Here's why your therapy facility might need a risk manager

When most of us think of managing risk at our facilities, we envision installing treads to prevent falls or developing a plan designed to avoid the disappearance of wheelchairs from our facility. But the job of a risk manager also includes preventive measures in the compliance and regulatory arenas that keep your practice off the Office of Inspector General's (OIG) radar screen.

Depending on your therapy setting and the size of your facility, you may have a risk manager designated specifically for related matters, or you may have various administrators and other staff members sharing these tasks. Either way, you should identify risk areas that need attention and get organized in 2004.

Consider the compliance and regulatory areas below. Scot Hasselman, JD, an attorney with Reed Smith, LLP, in Washington, DC, believes risk managers should be aware of these and periodically check on them in their facilities:

Certification/recertification. For a patient to receive therapy under Medicare, he or she must receive a prescription or referral from a physician. Once the therapist receives the prescription, he or she must write up a plan of care that includes the frequency and duration of each necessary modality, as well as the goals the patient is trying to achieve. The physician must then sign the plan of care and certify the need for therapy services on a periodic basis. Problems often arise, however, when the turnaround time is tight and the physician's signature is difficult to secure.

Eight-minute rule. Even though therapists count minutes and units of therapy on a daily basis, the eight-minute rule is an area of perpetual confusion. See the box below on minutes for details. In addition, therapists must aggregate minutes provided in more than one timed modality.

Group therapy. Your facility's therapists and billers should understand not only Medicare's billing rules for group therapy, but also its rules about group therapy for patients who have private insurance. This understanding can help you avoid denied claims and improve your reimbursement for group therapy. "A risk manager needs to help [staff] understand that how you treat patients may differ when there are different payers for each patient [in group therapy]," says Hasselman.

Varying state licensure. "If you're going to be a risk manager, you need to be familiar with state and federal requirements," says Hasselman. This involves ensuring that therapists keep their licenses up-to-date and follow state practice act laws. If a therapist loses his or her license, Medicare can exclude him or her from receiving program reimbursement.

Do you have what it takes?

Although they may come from varied backgrounds, successful risk managers exhibit the following traits, according to Hasselman:

Willingness to learn. Because CMS regulations and licensing requirements change frequently over time, a successful risk manager must be willing to continue learning throughout his or her tenure.

Willingness to teach. Risk managers should take the initiative in spotting potential obstacles at their facilities, but they also need to train others to do so. Organizing training sessions and providing staff members with the necessary resources are key ingredients in serving a facility well in this position.

Willingness to ask questions. Risk managers should not be shy, according to Hasselman. "[They] must be willing to be the cop because they are in charge of making sure that everyone is licensed," Hasselman says. In some facilities, risk managers may also conduct background checks on potential employees, he says. "Sometimes you have to ask personal questions."