons of 'typical' recoveries from physicians in California as well as graphic descriptions of physical therapy charge 'outliers'.

Originally published in the APTA Private Practice Section IMPACT magazine - March 2009.

Suggested Reading List

Bibliography

Suggested reading list - get familiar with issues related to physical therapy and learn about the following:

  • Treatment Based Classification
  • Alternative Payment Systems for Physical Therapy
  • Physical Therapy Diagnosis
  • Medicare Minimum Requirements for Documentation
  • Psychosocial Factors in Chronic Pain
  • Decision-making tools and styles
  • ...and more!

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