Therapy Meeting

1. Therapy Meeting March 1, 2013

2. Happy Stories! • Tell us happy stories!- GO!

3. RE Lists Distributed • Remember- Do NOT complete Superior re-evals until the auth department has notified you that you have auth.

4. Consent Forms • If the patient is required to pay a co-pay you will find this information on the referral form that Ruth sends out. Ruth will be putting this information, if applicable, in a prominent place on the referral. • The office has informed the family of this amount prior to you entering. If the family has any questions, please direct them to the office. • If you have any questions when filling out the consent form for a patient that has a co-pay, please call the office. • We are in the process of getting some clarification from the state on exactly what we have to give them in writing, and based on that info, we may be updating our forms to make it easier on you.

5. Change of Provider Form • What is it? • The Change of Provider form is a form that we have parents complete at the time of the IE when the patient has been receiving services through another agency. This information should be listed on the referral sheet that you receive from Ruth. • What do we need to explain to the parent’s when we are asking them to sign it? • When we explain this form to the parents we need to let them know that we are asking them to sign this so that we can get authorization from the insurance company to provide the service listed on the form. This will only affect the services listed on that form. For example, if we are only providing PT for that patient and they are receiving ST and OT through another agency it will not affect the ST and OT, ONLY the PT. They can continue to receive those services through the other agency.

6. Missed Visits • We are doing a clean-up of missed visits for the past few months, so don’t be shocked if the office contacts you and requests a missed visit note for visits that are old.  If you have any questions about any request, please talk to the person who is sending the request, and they can give you more information.

7. Community First Progress notes vs. Progress notes for continued Authorization • Be aware that there are two different types of progress notes that are requested. • Community First progress notes need to be a simple statement regarding progress the patient has made over the last month. These are due the 1st of each month. This is required by our Community First contract. (You can find out who your Community First kids are by looking at your RE list.) • Authorization progress notes are requested by various insurance companies in order to re-authorize services. They require more detail and need to include information regarding each goal and recommendations for continuation. These are time sensitive and need to be submitted within 24-48 hours from the date of the email, unless otherwise specified.

8. Abuse Neglect and Exploitation • Child abuse is an act or omission that endangers or impairs a child’s physical, mental, or emotional health and development. • Reporting requirements: • Texas Family Code requires “anyone who SUSPECTS” abuse or neglect needs to reports it • Professionals must report within 24 hours of first SUSPECTING abuse

9. Abuse, Neglect, and Exploitation Continued • Failure to report is a Class B misdemeanor punishable by imprisonment for up to 180 days and/or a fine of up to $2000. • Reporting suspicions to a supervision or other does NOT satisfy your obligation under the law (TFC 261.101). • Types of Abuse • Emotional abuse • Sexual abuse • Physical abuse

10. Abuse, Neglect, and Exploitation Continued • Types of Neglect • Physcial neglect • Medical neglect • Neglectful supervision • Abandonment • Refusal to accept parental responsibility ***see handout for more information on each of these types of abuse and neglect

11. Abuse, Neglect, and Exploitation Continued • Making the Report • When in doubt report • Be specific and factual • Focus on how the child is being endangered or impaired • Confidential vs. anonymous • Identity of all reporters is confidential • Reporters who act in “good faith” and “without malice” have immunity against civil and criminal liability • Anonymous reports are accepted via the hotline but can limit the scope of an investigation

12. Abuse, Neglect, and Exploitation Continued • Reports of abuse or neglect may be made over the telephone by calling: 1-800-252-5400 • Reports may be made over the internet at the following secure website: www.txabusehotline.org

13. Ipads for Patients • If an OT/PT feels that a child may be appropriate to receive an ipad through the state, talk to the child’s SLP, NOT the family. The SLP needs to be the one to make that decision. • Ipads from the state are for use as an augmentative communication device only, and the child must be determined to be appropriate for the ipad by the SLP. The state prohibits receiving an ipad for educational purposes.

14. Supervision • Supervisors please remember you get 1 point per therapy session, 1.5 per RE, and 1 for indirect when that assistant is working. • Supervisors (ST and OT)- please submit your supervision logs to Kristen in HR on the first of each month. • Please remember that you must complete direct supervision as outlined by your licensing board. For example, ST you must complete 1 hour of direct and 1 hour of indirect each week. If unable to complete this, you need to show documentation as to why, such as Assistant ST on vacation. This is required by your licensing board and is not just a Himmel requirement.

15. Why did we leave MJS? • Several reasons: • It was frustrating to therapists to open their schedules and see a big, red FAIL blaring at them. • It was frustrating to therapists and the office because it required the office to micro-manage therapist’s notes and clinical documentation. Nobody wanted that. • It’s billing system was seriously flawed, putting us in the position of possibly billing inappropriately, which could set us up for serious legal challenges.

16. Why did we leave MJS? • Reasons, continued: • When our billing department uploaded correct dates of service to the electronic billing system, MJS would re-translate the dates to future dates of service in 2013 and 2014. Obviously, we couldn’t have that! • MJS customer service was poor and could not take care of these challenges in a timely manner. • So, to make sure that we are billing appropriately, we left MJS after much debate.

17. Why didn’t we move to a different electronic system? • Chad and Heather searched for more than 6 months, via the internet, word of mouth, and exhibitors at conferences, to find an electronic system that would meet our needs. • We couldn’t find one. • Most electronic systems are created for geriatric nursing home health. • Many required internet access to be able to work on notes and evals. • The one that would possibly have worked, Healthwyse, was cost-prohibitive (requiring a 6-figure up front fee to get started, then taking a large percentage of each visit billed, whether we were reimbursed or not). In addition, after talking with the owner of an agency that currently utilizes Healthwyse, we found that this system is also flawed.

18. So, how did you come up with the current system? • SAM, the office software that we went back to, was the software we were using prior to MJS. It is quality billing and scheduling software that we had great success with prior. • But, since SAM does not have a point of care system, we adapted our paper versions of paperwork that we had prior to MJS and made it electronic. • We continue to look at software companies as we find them, but that search could take a long time. Electronic software systems are incredibly expensive, so before we invest in one again, we need to be certain that it will be quality and meet the needs of our therapists, office, and patients.

19. Some love it; some hate it! • To figure out why some people are happy with the switch and the paperwork and some despise it, we are going to do a survey. • If you want your opinion heard, please complete this survey!!!! • You will receive an email with a link to a survey monkey from Kristen today. Deadline for submission of surveys is Friday, March 8. • Heather also strongly encourages you to come and talk to her about what you like and dislike about the paperwork and any ideas you have for improvements. We can’t fix things that we aren’t aware of.

20. New Forms • Some forms have been updated. Effective today, these will be emailed to you and you are responsible for updating the signature line. • Communication Log- now has a place for you to date your signature • Physician’s Orders- now has a header and a place for you and the MD to date signatures • Illness report (on Missed Visit)- has a place for primary diagnosis (i.e. diagnosis for which patient is receiving therapy, NOT the diagnosis for the illness being reported) • Release/request for records- better clarifies what the document is to be used for.

21. How to edit a signature line? • You can ONLY edit a signature line from a computer with Word 2007 or later version. You CANNOT create or modify a signature line using your tablet (sorry!!!!) • You can use your home computer or an office computer. • To edit a signature line once you have created it, right click on the signature and select “Signature Setup.” • This will open the box that will allow you to change your settings.

22. How to edit a signature line continued. • A box will appear that says “Signature Setup” • Under “suggested signer”, type your professional name and credentials (ie Heather Schraeder, MS, CCC/SLP) • Under “suggested signer’s title, type your title (ie Speech-Language Pathologist) • Click OK • (You can skip entering your email address)

23. New Auth Letters • Welcome Cynthia Whitehouse, our newest auth coordinator! • New division of letters for the auth team based on the patient’s last name: • Stacey: A-E • Sonia: F-L • Cynthia: M-Rn • Tara: Ro-Z • Carlos: Authorization Supervisor, discharges

24. Time Study- Thank you!!! • Thank you to our participants who stuck with the time study for the entire 4 weeks! Andrea Dapkewicz Beckie Stratemann Sheryl Jonsson Christine Garza Trisha Wade Cecilia Perez Jamie Bishop Laura Andrews Lynda Glasgow Becky Massirer Rose Chase Vanessa Morris Kellie Westbrook Mallory Whitenton Randa Mullins

25. Time Study Results- To Come • We are analyzing the data and will have a synopsis for you at April’s staff meeting. We got great information from it, and I think it will make you all feel good!

26. Check Us Out on Univision! • Univision will be featuring Himmel on a segment called Helping Hands on Monday, March 4 at 10:00 (that’s this coming Monday). • Tune in or set your DVR to see our new stars, Isela, Rose, and Alicia… oh and of course Isela’s daughter, Issa, who was the absolute star of the shoot! • Thank you so much for all your help, Isela, Rose, and Alicia! • Also, thank you to those who volunteered patients!

27. Miscellaneous • Happy Birthday!! • Shannon McElroy 3/18 SLP NB • Lynda Glasgow 3/30 PTA SA • Jennifer Ramirez 3/22 office SA • Spring Break is this month, please plan ahead and talk to your families about schedules and services that week, especially if the patient is attending a Head Start facility or daycare….. • TSHA- if you plan on going please let Kristen in HR know. Please be sure to stop by the booth!! Heather and Kristen will be holding down the fort, and we’d love to see you! • Happy 10 year wedding anniversary, Chad and Heather today (March 1, 2003)!!!!

28. Referral Bonus • If you know any OTs looking for a job, please send them our way! • Check with Kristen to see what referral bonuses Himmel is offering!!

29. Next Staff Meeting • Friday, April 5, 2013 at 9:00 for both offices. • Please make arrangements to be present!

30. Happy St. Patrick’s Day