By Therese Ptak

Refuah Rehabilitation Department Training Manual

2013
A basic overview of Rehabilitation Department policies and procedures for the purpose of instructing new receptionists. May be updated and changed as necessary.

Refuah Health Center 728 N. Main Street. Spring Valley, NY, 10977 845-354-9300 ext 1800 Rehab Fax: 845-517-1908

Table of Contents
Rehabilitation Department Daily Duties ..................................................................................................... 3 Basic Guide to Rehabilitation Policies ......................................................................................................... 5 Rehabilitation Scheduling Rules and Policies .............................................................................................. 5 General Scheduling .......................................................................................................................... 6 Access Coordination......................................................................................................................... 7 Physical Therapy Department ............................................................................................. 8 Occupational Therapy Department .................................................................................. 10 Speech Therapy Department ............................................................................................ 11 Understanding The Importance of Paperwork.......................................................................................... 12 Authorizations................................................................................................................................ 12 Monthly Reports ............................................................................................................................ 13

Rehabilitation Department Therapy Daily Duties: Verifying for the next day 1. Verifying insurances: A. ALL patients MUST have their insurance verified before they are seen! B. Insurance must be active for the date of service they are being seen. C. Once insurance is verified, please initial in the Billing Notes. All billing related notes need to be written in billing notes section of the appointment. For myself I write what I did in the general notes also so that it comes up when I hover my mouse over it so I can see whats up with a pt without having to click on them. D. If patients have a copay, this should also be noted in the billing and general notes. Pay attention since our patients are coming to a specialty office and some may have specialty copays. (ex: Oxford) Specialty copays are often higher than regular office visit copays. a. Copays and self pay must be collected from patients before they are seen. E. Reception should verify all insurances besides for Empire and Medicare. Please call billing to verify them. If you are unsure how to verify a specific insurance plan, call billing for help. F. If a patients insurance is inactive, send them to the third floor billing office to complete a sliding fee scale. G. When verifying Medicaid, check if the patient has an additional payer or a managed care. If they do, that insurance must be active! Call billing if the other payer is inactive. Confirming for the next day o When leaving a message, make sure to tell the patient to give 24 hours notice if they need to cancel. Check Authorization for the Next Day (normally done while verifying) o Check the status of the authorization ahead of time to make sure the notes were sent in and that we are getting the authorizations back before they come in for appointments. When doing so, please write in the general notes has auth or awaiting auth to show what its up to. However, please make sure to double check the day before to update the status of awaiting auth that this still is the case or not the case. Things are constantly being changed. If you see you sent it in over a week ago and you still didnt get a response call the insurance company to make sure they received it. Monthly Reports for that day o Each therapy has a separate monthly spreadsheet be sure to check each one. o If a patient hasnt been there in more than three months we delete them off of the spreadsheet.

Listen/Return Voicemails Schedule/Check in Patients Log Visits Handle patient inquiries either at Front Desk or On the Phone All important paperwork that can be sent out must be sent out asap. o Evals o Extensions o Corrections or Addendums to Auth Paperwork that need to be resubmitted. Assisting providers in small miscellaneous requests

Extra Duties As Needed: Ordering new supplies from Get Help for the reception area when necessary Scanning as needed Delivering Receipts to Billing Giving Yitty the monthlies that dont get scanned by us. (Ill tell you which doctors do) Walking mail up to the 3rd floor basket.

Basic Guide to Rehabilitation Department Policies: We NEVER double book. Unless told to or asked by a provider who approves of the booking. We NEVER squeeze or push-in patients in this department. It is a specialty and therefore all patients have to wait for their appointments. Our office runs extremely on time. We usually ask the therapists if the patient is late if they will still see them as a courtesy but we never pressure the therapist. It is at the therapists own discretion whether they will see a late patient. Usually patients who are at least 15 minutes late are not seen. We only accept Medicare patients who are already established Refuah patients. All Rehab patients are required to read and sign our new attendance policy. This document can be found in the left middle wall basket by the front desk and should be given to the patients upon check-in. It outlines the following: o Patient or their parent/legal guardian will sign a copy of the policy to be kept on file, indicating their agreement to follow this policy. They will also be given a copy for their own reference. o Patients who are unable to make a scheduled appointment must call extension 1800 to cancel at least 24 hours prior to scheduled appointment. Patients will be given a verbal warning after one (1) incidence of missing an appointment (no-show) or failing to cancel at least 24 hours prior to scheduled appointment time. This warning will be documented in eCW by the Rehab Services receptionist. o Patients will be given a written warning after two (2) incidences of missed appointments (either no-show or failing to cancel at least 24 hours prior to scheduled appointment time). This written warning will be mailed to the patients home address and a copy will be placed in his or her medical record. o If the patient continually fails to attend scheduled appointments they may be subject to discharge from the Rehab Services Department. Discharge will only be considered after verbal and written warnings fail to improve the patients compliance. Care may be continued at the providers discretion. o Patients will no longer be allowed to schedule future appointments for Rehab Services after three (3) incidences of missed appointments (either no-show or failing to cancel at least 24 hours prior to scheduled appointment). Any previously scheduled appointments will also be canceled. After 3 months time has elapsed the patient may request to start services again. Allowance back into the Rehab Services schedule will be determined on a case by case basis. Adherence to the specific scheduling rules for each therapist is essential to a happyand efficient office. Please respect the rules about scheduling for each therapist. If the therapist is requesting to leave early or make any changes to their scheduled hours they must speak to their supervisor, Michelle Sentell (1326) before changing anything. o It is not your responsibility to change their hours or allow them to leave early. It must be approved by an administrator. o

General Scheduling Policies No scheduling evals until they have a referral from their regular doctor or the doctor who suggested they receive therapy. Once they have an eval they must wait to get approval from their insurance (usually a week), after we get approval from their insurance we will call them and book ALL of the visits that they are approved for. For no fault insurances you need to get the following information: Insurance name, Insurance#, address and telephone#, claim#, representatives name and number, claim# Also if they have the insurance papers scan in. If they have Fidelis in order to be seen the patient needs to have a prescription from a doctor with a diagnosis on it. With other insurances they also need a prescription and also might need to have prior authorization, so we must call up the insurance to find out what that persons specific plan requires. Credentialing emails us when they get onto an insurance. When a patient calls to schedule an appointment, please make sure the therapist they are seeing participates with their insurance plan. The participating insurance list can be found at G: /Excel/Financial/Participating insurance listing. Please make sure that you are looking at the most updated version of the list.

Access Coordination: Due to the overwhelming need for Occupational, Speech and Pediatric Physical Therapy the wait-lists were started a month or so after OT and Speech opened in November 2012. o This wait lists until very recently (April 2013) moved very slowly and were a source of annoyance and dissatisfaction with many of our patients. To help mitigate this result the administrators in charge of Rehab appointed an Access Coordinator to help prioritize, and streamline these lists to better schedule evals and confirm a patients interest in receiving services through our office. Currently Schulamis Larkin (Sandy Larkin) one of our pediatric physical therapists took on the project and is currently working with reception staff to go through the waitlist. What this means for us is that when a patient calls in asking for OT, Speech or Pediatric PT there are two routes: o 1.) The patient is not a regular patient at Refuah and therefore cannot be seen by our office, cannot be put on the waitlist but can call back in 6 months to see if our policy with regards to this has changed. Currently we only accept regular Refuah patients who see one of our pediatricians. Sometimes patients get very upset about this policy if they are agitated you can offer to have them speak to Michelle Sentell (1326) the Rehab Administrator. o 2.) They are a regular Refuah patient and can be put on the wait list. To be on the waitlist they must get referral from a pediatrician They must answer the basic questions that are on the waitlist (just ask them to answer each category, like age, Date of birth, phone number) They must also answer the specific questions which are: Is the child currently receiving services anywhere else? Has the child ever received services through EI, CSE, CPSE? o EI- Early Intervention (when they were little) o CSE, CPSE- County or school therapy services o If the parent doesnt know what EI, CSE or CPSE is you can ask them if they ever had therapy when they were infants/toddlers, or if they ever received or are receiving services through the county or their school. What is the reason you as the parent feel the child needs therapy? Dont forget to put the date they call on the waiting list. Once on the wait list you can tell them that you will submit their case to our Access Coordinator who will review it, discuss it with the appropriate therapists and will prioritize their case. Once you tell them that immediately send a telephone encounter about that patient to Schulamis with the reason being Access Coordination and the Therapy the pt is requesting and fill in any details the patient mentions in the tel. encounter.

Scheduling for Physical Therapy: No more than three evals in one day No evals in the last appointment slot No evals in the last slot before lunch Avoid double booking evals back to back If a patient has not been seen by the therapy department for over three months the patient MUST come in for a new consult before they can receive treatment. When scheduling, please notice that we have a number of providers who take varied insurances. Check the chart on the right wall next to the front desk if youre not sure which insurance each patient takes. I update the chart regularly.

Sherryl Spence: Only sees adult patients ages 18 years and older. Works Weekdays Monday-Thursday o May eventually have Fridays again in the future.

Farhad Rostami: Sees adult patients usually 18 years and older If you have an older child like a male 12-13 year old, and you cant fit them into a pediatric schedule, you can ask Farhad if he would be comfortable treating the patient. He will want to know what the patient is seeking therapy for so ask the patient before you ask him about seeing the patient. Works weekdays Monday, Tuesday, Thursday, Friday o May eventually have Wednesdays again in the future

Cynthia Lansang: Only works Sundays Sees adult patients

Schulamis Sandy Larkin: Works Mondays, Tuesdays and Thursdays Sees pediatric patients Evals are 45 minutes Needs a 15 minute break between every three follow up visits. o If there is an eval between the follow ups the third follow up still needs a break after it. If there are cancellations in her scheduled try to fill them by going to the Therapies Cancellation list in: G:UserShare/Access Coordination file on our network (or if you happen to be lucky and know a patient off the top of your head just give them a call! )

Jody Birkenfeld: Works once a week Wednesday nights Sees pediatric patients Evals are 45 minutes Do not book over her one break during the evening. Try to avoid scheduling evals in her time slot and if you must, never on a day that already has an eval booked there. If there are cancellations in her scheduled try to fill them by going to the Therapies Cancellation list in: G:UserShare/Access Coordination file on our network (or if you happen to be lucky and know a patient off the top of your head just give them a call! )

Scheduling for Occupational Therapy: Due to the overwhelming need for OT and Speech we do not have the necessary scheduling slots for evals readily available, this means that we have developed a waiting list for each therapy . (See the section on Access Coordination for more details) As of right now any patients who want to start therapy will need to have a referral BEFORE being put on the waitlist for Speech or OT When speaking to patients about the waitlist try not to give specific numbers about how many people are on the waiting list, give round figures and try to tell them that its an estimate but in general the waiting list is very long and it could be a few months wait. If there are cancellations in their schedules try to fill them by going to the Therapies Cancellation list in: G:UserShare/Access Coordination file on our network (or if you happen to be lucky and know a patient off the top of your head just give them a call! )

Cindy Klein: Works Mondays (evals only), Tuesdays, Wednesdays, Thursday Afternoons, Fridays, Every other Sunday Sees pediatric patients Her evals are 1 hour. Speaks Yiddish (enough to converse with her patients) Follow ups are 30 mins. Never book her notes blocks

Denise Fleischer: Works Mondays and Wednesdays Sees Pediatric Patients Evals are 1 hour Follow ups are 30 minutes Never book her notes blocks

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Scheduling for Speech Therapy: ONLY ONE eval per day either in morning OR evening never both unless otherwise specified There is a wait for Speech evals patients meeting the follow criteria can be put on the WAIT LIST: o Patients must be: Current Refuah patients only (meaning they regularly see one of our general doctors not just our specialty dept.) Have a Referral If there are cancellations in her scheduled try to fill them by going to the Therapies Cancellation list in: G:UserShare/Access Coordination file on our network (or if you happen to be lucky and know a patient off the top of your head just give them a call! )

Judy Davies: Works Monday -Friday and Every other Sunday Sees all ages Evals are 90 minutes Follow-ups are 45 minutes alternating with 30 minute appointments (you will have to adjust the appointment by hand). o When scheduling youll notice that some appointments are 45 minutes followed by 30 minute follow ups. Make sure you NEVER book two half hours back to back. There must always be a f45 minute follow up in between each 30 minute. She does speak Yiddish When scheduling as the patient why they are seeking speech therapy, and then put the reason in the reason slot in the ecw window (I will show you this when we train).

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Understanding the Importance of Paperwork Authorizations: Because Rehabilitation Services are considered specialty services insurance companies like Fidelis, Oxford, United Health Care, and Empire Blue Cross Blue Shield, require that we send reports about potential candidates for rehabilitative therapy. o These reports are reviewed by the insurance company and then they are either approved for therapy or denied. o When a patient receives approval for rehabilitation services we say that the patient has auth (auth= authorization for visits for therapy) When we put in for authorization for a patient but have not yet received it we say the patient is awaiting auth o All insurances with the exception of self-pay, no fault, and Medicare require insurance authorization prior to being seen for a follow up visit. o Each insurance company has different forms that need to be filled out and faxed to them after the patient is seen for a consult (I will go over this with you but to give you a reference if youre on your own and need a list of what goes into the Fidelis report Ill make a separate handout with whats necessary for you). o Patients have a limit on how many visits they are allowed per year. Usually this is defined by which insurance they have. Fidelis- limit of 20 visits total for any/all ailments per therapy. OT-20 vists PT-20 visits ST-20 visits Oxford-varies depending on plan EBCBS- varies depending on plan Medicaid- limit 20 visits per year. Unlimited for children under 21. o Just because a patient may get 20 visits per year doesnt mean that the patient will NEED to come 20 times. It is at the discretion of the therapist (but mostly its the insurance company ) who decides how many appts the patient will get. A patient may be discharged from rehab services without using their maximum amount of visits, its not a bad thing it just means that further therapy isnt necessary. However, often patients will still feel they need visits even after the 20 maximum. Remember that if the therapist is discharging them its the decision of the therapist and they feel that the patient has progressed as far as they could.

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If the insurance company has denied them because theyve reached their limit there is very little (in fact, usually nothing) we can do to get them additional visits. o For Fidelis: Sometimes you can put in an Appeal (usually Yitty Lominitz takes care of this) but the odds of getting approved for additional visits is very very low. Unless the therapist wants to do this try not to offer it, often it gives patients a sense that they WILL get more visits this way. For Fidelis patients we cant offer to let them self-pay for additional visits due to contractual agreements between Refuah and Fidelis. There are a lot of separate things that go into each authorization report but the one thing you should always do is when you send the paperwork out to the insurance company always write paperwork sent (date)-initials in the billing notes so we have a record of when the paperwork went out. If after a week to ten days we dont receive a notice of auth or denial we call the insurance company (usually Fidelis) and find out whats going on with the pts auth.

Monthlies Because were a rehab facility all of our patients are referred to us by other doctors. o In order to let the doctor know how the patient is doing we generate a monthly report on each patient every month on the same day each month This day is the first day came into our office for an eval. Ex: Mr. Green had an eval on the 16th of October so his monthly report goes out every month on the 16th day of the month. o We keep track of this by putting each new eval on a monthly list when they come in for an evaluation. o Generating a monthly report is a bit technical and easier to understand if you try it hands-on so Ill be showing you how to do it in ECW.

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