Compiled by Physical Therapy Products staff
Documentation software has evolved a long way from just simple paper charts with scribbled notes from yesteryear. They now are designed to do all the tasks required to run a successful practice—and feature everything from narrative templates to the ability to ensure claims are processed completely and correctly with the proper billing codes. Consumer demands and the realities of the current practice environment are continuing to drive the evolution of the next generation of documentation software. With this in mind, Physical Therapy Products invited some of the market’s leading manufacturers of documentation software to speak about some of the software’s features that have the most resonance with their customers, and what percentage of customers choose to customize it for their needs. They also share how their software is helping practices to get paid for the services they provide, and what effects they believe that MIPS is anticipated to have on how physical therapy clinics complete their documentation.
Participating in this Q&A are: David McMullan, senior vice president of customer operations, Casamba; Jerry Henderson, PT, vice president of clinical strategy, Clinicient; Sharif Zeid, business director, MWTherapy; Rodger Fletcher, director of product marketing, product management, Net Health; Lori Collins, product manager, product management, Net Health; Steven Presement, president, Practice Perfect EMR + Management Software; Kathryn Rigda, director of product management – therapy, Raintree; Daniel Morrill, PT, DPT, CEO/president, TheraOffice; and Heidi Jannenga, PT, DPT, ATC/L, president/co-founder, WebPT.
Q. What features in your company’s documentation software have had the most resonance with your customers?
A. David McMullan, Casamba: Casamba Clinic’s two key features that resonate well with our customers are 1) Customer-driven evaluation templates and 2) The ability to document on more than one patient at a time. 1) Our customer-driven evaluation templates provide therapists the flexibility to customize the clinical content they need to capture for the patient population based on the therapist preferences and the patient’s presentation. Our templates provide the combination of flexibility, ease of use, and compliance. 2) Casamba Clinic meets the needs of the high-volume outpatient rehabilitation market by allowing the therapist to easily and quickly switch from one patient documented note to another. We understand that it is not unusual to have two, three, or even four patients in the clinic at one time, and all at different stages of their treatment. Casamba Clinic allows our therapy providers to document each patient encounter easily through their treatment progression and quickly switch between each patient’s documentation.
A. Jerry Henderson, Clinicient: Clinical Content Management: Our clients may create their own content or start with an already existing comprehensive multi-disciplinary library, and edit it to meet their specific needs. Information Access: Everyone on the entire team from the front desk to the owner/manager has immediate access to all of the information they need in one system. Compliance safeguards built into a system that also promotes an efficient, best-practices clinical workflow, for example: coupling of clinical documentation to charges; the ability to automate away complex billing rules; and automatic tracking for authorizations, referrals, and insurance treatment limits.
A. Sharif Zeid, MWTherapy: MWTherapy’s specialty is customizable documentation. Our system is outfitted with comprehensive standard templates which can be fully customized by the practice. In today’s world, every practice is different, and documentation that fits means that documentation is fast and efficient. Clients also love our complete system—built for the ground up for PT. No more dealing with multiple systems and trying to keep everything in sync. There’s no time for that in 2018.
A. Rodger Fletcher, Net Health: Our software, ReDoc powered by xfit, is the all-in-one solution for rehab therapy environments. It bolsters scheduling, clinical documentation, billing, and reporting all within the same platform. This enables clinicians to be successful and marks ReDoc as a comprehensive and cohesive solution for physical and occupational therapy, as well as speech-language pathology professionals. ReDoc’s features simplify the documentation process for therapy service providers and boosts their productivity. The all-in-one capabilities also eliminate double data entry, reducing error and enhancing reporting.
A. Steven Presement, Practice Perfect: Everyone wants to do their notes quickly—and in their way. As a result, our three most-popular features, common-sense as they seem to be, include the ability to bring-forward and modify previous sessions notes, the ability to set up macros for phrases that are used repeatedly, and the ability to completely customize evaluations or any other kind of template that the user wishes to create. This trifecta, combined, helps to reduce the time taken to document patient encounters and, more importantly, provides meaningful and easily readable output.
A. Kathryn Rigda, Raintree: One of the things customers find beneficial are the real-time hints and notices to ensure documentation compliance. These can be set up to accommodate different payor rules, allowing clients to submit claims with the confidence they have documentation that supports the billed charges. Raintree also includes industry-leading revenue cycle management tools allowing clients to effectively and efficiently manage all aspects of their business. Built-in templates to pre-fill data based on patient injury or symptoms allow providers to spend more time treating patients and less time completing documentation.
A. Daniel Morrill, TheraOffice: Our customizable templates serve as the foundation for our documentation system. The ability for providers to jump into a template and create their own unique preset preferences from the ground up without having to pick up the phone to call us for assistance is key. We designed our template editor to be quick, easy to navigate, and save countless hours of manual typing by allowing for complete customization. Additionally, the fluidity of data from note to note is another massive time-saver. Once you enter treatment information into a patient’s initial evaluation, that same information will carry forward into your next daily note, and so on.
A. Heidi Jannenga, WebPT: Our customers love our customization options (which help speed up the documentation process) as well as our built-in payor compliance features (which help ensure fast, maximized payments). Plus, the WebPT EMR works within a full end-to-end practice management solution that features scheduling, appointment reminders, a home exercise program, patient relationship management, robust reporting and analytics, and patient outcomes tracking/reporting. So, WebPT customers can access everything they need to run their practices in one place.
Q. How is your company’s software product helping clinics get paid for the services they provide?
A. David McMullan, Casamba: Our Casamba Clinic product is designed to allow the therapist to focus on the patient. All we ask of our therapy providers is to document the services they provide to the patient, and our Casamba Clinic solution will help ensure the appropriate and correct charges will be applied. Casamba Clinic’s documentation and payor-specific rules engine allow our customers to get paid for the services they provide and that their documentation supports.
A. Jerry Henderson, Clinicient: Instead of asking clinicians to memorize complex and ever-changing insurance billing rules, the system automates compliant charge capture based on the therapist’s clinical documentation and billing rules for the payor. In other words, the clinician’s job is to document the procedures they performed and reconcile their time. The system then applies the proper billing rules and aggregates the maximal correct charges automatically.
A. Sharif Zeid, MWTherapy: MWTherapy has a complete billing module built right in and includes easy electronic billing and hand-off electronic posting. Because billing is built-in, there is no “bridge” over which data must travel, no chance to be out-of-sync, and no chance of losing claims into a black hole. MWTherapy’s billing module has been built from the ground up for PT billing and is efficient every step of the way. Codes are entered efficiently and checked for compliance. They are immediately ready for billing through a transparent process that makes it easy for billers to take control. Faster documentation, faster charge entry, faster billing all under an umbrella of code and claim scrubbing means getting paid more, faster.
A. Rodger Fletcher, Net Health: Our billing module allows for the seamless flow of information from the front desk to the back office. Insurance information is captured at the front desk, charges are captured during or after treatment, and documentation is all inclusive. It is here that the billing staff can efficiently process charges and claims.
A. Steven Presement, Practice Perfect: Quick and reliable reimbursement usually comes from clean claims being submitted. Practice Perfect prevents disallowed CPT codes, by insurer, from being used. We pre-scrub claims before they are submitted to make sure that no key information is missing. We track funding limits, making sure that the user is well-aware if a patient is approaching their coverage, whether it be dollar, date, unit or visit-based. We track outstanding balances and provide for users to make comments about collection efforts—and be automatically reminded when they have to follow-up on a broken promise. Billing isn’t enough; you really need a whole collection system—and that’s what we provide.
A. Kathryn Rigda, Raintree: Raintree provides coding edits and billing rules that can be defined by payor, to ensure that all appropriate modifiers are automatically included. We also provide authorization request forms for many major payors, allowing information to be automatically transferred from the documentation onto the specific form, reducing time and errors. Raintree tracks plan of care requirements, authorization limits, direct access visit thresholds, FLR reporting, and progress report requirements to ensure that all visits are approved, and authorized before treatment occurs, and that required items, such as FLR codes, are completed.
A. Daniel Morrill, TheraOffice: TheraOffice creates a streamlined process for getting claims submitted and paid as efficiently as possible. Charges are automatically generated once a therapist locks a note. Those charges are then checked for CCI edits and CPT checks before being batched for the clearinghouse. Once claims are sent to carriers, comprehensive billing tools will break down the insurance claims by aging to show what is outstanding and help resubmit denied claims. TheraOffice will also alert you if you are not receiving payments as quickly as you should based on previous reimbursement. Once paid, automatic payment posting (ERAs) can be applied in a few seconds. Remaining balances can be forwarded to secondary insurances or dropped to patient statements with the click of a button.
A. Heidi Jannenga, WebPT: We’ve integrated payor guidelines into our documentation software to ensure it meets the requirements for payment—and we’re continuously updating those rules. WebPT also offers a suite of billing solutions featuring a 98.5% first-pass claim acceptance rate and a track record of increasing revenue per visit (RPV) from 3% to 10%.
Q. What percentage of your clients choose to customize their own templates? What are they typically trying to achieve through customization?
A. David McMullan, Casamba: Over 95% of our Casamba Clinic customers use and customize their own documentation templates. The primary goal our customers are trying to achieve is clinical documentation efficiency that is balanced with compliance. Each customer and their therapy providers have their preferences in both their approach and assessment of the patients they provide care for across the care setting. Casamba Clinic templates enable our customers to document their findings and care plans in a compliant format that is based on their preferred customized template.
A. Jerry Henderson, Clinicient: Most of our clients start off by using a subset of our existing templates. While using our standard templates and clinical content after going live with the system, most clinicians will inevitably find at least a few small adjustments they would like to make. Since the system is flexible enough to allow free text entry or structured data entry, a clinician can use a bit more free text in the beginning, and then incorporate those frequently used phrases, tests, and procedures so the system fits like a glove with their practice.
A. Sharif Zeid, MWTherapy: Almost all of our clients customize their documentation templates in MWTherapy. There are many reasons, but the biggest ones are efficiency, accuracy, differentiation, and compliance. By customizing, practices can form the documentation around staff practices and preferences. Customized documentation also makes a huge difference in terms of differentiating a practice from others when documents are presented to various referral sources. Finally, and one of our favorites, is when a staff member at a practice takes a course in a new treatment method or methodology and customizes documentation to integrate that right into the practice’s documentation templates.
A. Lori Collins, Net Health: ReDoc powered by xfit is highly configurable to meet the specific needs of clinics and clinicians. As such, a very high percentage of our customers customize their workflows so that information is accessible in a more attainable way. Additionally, as a result of the highly configurable nature of our product, we are able to serve a range of clinical environments, enabling us to meet the unique documentation needs of specialty clinics.
A. Steven Presement, Practice Perfect: Good question, and I’m not sure I would know the answer to this; its not something we track. But, there has certainly been an uptick in the number of clinics inquiring about customization. I would guess right now only 20% of our clinics customize. This low number is the result of two factors: 1) Users like our built-in templates and don’t feel the need to customize and 2) Customization does take time—time clinicians don’t have. Why customize? This allows a clinician to put their “voice” on reports, to stand out, maybe provide something more specific for their referral sources.
A. Kathryn Rigda, Raintree: Most of Raintree’s clients have some level of “customization.” However, Raintree is able to accomplish most customization through configuration options. Raintree provides easy-to-configure options allowing customers to define the rules, workflows, and documentation content that they want to incorporate into their practice. This allows “customization” without necessarily the need to customize the documentation templates. If clients do choose to add customizations, it is typically to add additional business rules to meet their corporate needs, or to address state-specific payor requirements.
A. Daniel Morrill, TheraOffice: The template customization process is an integral part of TheraOffice’s extensive implementation process. Documentation efficiency is at the top of the totem pole when it comes to clinical workflow processes. Whether our providers are creating their own custom templates from scratch or adjusting our existing premade templates, they are all using the template editor to some extent. The primary goal is to set up templates that have the bulk of information already entered in. By configuring custom drop-downs, custom phrases, and setting up preset comments, providers are able to complete notes extremely quickly by updating only what is necessary, such as treatment values, as opposed to manually typing out the same information time and time again.
A. Heidi Jannenga, WebPT: The vast majority of our user base—probably more than 80% of users—create their own customized evaluation templates. Typically, this happens during the onboarding phase as they’re learning the system, which gives us the opportunity to help them get the most out of WebPT’s customization options. That way, they can document more easily and efficiently—and thus, reduce the overall time spent on documentation.
Q. The Merit-Based Incentive Payment System (MIPS) for Medicare Part B providers is on the horizon. What effects is MIPS anticipated to have on how most PT clinics do their documentation?
A. David McMullan, Casamba: For most customers that have continued to report the quality measures (formerly known as PQRS), the transition to MIPS will have less of a documentation impact since they are already meeting the quality measures component in their documentation. The most significant effects will result in the need for Medicare Part B Physical Therapy clinics clinical documentation solution and workflows to meet the requirements in Improvement Activities and Promoting Interoperability categories for MIPS. Physical Therapy clinical documentation will need to be more patient-focused and include feedback from patient outcomes and engagement tools. Also, Physical Therapy documentation will be essential in the overall care continuum as our patient’s documentation is shared with other healthcare providers in both the post-acute care and acute care settings. Our Casamba Clinic solution supports the capture and transmission of the quality measures for MIPS today, and we are completing changes that will assist our customers with this transition to MIPS.
A. Jerry Henderson, Clinicient: The biggest immediate day-to-day effect of MIPS for clinical documentation will be the need to demonstrate quality, either through a certified Quality Clinical Data Registry (QCDR) or through the Quality Measures published by CMS. (Quality Measures are the new name under MIPS for our old friend, PQRS.) From a clinician’s perspective, this should be relatively seamless. In other words, the system should automate the collection of Quality Measures or other quality data required by the QCDR. Although there are two other components of MIPS (Advancing Care Information and Improvement Activities), the Quality Measures component has the most immediate effect on the clinical workflow.
A. Sharif Zeid, MWTherapy: MIPS is a complex program that has yet to be applied to PT clinics. All indications are still that it will begin in 2019. There is a lot of uncertainty as to the longevity of the program. As with previous CMS mandates, MWTherapy is working hard to mitigate those impacts and continue to deliver a system that makes compliance as easy and efficient as possible. As with other efforts, clinics will need to learn more about MIPS as they decide how to tackle MIPS.
A. Lori Collins, Net Health: As of this writing, it remains to be seen how therapy providers will be impacted by MIPS. This is an area we are watching closely, especially given how, in many ways, therapy treatment and documentation differs significantly from many other types of providers. We’re prepared to respond quickly to assist providers with compliant documentation and workflows should the inclusion of therapists actually become a reality.
A. Steven Presement, Practice Perfect: MIPS is still formative, much is still in flux. We do know clinics will need to collect a lot more information about their clients. For example, clinics will need to collect info about their patients’, height, weight, BMI, race, smoking habits, and more—all of this is required for ONC certification and, as a software company, if we aren’t ONC certified, we can’t submit MIPS scores directly. How this will trickle down to documentation remains to be seen. But, that being said, we have heard from many clinics that they would rather take a small percentage bite from their Medicare revenue, the claw-back, rather than do the MIPS dance. So, we’re keeping our eyes open. This story is unfolding as this goes to press.
A. Kathryn Rigda, Raintree: Incorporating MIPS into clinical documentation so it can be completed as part of the treatment will be critical to compliance and will reduce the time needed to meet the requirements. Providing hints and warnings on missing items to providers will assist in ensuring compliance and frustration. MIPS is designed to monitor and improve quality of care. Therefore, it should be included in documentation in a way to reduce the burden on the providers and incorporate the process into their daily workflow.
A. Daniel Morrill, TheraOffice: Rehabilitation providers, as well as other healthcare providers, typically agree that outcomes and the collection of critical data are essential steps to improving all facets of healthcare. The argument over what data and outcomes are the gold standards is where things become very complicated. MIPS was designed to look at quality and efficiency of care and then tie it to healthcare payments. Great in theory, but much more complicated to execute. Those who participated in the PQRS program were quick to realize that the data collected was probably not the best data points to help demonstrate efficient or quality of rehabilitation care. The more objective and data-driven we can make our documentation to support the requirement of skilled services is a win-win for patients and providers. The important takeaway is that we need to demonstrate medical necessity and the progression of rehabilitation patients toward functional goals.
A. Heidi Jannenga, WebPT: We’re still researching exactly how MIPS will affect our membership (for example, the minimum volume/billing requirements may affect some of our customers’ eligibility to report). That being said, we have already developed a preliminary MIPS solution that seamlessly integrates the reporting requirements into our documentation software. It will function very similar to our PQRS reporting tool. PTP