Medicare Documentation and Medical Necessity

See How Much You Could Save with SPRY!

This calculator helps you compare the costs of insurance eligibility verification using traditional methods, competitor solutions, and SPRY EMR. Adjust the values below to see how much your clinic could save by switching to SPRY’s real-time verification solution.

Your Clinic’s Current Metrics

Adjust the sliders to match your clinic’s numbers. The calculator will do the rest!

Monthly Patients Enter the total number of patients your clinic sees each month.

100

% Needing Verification Enter the percentage of patients that require insurance eligibility verification.

Minutes Per Verification Enter the average number of minutes it takes to complete a verification.

Staff Hourly Rate ($) Enter the hourly wage of your staff performing verifications.

Denial Rate (%) Enter the percentage of claims that are denied, which could impact verification costs.

Average Claim Amount ($) Enter the average amount billed per claim.

150

Competitor Cost Per Verification ($) Enter the cost charged by your current competitor for eligibility verification per patient.

Monthly Cost Comparison

See the SPRY Difference!

Traditional Process

Competitor Solution

SPRY EMR

Projected Annual Savings with SPRY: $0

Based on 0 verification volume, SPRY could help you save significantly on time and costs annually.

CPT to RVU Calculator

Our user-friendly CPT to RVU Calculator takes the hassle out of RVU calculations. Simply enter the CPT (Current Procedural Terminology) code, and the calculator instantly provides an estimated RVU value.

Calculate Your wRVU Value Now

Select CPT Code: Choose the appropriate CPT code for the procedure performed. (For example: 99213 for an office visit or 99396 for a preventive care visit.)

Number of Units: Enter the number of units billed for the selected CPT code. (For instance, if you performed the procedure twice, enter "2.")

Timed Up and Go (TUG) Test Calculator

The Timed Up and Go (TUG) test is a simple and widely-used assessment to evaluate mobility, balance, and fall risk. This calculator helps you interpret your results based on completion time, age, and health condition.

Calculate Your TUG Test Score

Time to Complete (seconds): Age (years): Health Condition (1 = Poor, 5 = Excellent):

Timed Up and Go (TUG) Test Reference Table

Time (seconds)	Interpretation	Risk Category
Under 10	Normal	Low Risk
10 - 19	Normal for Older Adults	Low Risk
20 - 29	Borderline	Moderate Risk
30 or more	Abnormal	High Risk
Over 45	Severely Abnormal	Very High Risk

Gait Speed Calculator: Assess Your Walking Speed

Calculate Your Gait Speed

Enter Distance: Enter Time:

Your Gait Speed is: -

Gait Speed Reference Table

Understanding your gait speed can help assess mobility and health. Use the table below to compare your result with typical walking speeds for different age groups.

Age Group	Men's Gait Speed (m/s)	Women's Gait Speed (m/s)
Young Adults (20-40 years)	1.2 - 1.4	1.2 - 1.4
Middle-aged Adults (40-60 years)	1.1 - 1.3	1.1 - 1.3
Older Adults (60-80 years)	0.9 - 1.2	0.8 - 1.1
Very Elderly (80+ years)	0.7 - 1.0	0.6 - 0.9

Therapy Productivity Calculator: Optimize Your Efficiency

Therapy Productivity Calculator

Productivity Based on Billing Units

Time Spent with patients (hours):

Total Units Billed:

Productivity Percentage: 0%

Therapy Productivity Calculator

Productivity Based on Time Efficiency

Time Spent with Patients (hours):

Time Spent on Documentation, Scheduling, etc. (hours):

Total Available Time (hours):

Productivity Percentage: 0%

Deciphering Medicare's Core Guidelines

Medicare has laid out specific criteria that define the core of therapy services. Here's a distilled understanding:

Clause: Only when therapy services demand a certain level of complexity and expertise do they qualify as skilled.

What this means for you: If you're seeking reimbursement from Medicare, ensure that a qualified therapist directly oversees the patient's treatment. Your records should indicate the patient's dependence on the therapist for the activity.

Clause: Skilled services either enhance, maintain, or prevent the decline of a patient's health status.

What this means for you: Your records should paint a clear picture of how your services are either improving, sustaining, or halting the decline of the patient's health.

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Medicare's Perspective on Sustaining Current Health

If you're aiming to provide services that maintain a patient's current health status, Medicare has a checklist:

1. Your records should make a compelling case for the need for skilled personnel to achieve this maintenance goal.

2. Consistently update your documentation to reflect progress toward treatment goals. Think of it as a health diary, with entries made at least once every ten visits.

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The ABCs of Medicare Coverage

For Medicare to cover a therapy visit, ensure the following:

The treatment plan is penned down either by a physician or therapist.
The plan zeroes in on specific treatment objectives, detailing the modalities, frequency, and duration.
The documentation should objectively measure the patient's functional limitations.

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Crafting a Medicare Plan of Care (POC)

When sketching out a plan of care for Medicare, remember:

A nod from the referring physician is a must.
Major tweaks to the POC? Get them greenlit by the referring physician.
The physician should re-certify the plan within its initial duration or 90 days from the start of treatment, whichever comes first.
Clearly outline the treatment's frequency and duration in the POC.

Reduce costs and improve your reimbursement rate with a modern, all-in-one clinic management software.

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