Demonstrating Value and Cost Avoidance

Example

Physical Therapist

Physical Therapist Evaluates and Treats Patient

PT documents services provided via CPT/ICD-10

Revenue Generation

Physical Therapist bills insurance provider for services.

Athletic Trainer

Treatment done in-house. Billing not needed

Cost Avoidance

Patient recovers, preventing need for seeking PT.

Athletic Trainer Evaluations and Treats Patient

Step One:

Create a Master Document

• Work with your classmates to create a master document (excel or google sheets) that lists represents every CPT code the class has found.

• When you create this document, you should have a minimum of four labeled columns:

Non-Facility Price

Description

CPT Code

Facility Price

Determine Value of CPT Codes

Step Two:

• Navigate to the CMS.gov using the link in this week's Organization and Administration Course.

• Use the search engine to determine the "Facility Price" and "Non-Facility Price" of all the CPT codes on the Master Document.

Facility Price: Billable in in-patient facilities like hospitals where there is large facility overhead required. ATs in hospitals, nursing homes, or urgent care clinics will use these prices.

Non - Facility Price: Billable in out-patient facilities like physician offices, physical therapy clinics, and Athletic Training facilities. Most ATs will use non-facility prices.

Organize and Assess your CPT Codes

Step Three:

• Organize you and your partner's CPT codes from the last five weeks into a new document. In this new document, you should have four columns as seen below.

Number of Times Logged

Fee Schedule Price

Total Cost Avoidance

Description

CPT Code

• To determine the "Total Cost Avoidance" of each CPT code simply multiply the "Fee Schedule Price" by the "Number of Times Logged". Once you've done this for each CPT code, calculate your TOTAL COST AVOIDANCE over the last five weeks from all your CPT codes.

Note: Each member of the group should do this separately.

Final Report

Once you've totaled up all of your CPT codes and determined your total cost avoidance over the last five weeks, you will prepare a final report that you will submit to Canvas in the form of a five slide PowerPoint.

Slide One:

The first slide of your PowerPoint will be a the title page. This title page should include the names of you and your partner, as well as a title of your own choosing.

Slide Two and Three:

The second and third slide of your PowerPoint will be an individual breakdown of the last five weeks for each of the two group members. On this slide the following information must be present:

1. Top three most commonly reported CPT codes.

2. Revenue generated from these top three CPT codes.

3. Total revenue generated from all CPT codes over the last five weeks.

4. One graphic of your choosing to demonstrating value from the data collected.

Slide Four

The fourth slide will be a breakdown of BOTH you and your partner's data from the last five weeks. In this slide, you will need to include all of required information from slide two and three seen above.

Final Report

Slide Five

In slide five, you will be reflecting on the process of demonstrating your cost avoidance. This can be done in a narrative format or through voice recording if you so choose.

Reflection Questions:

• How was the process of collecting your CPT codes? If you were to do this project again, what could you do to make the collection process easier?

• When you and your classmates made the master CPT code document, did your group leave out any important codes? If you were to do this project again, would you track any additional codes?

• What are some ways you could scale this project up to a full sized Athletic Training Clinic with multiple Athletic Trainers?

SUBMIT YOUR FINAL PROJECT TO CANVAS!