Marching to the tune of technology: providing better therapy, more accurate billing, fewer denials.

Like a brass band, technology has marched into the therapy arena trumpeting a change in the tempo of therapy. Gone are the hours of repetitive paperwork and errors in record keeping. The new tune has the snappy, key-clicking rhythm of the computer. It frees therapists for more hands-on treatment time, speeds billing, ensures accuracy, and provides a wealth of aggregate data for reports on residents and trends.

What does this technology mean to the nursing home? "Most facilities shop for therapy on the basis of price and service," says Jeff Boland, a consultant with KPMG Senior Living Services. "Technology factors into that because the more sophisticated a therapy company is in terms of how it collects data and transmits them to the billing staff, the more time it can save the client."

Long-term care has traditionally been a bit timid in climbing aboard the silver streak of technology. "Many times a facility will say, 'Oh, it's some sort of whiz-bang technology thing that I don't understand, and I can't imagine it has value for me,'" says Sandro Grima, vice-president of information technology at Aegis Therapies. "But once they see the results technology can deliver, they become very enthusiastic."

Here is a brief tour of what a therapy company's technology should deliver and why evaluating technologic capabilities is important in choosing a therapy company.

Managing the Paper Trail

It's the end of the month and the therapist is adding up units and minutes of treatment for her residents, endlessly writing the resident's name, Medicare number, and all the other resident information on each form. She makes an error and has to turn the 9 into a 7, hoping it will be legible. Although she is a skilled therapist, much of her time is spent on paperwork--and that paperwork is subject to human error.

"Anyone who has had to review handwritten documentation--especially copies of copies of faxes--knows that what those reviewers at Medicare have to look at is just scary," says Bill Goulding, director of outcomes and appeals management for Aegis Therapies. "It's a wonder that they go to the trouble to decipher what the therapist writes."

From the moment the resident is admitted, technology should become the therapist's partner, storing information in a Web-based system and delivering it at the click of a key from any computer with the proper security passwords. Need to fill in resident information, medical information, and payer information on a form? That information, along with CPT codes and care plans, should automatically appear every time the resident's file is opened. The therapist need only enter treatment quantity and time. "The system actually prevents therapists from keying information if it doesn't fit the regulations," says Grima. "That's a huge safety factor for denials." Added benefit: The computer delivers a crisply printed, totally legible log.

"Technology makes clinical care better, easier, and more accurate," says Deb Neil, district manager for Aegis. "We used to have to sit down and fill out two logs for every resident every day. Now the computer actually creates the second log. It allows the manager to track resident care time on a daily, weekly, or monthly basis. We can compare numbers of residents in a time frame and calculate our utilization percentages."

An "e-signature," created when the therapist logs onto the file and certifies the information is correct, protects the integrity of the resident's file. "The system will not allow those records to be changed," says Grima. "That e-signature is as good as the day it was put in."

Once therapists become acquainted with the system, it takes less time to capture their treatment data electronically than it did on paper, which means they can dedicate their time to what they do best--treating residents.

Delivering Oh-so-Accurate E-billing

After using technology to create the resident record, the next step is to transmit it electronically to the facility. Robert Campion, executive director at Heritage Square Healthcare Center in Greendale, Wisconsin, remembers when billing for therapy meant delivering the therapists' handwritten billing logs to a receptionist who would work on them at night. "In between answering the phone and greeting people as they came in the door, she was logging in Medicare billing," he recalls. "Obviously, there were issues of accuracy."

With 21st-century technology, such scenarios have gone the way of the woolly mammoth. No longer must human hands labor to transfer information from one computer to another. A computer interface makes it possible to send electronic files that download directly into the receiving computer. "The ability of the therapy company to feed directly into the facility's billing system without human intervention has really helped our compliance," says Campion. "If there are errors in terms of entering, they are easy to correct, and the system leaves a trail easy to track. From a compliance standpoint, that's huge."

Getting computers to talk to each other can be difficult, but if some therapy companies have their way, that problem, too, will follow the way of the woolly mammoth. "We have produced a unique interface engine that allows us to customize billing information in whatever format the facility needs," explains Aegis's Grima. "With this tool, we don't have to reinvent the wheel and take months to write programs to match the client's system. Start-up time is fast and smooth. After a quick setup the first month, the information can be downloaded with the click of a button."

That's how B.J. Brown, accounts receivable at Lutheran Home--Hickory West in Hickory, North Carolina, receives therapy invoices. "Thank goodness I don't have to enter all that data!" she declares. "When the therapy logs come in by e-mail, my system downloads them and automatically compiles them for Medicare. It's very, very efficient."

With electronic transfer, therapy invoices are delivered in minutes, enabling the customer to bill third-party payers faster, thus enhancing cash flow. "In choosing a therapy company, the ability to bill electronically should be high on the list," says Aegis's Goulding. "It absolutely reduces regulatory exposure from billing errors. Because it's cleaner, quicker, and much more efficient, it greatly reduces headaches for the facility billing office."

KPMG's Boland encourages his clients to computerize their billing. "If a facility can submit a clean, electronic claim to Medicare, it can get paid in 14 days, as opposed to submitting a paper claim and having it take 30 days," he says. "That's a real incentive to bill electronically."

Slicing and Dicing Information

Technology can't be beat for tracking clinical outcomes and producing reports. "The added value that a therapy company's technology brings to a facility is the ability to capture, analyze, and report data in a variety of ways," says Mark Besch, vice-president of clinical services for Aegis. "That information gives great insight not only into the volume and cost of therapy, but the quality and nuances of the services." Reports--whether single resident outcomes, aggregate data on diagnoses, functional improvements, referral sources, utilization, payers, or even productivity reports--should be able to be customized to fit the facility's needs.

For example, Aegis uses the Rehabilitation Outcomes Measure (ROM) to evaluate every resident upon admission to therapy and upon discharge. "We've been tracking outcomes for several years, so we have a significant amount of data," says Louanne McCray, Aegis regional sales manager. "It's a great marketing tool and good quality assurance for facilities to show a referral source how their residents have improved or to identify best practices."

Tracking Denials

The Remittance Advice (RA) from the Medicare fiscal intermediary (FI) delivers a grim message: Payment for service rendered has been denied. Now begins a long process of discovering why and how to remedy the denial.

"Tracking denials can be a real bear without technology," says Goulding. "You can go for months and get very few denials, and then sometimes you'll just get swamped. It's difficult to say why, and that's the very reason you need to track them." The therapy company that can track denials, follow trends, and keep abreast of appeals can significantly reduce risk of nonpayment for a facility. "The whole reason for a tracking system is to become proactive and begin to affect those trends," adds Goulding.

Aegis's data-sharing agreement with one of the 19 FIs that it deals with is a good example of this approach. "United Government Services facilitates denial tracking by sending more than 200 fields of information about the denial, from resident name to specific treatment codes and amounts," says Goulding. "That gives us a huge jump start on tracking denials."

When denials come in, an e-mail containing all the information is automatically sent to the executive director, the director of nursing services, the business office manager, and the rehab district manager. The system tracks comments on why a manager feels a claim was denied and whether it will be appealed, with built-in prompts for each step along the way. For example, 90 days after an appeal is made, the system automatically sends an e-mail to those involved as a status reminder. "You need a tickler system to make sure nothing falls through the cracks," says Goulding.

When viewed together, a group of denials could indicate a trend. By collecting denials information over time, it's easy to spot such trends and triggers. "Our ability to track and trend denials allows us to quickly identify problem areas and take action to eliminate them," says Grima.

When a therapy company has a strong denials tracking system, the facility will most likely see a reduction in denials and, on the ones that do come in, will see that they are overturned. That's good for the therapy company, good for the facility, and good for its residents.

RELATED ARTICLE: Therapy Technology Checklist

Check these 12 areas to see if your therapy company is capitalizing on technology:

1. Is resident and treatment information computerized, easy to enter, and automatically called up with the resident record? Is an electronic signature system in place to ensure accuracy of records?

2. Are customized reports available in a wide variety of formats?

3. Is compliance assured by a warning system on screen when an entry doesn't conform to regulations?

4. Have therapists been trained in good documentation?

5. Is the computerized system Web-based so that information can be accessed in real time from any computer in any location?

6. Is billing computerized so legible, accurate invoices are generated?

7. Can billing data from therapists' logs be transferred electronically to the facility billing office so UB92 and other forms can be automatically generated with no errors?

8. Does the company have an IT interface that facilitates easy start-up in the format required by the customer without months of program writing?

9. Can the company quickly customize information to accommodate changes in the needs of the facility and in the regulatory environment, rather than relying on a third-party vendor to rewrite programs?

10. Can reports be formatted to meet the hierarchical structure of a chain?

11. Can changes in regulations be e-mailed quickly to all necessary recipients?

12. Are denials tracked, generating reports on the reason for denials of payment, the status of appeals, the number of dollars involved, etc., with timely e-mail reminders of each step in the process?