Physical Therapy

Compliance in PT: The Good, the Bad and the Ugly

If you’re fairly new to dealing with compliance issues or maybe you just like to make sure you’re on top of things (keep at it!), knowing everything there is to know about compliance is a daunting task—but very necessary as a private practice owner.

Compliance is simply checks and balances to make sure you’re providing the best quality care and meeting the standards set by your state.

The biggest mistake you could possibly make is not being educated or being careless about compliance. So many PTs think they are doing just fine and aren’t worried about an audit, then one day they become a headline published by the Health Care Compliance Association about issues with HIPPA, PQRS, False Claims Act or fraud.

There are many resources out there to avoid compliance issues. You definitely want to avoid any of these risky behaviors (WebPT):

  • Frequent use of the KX modifier
  • Billing under one PT provider number rather than each separate PT
  • Billing excessive number of codes per session
  • Billing for services furnished by aides or techs, one on one codes instead of group therapy, or co-treatment when co-treatment hasn’t occurred
  • Submitting claims for services that you know are not reasonable and necessary
  • Code Gaming, like unbundling and upcoding
  • Billing for “not medically necessary” services without an Advanced Beneficiary Notice
  • Billing for maintenance care; excessive duration and frequency of services; services not furnished; or student services

Compliance is a beast, and there is so much more you need to know. Check these online resources for more help with compliance APTA, PT Compliance Group, Health Care Compliance Association.

If all of this isn’t enough to keep you up-to-date and knowledgeable on compliance, let’s discuss the benefits of a solid compliance program in your PT practice.

Assurance of cash flow

A compliance program will ensure that there are little to no mistakes occurring when it comes to documenting and billing. Mistakes can happen by accident and by carelessness and staying compliant will prevent both, and ensure that you are collecting every dollar you’re owed for the services you provide.

Promote trust

If you’re clear and concise on compliance rules and regulations with your staff and PTs—and you show them that you are following these rules—they will trust you and follow suit. All of your employees should understand the necessity for the compliance program and trust that the entire practice is operating ethically.

A compliant practice also builds more trust with payers and providers.

Promote confidence

With a solid compliance program, you and your staff will feel more confident that you are providing the best care and holding up to industry standards. You can sleep soundly at night knowing that you and your team are doing the right thing day in and day out.

Protect yourself, staff and patients

There are major consequences for violating compliance regulations. You, your staff and your patients will all see the repercussions of failing to maintain a compliant practice. Don’t take the rules lightly and keep up with any changes that may occur so that you do things right in your practice. You have your safety—as well as the safety of others—in your hands.

If compliance makes you nervous or confused—join the club! It’s one of the necessary evils of running a private practice. BUT once you put a solid program in place, it’s smooth sailing from there and you can get back to treating your patients. Just make sure you get educated and get your whole team on board when it comes to compliance!

Sometimes it helps to have other private practice owners, and compliance experts on your side to help you through this process! To learn more about how the FYZICAL network can help you with compliance (AND SO MUCH MORE!), click here to see our Resources.

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