Resources to be a Successful Home Health Therapist
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1099 Tips
A contractor is a beautiful career path, even if it is a learning curve. It gives you flexibility and increased pay by submitting the right documentation to the IRS for tax purposes. Therefore, the number one thing to research is ‘what you need to know as a contractor when it comes to taxes.’
Mileage IQ App or Stride, or other mileage apps: Keep track of all your mileage through an app providing annual reports for your tax purposes. This is key! (detailed mileage reports are required by the IRS to reimburse you per mile)
Supplies: Keep track of the supplies you purchase, keep the receipts and submit at time for tax returns as a tax write-off (i.e. bag items you purchase including gloves, ETOH wipes, gait belt, sock aide, square footage of your home office, etc).
Expenses: Keep track of your car expenses (receipts) as these can also be written off on your tax returns. (i.e. oil changes, tire rotations, new tires, or a new car altogether; either or can be a tax write-off)
Additional Resources: Here are some additional websites available with data that will assist you in this venture:
https://sharedeconomycpa.com/blog/2018-tax-updates-for-1099-contractors/
CPA Tax Support and Tax Planning Resource
1) Casillas CPA & Consulting LLC @720-626-4838 or https://cpacasillas.wordpress.com Please let them know you are calling from ATS for Tax Prep and Planning.
2) Fran Parker - Director of Accounting @PWB Tax & Accounting Solutions, LLC www.pwbtaxaccountingsolutions.com Office Phone: (404) 537-3151, Mobile Phone: (217) 497-9626
3) DC Finance https://www.dcfinanceservices.com; 685 Briggs St, Erie, CO 80516, Phone:(720) 429-4232
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Bag items should include:
BP cuff
Stethoscope
Pulse ox
thermometer (temporal or ear)
gait belt
gloves
alcohol wipes
disinfectant wipes (Clorox or medical grade)
bag barrier (disposable or reusable, or bag on wheels)
monofilament test
spill kit
CPR shield
goniometer
standard precaution kit
Recommended:
eye light pen
therapy band
estim/ultrasound (or other fav modalities)
bio freeze/ or other cryotherapy
exercise ball
cones/cups
**Please make sure to review bag technique by watching the video provided
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How to Build LLC for Tax Purposes
Step 1: Complete the application for your own LLC at: https://www.coloradosos.gov/business/filing/llc/entityname
To prepare your articles, you'll usually need the following information:
Your LLC name.
The LLC's street address.
The name and address of your registered agent (you will use your name and address as the registered agent).
The effective date of your business.
The name and address of the person forming the LLC.
A reason why you formed the LLC. This can be a general statement (such as independent contractor).
Management structure: Will managers or members manage the LLC? (this would be you only)
A statement that LLC will be run by at lease one member.
The person forming the LLC is required to sign the articles.
The name and address person filing the LLC the articles.
The state will issue you a certificate that confirms the LLC formally exists after the LLC's formation documents are filed and approved. The Colorado Secretary of State won't mail a confirmation, but you can access the certificate it by selecting “Filing History and Documents" on your LLC's summary page.
This certificate will allow the LLC to obtain an Employer Identification Number (EIN), business licenses, and a business bank account. Please note: You do not need an operating agreement.
Step 2: Apply for your EIN after you have your LLC application completed at: https://www.irs.gov/businesses/small-businesses-self-employed/apply-for-an-employer-identification-number-ein-online (You do not need an EIN from CO, only a federal EIN)
Step 3: Update your W9 in SOLI with your LLC name and EIN number instead of your SSN! That’s it!! Welcome to the world of owning your own business through ATS!
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What to do when you can’t get in contact with a patient
Call the patient phone number listed on SOLI, leave a message if possible
If the patient SOC was started, that means someone has made contact. Reach out to other therapists for information on how to best contact the patient.
Try calling the emergency contact listed in Soli; Text the patient; Confirm you have the correct patient phone #
Call the Agency’s contact listed on Soli. Speak with them about the best way to reach the patient.
Finally, after notifying the agency, if the agency is in agreement to non-admit, notify the ATS task force before completing the non-admit documentation and call the MD. The ATS task force needs to be notified of a non-admit to remove scheduled evals in kinnser as well as to know for case conferences
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Communicate with your supervisor often
Document your daily communication with the supervising therapist
Make sure you pay attention to frequency set
Make sure the re-evals (once every 30 days at least) and DCs are plotted correctly
Refer to the Frequency Tool if you have questions
Use ATS Kinnser to view the patient calendar for plotted visits. This will give you a visual cue on what weeks you need to see the patient.
If patient is not ready for DC, please communicate with the therapist before the therapist re-evaluates.
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At minimum 30mins of face to face skilled care with a patient, documentation time should be added to your total time (i.e. Face to Face with the patient 30mins and document for 15mins = 45mins total)
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Scheduling Your First Visit
Introduction by Phone: “Your doctor has ordered home health ‘Physical Therapy’ for you. Therefore, I am calling to schedule your initial appointment, as your doctor prefers we come out to see you as soon as possible. I currently have a ‘2:00pm available on Friday,’ would that work for you? Or do you have another day and time that you prefer?”
Make sure to paint the picture for the patient that their schedule is the most important. Don’t share your personal scheduling conflicts, rather offer other times that work for you and them. The number one complaint from a patient regarding a therapist is ‘they made it seem like their schedule was more important…I don’t care if their kid was sick, I need my therapy’….or… ‘they talked too much about themselves.’ Home health is FLEXIBLE, so have an idea of what your personal boundaries are before calling to schedule with a patient to alleviate any headaches from either end.
Key Questions to ask: Before I come out to see you, I just have a few questions to ask:
Have you ever had home health therapy in the past?
If not, home health therapy is covered by your insurance as long as you are considered homebound, meaning it is a taxing effort for you to leave your home. (Make sure they are homebound to prevent wasted time on your end and the patients end)
Do you have any special instructions on where to park at your home?
Any special instructions on how to enter your home?
What is your current greatest challenge that you need home health therapy for? (this will help you plan wisely for a successful first visit)
Calling to schedule re-visits: “Hello my name is ______, PT/OT/ST home health. I met you at the initial evaluation on (ex.Monday)_____ and I am calling you today to schedule your next visit as your doctor approved the plan of care. How does Tuesday at 8:30am sound?”
It is best to schedule regular visits if possible for the entire treatment plan to alleviate any confusion or missed visits (i.e. How does every Monday/Wednesday at 8:30am sound?).
Always plot your visits on a calendar in the patients home for better customer service and decreased missed visits. This is a requirement from the conditions of participation for Medicare and customer service.
Introducing Yourself
Reminder: You are constantly inadvertently marketing yourself in all interactions with families, patients, retirement facilities and doctors. So, always introduce yourself in a professional manner:
Introduction by phone: “Hello my name is _________, I am a ‘Physical/Occupational/Speech Therapist’ representing (Ex. “Accent Care/Alliant/Team Select etc”)_Home Health. Your doctor has ordered home health ‘Physical/Occupational/Speech Therapy’ for you. Therefore, I am calling to schedule your in home therapy appointment.”
Introduction in person: (Offer to shake hands) “Hello my name is _________, I am a ‘Physical Therapist’ representing (Ex. Accent Care/Choice/Optimal” Home Health. It is a pleasure to meet you. As mentioned by phone, I am here to initiate your (PT/OT/ST) home health therapy. Thank you for letting me come to your home today.”
“First, I’d like to ask if there are any details you prefer when I enter your home” (i.e. take my shoes off, knock and then enter).
“Second, do you have any scheduling preferences moving forward” (i.e. do you prefer mornings, afternoons etc).
“Third, please remember I am here to help you per doctor’s orders. It is important that we develop a treatment plan together in which we are both in agreement to prevent missed visits and assist you in meeting the highest level of functional independence.”
“Now, let’s get started with the evaluation/treatment.”
Exiting the home: After completing the visit or evaluation, clean up any items you might have used (please refer to the bag technique for details); clean your hands and offer another hand shake.
“Thank you so much for your time today, and thank you for allowing me to evaluate you. It was a pleasure meeting you and I look forward to working with you in the future. I wrote my number on your calendar should you need to call me with questions, concerns, or if you need to reschedule a therapy session. I will see you next time.”
Eye contact is key
Bag tech upon entering/exiting the home is key
Wear proper name badge
Dress professionally and remember to wear closed toed shoes
Wear proper foot wear and be prepared with shoe covers, should the patient request you to take off your shoes or wear covers depending on your comfort and theirs.
Remember to smile over the phone and in person, this will alleviate the patient’s anxiety and anticipation of you coming to their home. (They are likely to be nervous, as their home is their sacred place and they need to learn to trust you with excellent customer service)
If you need to step out or take a call, please remember to say “excuse me for just a moment” or “just a moment please.” NEVER take a call unless it is absolutely necessary while you are with a patient. Time is valuable.
It is important to be intuitive to each patients needs and communicate as appropriate. (i.e. some patients enjoy learning about your personal life, while others complain if you talk too much about your personal life…this can be hard to determine sometimes, but something to be mindful of.
Always ask if it is ok that you document your notes while in the home. Some patients do not appreciate the attention on your tablet/phone rather than quality treatment time 1:1. Therefore, explain and ask them upfront if they mind if you document during the treatment.
How to present yourself at an Assisted Living Facility or Retirement Facility
***You are constantly inadvertently marketing yourself in all interactions with families, patients, retirement facilities and doctors. So, always introduce yourself in a professional manner:
Introduction in person to facility: “Hello my name is _________, I am a ‘Physical/Occupational/Speech Therapist’ representing (Ex. “Accent Care/Alliant/Team Select etc”)_Home Health. I am here to see one of your residents. Are there any specific processes I need to know about, such as who I leave the progress notes for after the treatment?”
Sign in and out of the vendor list at each facility
NEVER wear your Alpine Name Badge into a facility, unless you have the Alpine logo covered by a sticker indicating the company you are representing and if you have a surveyor with you.
Make sure to bring a facility progress note (blank) to be filled out during your treatment with the patient and to leave with the wellness director (depending on the specifics of each building). Progress notes are typically needed for all ALFs, SNFs etc, but not needed for ILFs.
Introduce yourself in the same manner to the wellness director or point person receiving your notes upon first visit. “Hello my name is _________, I am a PT/OT/ST representing (i.e. referring company). I just wanted to introduce myself as I am treating a resident in your building. I will leave progress notes each visit to keep you in the loop, but please feel free to reach out to me directly should you need additional information or have concerns.” The wellness directors will advocate for you and possibly refer patients directly to you/Alpine Therapy Services with this type of approach. This is where you can really market yourself!!!
Introduction in person to the patient: (Offer to shake hands) “Hello my name is _________, I am a ‘Physical Therapist’ representing (Ex. Accent Care/Alliant/Team Select” Home Health. It is a pleasure to meet you. As mentioned by phone, I am here to initiate your (PT/OT/ST) home health therapy. Thank you for letting me come to your home today.”
“First, I’d like to ask if there are any details you prefer when I enter your home” (i.e. take my shoes off, knock and then enter).
“Second, do you have any scheduling preferences moving forward” (i.e. do you prefer mornings, afternoons etc).
“Third, please remember I am here to help you per doctor’s orders. It is important that we develop a treatment plan together in which we are both in agreement to prevent missed visits and assist you in meeting the highest level of functional independence.”
“Now, let’s get started with the evaluation/treatment.”
Remember that patients in facilities talk amongst themselves about their favorite therapists, so again remember you are marketing yourself in every face to face encounter with these facilities.
Exiting the home: After completing the visit or evaluation, clean up any items you might have used (please refer to the bag technique for details); clean your hands and offer another hand shake.
“Thank you so much for your time today, and thank you for allowing me to evaluate you. It was a pleasure meeting you and I look forward to working with you in the future. I wrote my number on your calendar should you need to call me with questions, concerns, or if you need to reschedule a therapy session. I will see you next time.”
Eye contact is key
Bag tech upon entering/exiting the home is key
Dress professionally and remember to wear closed toed shoes
Wear proper foot wear and be prepared with shoe covers, should the patient request you to take off your shoes or wear covers depending on your comfort and theirs.
Remember to smile over the phone and in person, this will alleviate the patient’s anxiety and anticipation of you coming to their home. (They are likely to be nervous, as their home is their sacred place and they need to learn to trust you with excellent customer service)
If you need to step out or take a call, please remember to say “excuse me for just a moment” or “just a moment please.” NEVER take a call unless it is absolutely necessary while you are with a patient. Time is valuable.
Always ask if it is ok that you document your notes while in the home. Some patients do not appreciate the attention on your tablet/phone rather than quality treatment time 1:1. Therefore, explain and ask them upfront if they mind if you document during the treatment
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What is it?
Frequency is the number of visits per week set at initial evaluation, to include the evaluation and discharge visits.
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Health Insurance Option for W9 Therapists
1) CO Health Insurance Brokers @303-541-9533 or http://cohealthbrokers.com Please ask for Jaime Smith and let her know you are with ATS for health, dental and/or vision insurance for contractors. They have family plans available as well!
2) AMAZON offers health insurance plans as well - click here for more details.
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HOW TO STAY ORGANIZED
Write everything down!
Use some sort of digital calendar for patient scheduling. Apple Calendar syncs both with iPad and iPhone. This will prevent you from having to erase or scratch things out on a handwritten calendar.
Incorporate different colors for different tasks on the calendar. Examples would include but are not limited to: confirmed visit, note incomplete, note complete, odd patient issue, hospitalized, etc.
Save the agency name and Sandata ID with the patient name on your calendar for quick reference
Have a system or reference sheet to keep track of documentation systems and logins for various agencies
HOW TO PLAN YOUR DAY
Get to know your patients!
Find out which patients get up early and would be willing to see you in the morning
Make sure to ask every week about MD appointments and other scheduling conflicts coming up in order to work around those
Know which patients require slightly extra time and plan accordingly
Front load your schedule
Don’t wait to schedule patients later in the week.
They may have scheduling conflicts that you need to know about sooner, rather than later.
Often there are a lot of referrals coming in prior to the weekend so always try to leave room in your schedule at the end of the week for new patients
Start your day as early as possible. The earlier you start the earlier you’re done and you can also work more new patients in on short notice.
Set the expectation for 30-40 minute treatment visits right away. We get paid per visit, so you are essentially working for “free” during anything over the minimum billable time.
You have to “tell” your patients when you will see them as opposed to “ask”
Explain how you have to drive all over during the day and that you are only available to see them on certain days of the week or certain times of the day. If need be, compare yourself to the patient having an MD appointment and how the MD is only available at certain times, certain days. This usually puts things in perspective as most patients have to wait weeks if not months to see an MD.
Schedule patients with a 30 minute window for your arrival (ie. “between 1-1:30pm) to give yourself more flexibility during your day
Schedule patients that are near each other, you want to spend as minimal time as possible on travel time between patients. You aren’t paid for your drive time so try to decrease it as much as you can
Every time you’re looking to pick up a new patient, pull them up on GPS and see how you can work them in to your schedule.
Most patients are seen twice per week, have your Monday/Wednesday patients, Tuesday/Thursday patients and use Friday as a catch all. Try to use Fridays as a day to complete new Evals/SOCs or make up visits from earlier in the week.
HOW TO DOCUMENT TIMELY
Never go to bed with incomplete documentation from that day!
Before you leave to your next patient, make sure you have vitals, subjective, objective, assessment and plan written down.
If possible, try to completely finish your note prior to leaving for your next patient
Once you finish notes for the day, prep for the next day
Make sure every visit for the next day is plotted and scheduled on the appropriate documentation system
Make an evaluation and treatment template for each patient and update as needed for every re-evaluation/regular visit (use something like Word or Notes on an iPad). These templates can easily be copied and pasted into the appropriate documentation system and will make completing notes much quicker on a daily basis.
If you have any new Evals/SOCs, read through the PMH and write down what you need to for the visit
HOW TO MAINTAIN GREAT COMMUNICATION
Communicating with patients
Find out if patients have a preference between calls or texts for scheduling.
Plan ahead! Scheduling in person will decrease the amount of phone calls you make and will help exponentially with scheduling. Many patients are hard of hearing, get confused on the phone or forget to write down when you’re coming.
Get to know your patients personally during your first visit. Ask them a few questions about things other than their medical history. Often times our patients have little to no one to talk to. This will help to develop patient rapport.
Write things down, even if patients say they will remember. Always write down when you’ll be back. This helps to decrease confusion, keeps family members up to date and decreases the amount of missed visits you may have
Check your email, SOLI (new patient requests), TigerTexts, and texts between each patient. This will help you stay updated throughout the day without being completely overwhelmed at the end of the day
Make sure you are touching base with other therapists involved in patient care on a weekly basis, whether it be assistants or other therapists working with the patient. This will help to make sure you are all on the same page in regards to POC, re-Evals, DCs, etc
HOW TO ENJOY FLEXIBILITY OF BEING A 1099 THERAPIST & KEEP A WORK LIFE BALANCE
You’re your own boss; You can work as much or as little as you like!
Make sure to communicate with the ATS task force in advance anytime you will be taking off in order to get visits covered and allow you to fully enjoy your time off
Besides work, during the “work week” always try to do something active for at least 30 minutes each day Monday through Friday. It helps to stay physically and mentally sharp during the work week.
Set limits for yourself. Take at least one day per week completely off from work. Everyone needs to take to time relax and recharge.
You live in Colorado, get out and enjoy it! Always make plans on your non work days so you have something to look forward to. This will help with motivation during the week to work harder and prevent burnout.
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How to call a Doctor’s office for orders
**Make sure to have the SOLI app open when calling the MD office to provide the patients name and DOB, as well as the company you are representing.
Introduction/VO request by Phone: “Hello my name is ________, PT/OT/ST representing _________ company for patient ________ whose DOB is __________. I am calling to request verbal orders to continue therapy ___(i.e 2w2 starting next week) as I completed the initial evaluation today. My care plan focus will be on _______(i.e. strength, balance, endurance, gait, ADLs, dysphasia). Questions, you can call me at ___________ and leave a confidential voicemail.
REMEMBER: Always make note of who you spoke to, time of day you spoke to them and date. Keep record of this in case the Verbal Order is ever in question by a company. You must have a verbal order to continue skilled therapy, UNLESS we are specifically told otherwise (in the case of VA patients only). This protects your individual licensure. This information will be written on the patients chart as a new order, communication note or within the evaluation itself. Please refer to the individual company protocols for details.
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How to Stay Organized in Home Health:
It’s important to remember that organization is KEY to success at ATS. It will assist your work/life balance and increase your enjoyment in this position. Everyone is different, so please note these are simple suggestions and considerations. Let us know if you have other ideas to assist in organizational skills or if you have any questions!
Consider using a calendar/planner with pencil to erase and re-arrange your schedule as needed for patient visits.
Consider using a bullet point next to the patients names on your calendar once you have completed the note, and a check next to the patients names on your calendar once you have billed for the visit in Alpine Kinnser.
Have a folder in your car available with extra HEPs, SOC forms, NOMNC forms etc for each company you are representing.
Organize your bag and develop a bag tech process that is natural for you to stay organized and infection free.
Complete your documentation daily to prevent disorganization and to have a better work/life balance.
Keep a notebook for notes to include items such as VO’s in case a VO is lost in documentation. Always keep a copy, even if it’s also in your calendar/planner.
Consider using the notes section of your smart phone if you are unable to document while you are with the patient.
Create a To Do list to prevent forgetting items that are needed, such as obtaining VO or speaking to the treatment team about your concerns related to a patient.
Make sure to plot your patients on your calendar from initial visit, to include re-evals and DCs to assist you in your organization. This will also make sure you to don’t miss deadlines, such as recerts, re-evals or DCs, or miss frequency.
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TIPS FOR NATURAL DISASTER:
What is it? How to be prepared
Where can I find it? (BELOW)
Fill your car with gas
Store important documents like passport, SS card, etc in a waterproof/fire proof container
Have a first-aid kit available
Keep away from standing water and floodwater, or fire
Charge your phone
Extra Supplies – store 2 week’s worth of toilet paper, paper towels, canned foods and water as well as extra pet food
Store batteries and flashlights in a safe location in your home
Have an evacuation plan ready if needed
Have a savings account with at least 2 months of pay checks reserved in the event of an emergency.
What to watch for:
Call 911 if you become trapped or need immediate medical assistance
Keep track of your extra supplies, always. ALWAYS be prepared!
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TIPS TO STAY HEALTHY:
What is it? How to take care of yourself while treating patients.
Where can I find it? (BELOW)
Take care of yourself (do what fills your cup, ex. Run, bike, yoga etc)
Drink Green Tea
Stay hydrated
Consider taking supplements such as Vitamin B12, Vitamin D and Glutathione
Up your Vitamin C intake from fruits and veggies
Eat healthy
Make sure to get quality sleep
Reduce alcohol intake
Exercise at minimum 20mins/day
Consider meditation
What to watch for: (use the ATS phone tree if you begin experiencing the following symptoms)
Fatigue
Fever
Shortness of breath or difficulty breathing
Cough
