Units per Visit KPI

When we think about billed units, there are really two main ways we can look at this. We can look at a volume metric and dictate a specific number of units that should be billed out for each visit. Or, we can look at treatment focus and determine the correct ratio of treatments applied for that type of visit (e.g., we expect a 2:1 ratio of therapeutic exercise to therapeutic activity).

At the end of the day, time is money. It's important to examine the units your providers are billing per visit, focusing on the quantity and type. In addition to uncovering instances of over- or under-billing, you can also determine if your clinics are billing in the way that is representative of the treatment provided. Billed units are often a direct representation of the patient’s care plan.  

Click on this chart to open the By Clinic comparison chart for Units per Visit. You’ll be able to see a breakdown of this data by clinic, view a data table containing the calculation values, and export the results.

Calculation

  • Visits: The total number of finalized, billable notes with a Date of Service that occurs within the given date range. Excludes no-charge visits.
  • Billed Units: The total number of billed CPT codes for a given date range, as pulled from finalized notes. This does not include G-Codes.
  • Units per Visit: the average number of CPT codes billed out for a visit, as documented in the SOAP note. Excludes no-charge visits and G-codes.

These figures include finalized notes for both SOAP 1.0 and 2.0 Data.

Strategies for Management

Be aware of incorrect billing practices. These typically appear as outliers in the data.

Overbilling

Typically, overbilling occurs in the following ways:

  • Upcoding: charging for services that are more expensive than the ones that were actually delivered.
  • Utilization Abuse: scheduling extra visits or providing unnecessary services to generate additional revenue.
  • Overcharging: charging additional units of the services the therapist performed or tacking on codes for services the therapist didn’t perform at all.

Underbilling

On the other side of the billing coin is underbilling. This typically occurs when clinics:

  • Incorrectly follow the 8-minute rule for Medicare beneficiaries
  • Document and bill using the 8-minute rule with payers to which that rule doesn’t apply
  • Attempt to cancel out Medicare overpayments
  • Fail to identify all billable codes
  • Undercode due to CCI edit/bundled code confusion (this issue is especially common; many PTs don’t understand modifier 59)

Data Requirements

There are a few things to remember about the data the make up the Units per Visit metric. To be included in the reporting, each of the following must be true:

  • The visit (finalized note) must be active (not inactive or deleted)
  • The billed unit must not be a G-code
  • The visit must contain billable CPT codes
  • Billed units must belong to a finalized note

Therapist Attribution

The therapist who forwards the note—this is the Documenting Therapist in Analytics—will be allocated the billed units. This really only matters in scenarios where the note was forwarded to another provider, which typically occurs when the person who forwards the note is an assistant. If the note was never forwarded, the individual who finalizes the note is also the Documenting Therapist.

Custom Codes

While you will be able to view all billed custom codes in the Billed Units analysis grid, these will have a zero unit associated with them. We purposely have designed the integration to bring over the custom code itself but not the number of units billed. This ensures custom codes will not skew the Units per Visit metric.

Data Best Practices

Follow the link for all recommend Analytics Data Collection Best Practices.

  • Finalize notes in a timely manner.
  • Include a Daily Note with evaluative notes if you want to bill for them, as billing data only flows over through the Daily Note.