Physical therapy services

Medical Billing — Its Role and What it Means to Your Office Structure

by Nitin Chhoda PT, DPT | Jun 30, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

A structured medical practice is essential to ensure that reimbursement claims are submitted in a timely manner.

Missing, lost, misplaced or improperly filed patient records creates unnecessary medical billing delays and interrupts the flow of funds into the practice.

Organization is the key to a well-run practice that treats as many patients as possible and generates a steady stream of reimbursement claims for medical billing and coding specialists to process.

In the absence of clear cut rules, direction and procedures, waste and chaos results. Distracted billers can make costly mistakes.

Filing practices
Maintaining accurate and easy to access patient records is essential if a biller is to do his/her job. The information contained within the patient’s record is the basis upon which reimbursement claims are filed.

Incomplete, inaccurate or illegible records cause delays in medical billing and can easily result in a payment denial or rejection. The information needed to obtain payment must be maintained in a manner that allows billers to quickly access the information they need to submit claims.

Each to his own task
In smaller practices, staff members may be required to wear a variety of hats, including the clinic’s medical billing and coding specialist. While it’s possible for a clinic’s healthcare staff to multi-task by answering phones, looking up records, scheduling appointments and communicating with other healthcare facilities and pharmacies, it’s not conducive to medical billing practices.

Each team member should have set responsibilities and clear cut job descriptions to avoid wasted effort. That’s not to say that personnel shouldn’t be cross trained to handle other duties should the need arise. Clinicians need to plan for such contingencies and ensure staff has a clear understanding of what to do in specific circumstances.

Set office hours
Setting regular office hours allows patients to know exactly when the clinician is available and keeps practitioners from being pulled in too many directions at once. Scheduling appointments to see clients allows providers to best utilize their time and provides medical billing specialists with a steady stream of claims to submit throughout the day.

Some healthcare professionals prefer the walk-in method of seeing clients with no appointment necessary.

It eliminates the problems of cancellations and no-shows, but there’s no way to ascertain how many patients may or may not arrive.

Clinicians could find their medical billing specialists have few reimbursements to submit.

A well-structured office is one that operates efficiently and where every detail of a patient’s visit is carefully documented and filed for retrieval by the practice’s medical billing specialist.

Careful organization and an eye for detail ensures that billers have the information needed to process reimbursement claims to maintain a steady cash flow into the clinic.

Health Insurance and Its Top Three Mistakes or Issues

by Nitin Chhoda PT, DPT | Jun 23, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

There are three major mistakes within the office setting that are contributing to a loss of revenue through non-payment. The errors can easily be prevented and some can be eradicated before patients ever arrive for their appointments.

Clinics across the nation are feeling the effects of longer turnarounds on reimbursements and outright denials by health insurance companies to pay for services.

Verify Health Insurance Information Each Time Services Are Provided
The number one cause of denied reimbursement claims is a failure to verify health insurance information. Loss of employment and changes in insurance coverage can occur at any time. It’s essential that client coverage is verified for each patient anytime services are rendered.

Denials occur for any number of reasons, but the most common is the coverage has been terminated, followed by the patient being ineligible. Many health insurance plans require pre-authorization for procedures and have limits on benefits.

Failure to obtain permission or determine if the client has reached a maximum benefit amount will result in denial of payment. Practitioners should also ascertain if specific services are covered.

Current Patient Information Is Essential
They may seem like simple errors, but incomplete or incorrect patient information is the second most common cause of denials. Clinicians should ensure that the client’s name is spelled correctly and the date of birth is accurate, along with the address, complete contact information and gender.

Some patients have healthcare coverage through multiple providers, requiring clinics to perform additional checks to coordinate benefits. The policy holder and their relationship to the patient must be clear.

Each health insurance provider has its own set of rules for submitting claims and special attention should be paid to ensure those requirements are met.

Diagnosis, Procedure Codes and Sloppy Handwriting
Diagnosis and procedural codes provide essential information to health insurance companies about the patient’s condition, symptoms and treatment. Codes that don’t match the information provided can result in a denial on the grounds that the procedure wasn’t medically necessary or it doesn’t match an authorization.

Clinicians should ensure that their medical billing and coding experts are utilizing current codes and that they’re updated yearly. Another source of denials is poor penmanship on the part of the practitioner, a situation that is easily corrected with implementation of an integrated electronic medical record (EMR) system.

Navigating the labyrinth of rules, regulations and requirements set forth by health insurance providers can be a daunting process.

Human error and failing to verify health insurance information complicates the process, leading to payment denials and loss of revenues.

Vigilance is the only cure for clinics still using paper records. Implementation of an EMR transitions clinics away from wasteful paper records and virtually eliminates the top three mistakes of health insurance claim submissions that rob practitioners of revenues.

Medical Coder and Practice Staff’s Ethics are More Important than Their Typing Speed

by Nitin Chhoda PT, DPT | May 5, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

There’s a code of ethics that automatically comes into play in medical offices and employees are cognizant of this.

Staff and medical coder are aware that they can’t share personally identifiable information with outside sources, but what they don’t realize is that a casually made comment can also break the bonds of ethics and the law.

Medical billing and coding specialists deal with confidential information each day.

It’s important for them to perform their tasks with alacrity, but it’s imperative that their moral and ethical standards surpass their typing speed.

Practice owners want reimbursement claims filed as quickly as possible, but they can’t overlook or tolerate a breach of confidentiality no matter how efficient the medical coder is.

Practitioners have a myriad of state and federal agencies with which they must comply or they open themselves to lawsuits. A medical coder who gossips and shares patient information with anyone else is placing themselves at risk, along with the practice owner and the entire medical facility. Penalties can be leveled through civil, state and federal agencies.

Don’t run afoul of common, statutory, administrative and case law.

There are four law classifications by which clinics’ owner, staff and medical coder must operate – common, statutory, administrative and case law. They can be confusing and vague, but it’s essential that clinicians become familiar with each.

A practice is considered common law if it’s accepted as fact by the majority of the population. Common law practices don’t have the force of a governing entity behind them.

Statutory law is legislative in nature and can be created at the local, state and federal level. Administrative law encompasses sets of rules made by government bodies or officials that allow them to administer statutory laws. Case law is made by courts when they interpret administrative and statutory laws.

The penalties for loose lips are severe.

The penalties for breaking confidentiality not only by the medical coder but the rest of the practice staff are significant, far reaching and determined through civil law if a patient decides to sue. The court can rule to award monetary amounts to clients for medical expenses, lost wages and distress. In civil cases, some practitioners choose not to go before a jury, admit no guilt, and settle out of court for a specified monetary amount.

Medical coder may find themselves facing misdemeanor or criminal penalties for their lack of discretion, as well as the clinic owner by extension.

The consequences are fines and jail time for a misdemeanor. Those who violate HIPAA standards could serve jail time for a felony. Fines in such cases have ranged from $50,000 to over $4 million.

Medical coder must treat each client’s data as highly confidential, even if it seems that a particular bit of information is common knowledge.

Stay vigilant

Patients must give permission before their information is shared and they must designate with whom. Those medical coder or other members of the practice who violate HIPAA codes in any way must be prepared for the consequences.

Failure to adhere to HIPAA regulations will result in litigation that can damage a practice so severely that it never recovers.

Even if everyone, including the medical coder involved, are found innocent, clinicians will contend with a loss of reputation, clients and revenue.

No matter how skilled a coder is at efficiently submitting claims, it’s not worth the risk if he or she doesn’t come equipped with a superior set of ethics.

Supply, Demand, and Combatting Limited Reimbursements of Insurance

by Nitin Chhoda PT, DPT | Apr 28, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The way healthcare insurance is viewed and paid for has evolved significantly over the last century and the law of supply and demand is the rule of the day.

The business of selling insurance is a multi-million dollar industry, the sole purpose of which is to make money for the company providing the services.

Patients no longer visit their local insurance provider to obtain coverage. Insurance is packaged and sold like cars and the latest deodorant through state-of-the art advertising agencies.

Supply and demand dictates that if there’s a consumer need for a service or product, someone will provide that product or fill that need.

The Law of Supply And Demand

Consumers mistakenly believe that as more customers enter the market and purchase insurance, the cost will eventually go down. In a capitalistic system, that’s not necessarily true. If the revenues to be made are great enough, the cost will continue to increase as insurance providers strive to make ever greater profits.

Healthcare insurance providers charge the maximum amount that the market will allow for premiums.

The result is that consumers pay more for their healthcare insurance and malpractice insurance continues to skyrocket for medical professionals. Practitioners must charge sufficiently for their services to cover these costs and make a profit, while remaining competitive enough to attract new clients.

Payments versus Actual Costs

Healthcare insurance typically pays hospitals, labs and medical providers a set fee for services. In many instances, that payment doesn’t cover the actual costs involved.

Medical professionals must then decide if they will accept the insurance reimbursement as full payment, bill the difference to patients and face additional costs involved in collecting the debt, or if they want to offer the service at all.

To offset costs, medical providers need to create multiple revenue streams. Depending upon factors that include geographic location, clientele, patient load and availability, clinicians can do this through a wide variety of means. They can charge parking fees, write a book, schedule speaking engagements, add new services or develop new products.

Playing the Money Game

The primary way practitioners are paid is through reimbursement claims, which is normally prepared by medical billing professionals, to insurance companies, but there’s a dirty little secret lurking in the shadows. Insurance companies invest the funds they collect from clients to make more money. Each month that the firm can retain those funds, the company makes more on its investments.

That means healthcare providers are often forced to wait for up to three months to be reimbursed for their services. Insurance providers have teams of specialists whose job it is to calculate the fair market price for medications, office procedures and surgical interventions.

Insurance companies say these teams are eliminating waste, but the truth is that their job is to identify ways to reduce reimbursements paid to medical professionals.

Clinicians who choose not to offer specific services run the risk of losing clients to competitors who do.

If they accept insurance company reimbursements as the total payment for services rendered, they lose money.

Increasing patient numbers is one way to grow a clinic’s revenues, but creating multiple revenue streams is the most desirable. Funds coming in from a wide variety of sources will benefit practices in times of feast or famine.

Medical Billing And Coding Outsourced

by Nitin Chhoda PT, DPT | Feb 17, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

Medical billing and coding are indeed a very complex subject. It is important to analyze whether your practice will need an in-house medical biller and coder or have it outsourced.

Nitin Chhoda gives some factors to consider in order to guide your physical therapy practice when it comes to your medical billing needs.

Outsourcing often increases efficiency, especially in technical fields like accounting and medical billing and coding.

Within a single office, a number of practices can be serviced by a handful of highly skilled professional medical billers and coders.

They can focus all of their resources and attention on efficiency and a system that works. At a medical clinic, the primary focus is often the patients, as it should be.

Reasons to Outsource Your Medical Billing and Coding

Here are some very good reasons that a practice should consider outsourcing medical billing and coding. For the most part, the decision will be financial. But to determine whether or not it will be worthwhile for your practice to outsource can be so complex that identifying key reasons to outsource will help.

You’re New

New clinicians or health care providers have a whole host of things to worry about. How do you maintain a steady stream of patients?

Does your practice have the in-house testing capabilities necessary for the needs of the community? How do you balance the business side with patient care? How many hours per day should you be seeing patients?

Probably the top concern is how your patients are doing, how they feel about you, and whether or not you’re helping them. Managing a business at the same time as you’re learning what it means to run a private practice can be overwhelming.

Staff Turnover is High

If you are handling in-house medical billing and coding, but have to hire a new biller or coder regularly, your practice will suffer.

The learning curve for medical billing and coding is unforgiving and even a skilled medical billing and coding professional is going to be slow to start as they figure out your particular system. For practices that can’t seem to keep medical billing and coding staff members, a consistent service from elsewhere will be more efficient.

Inefficiency is Obvious

Outsourcing has a couple of major benefits, and one of them is that rejections and denials are usually decreased when you outsource medical billing and coding.

If you are experiencing problems with collections and your rejection and denial rate is high, it may be time to consider giving the job to a service that specializes in getting claims accepted.

You Don’t Want to Focus on Billing

Chances are, you don’t want to think about medical billing and coding. As critical as getting paid is to the health of your practice, if you became a doctor because you want to help people feel better, billing is probably an annoying part of your job.

Not to mention the fact that an incredible amount of tech savvy and skill is required to make your medical billing and coding system efficient and effective. Many clinicians decide that the billing side is the part they don’t want to know about – they’d prefer to let someone else worry about the medical billing and coding courses so they can continue to provide a service to the community.

Medical Coding As A Modern Necessity

by Nitin Chhoda PT, DPT | Jun 24, 2018 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

Nitin Chhoda provides reasons why medical coding is necessary and the role it has in a private practice setting. By defining what medical coding is and what codes are involved, it helps simplify the process for practice owners and staff.

What is medical coding?

Medical coding is an important step between the treatment of a patient and medical billing for the procedures, tests, and services. Clinicians will talk to patients, administer or order tests, and write down notes about each visit.

Those notes may describe what the patient needed, and in turn a medical coding staff member will translate each billable item into the assigned medical code.

Every doctor, medical clinic, and hospital must record a patient visit and include any procedures and tests performed. No matter whether the patient, their health insurance company, or another party is paying the bill, medical coding will take place to document how the bill should be drawn up.

What are the codes that are used?

There are a few kinds of necessary codes that medical coding staff members handle. The first is ICD-9 codes, or the International Classification of Diseases codes.

The number 9 refers to the version of this form of classification, and in 2013 a new version will be introduced, ICD-10. CPT codes, or current procedural terminology codes provide a list of alphanumeric codes used by medical coding professionals in the United States.

HCPCS codes, or Healthcare Common Procedure Coding System codes, are used for Medicare and other insurance programs. All codes were developed in an attempt to streamline and standardize the way medical procedures and tests are described and billed.

Why is this necessary?

The most interesting thing about medical coding is that it comes from an interest in standardization. The fact is that most medical procedures can be described in a single way – medical tests and processes have been developed over time, and while that development continues, clinicians are taught a right way to do things fairly consistently.

Medical coding allows a medical facility to bill for anything using a standardized system.

If one hospital performs a surgery and describes it differently from another hospital, even though the procedure is essentially the same, a health insurance company is going to have a hard time determining whether or not they truly are the same procedure.

Rather than spending the time guessing about the appropriate amount that should be billed, medical coding allows everyone to agree in advance that a certain code can be billed at a certain rate.

Does that really work?

The sad thing is that this attempt at a system works in some ways and fails in other ways. The first problem is that health insurance companies change their billing requirements constantly.

Even if a certain medical code is used for a certain test, the billable amount for that test may have changed. Laws attempt to keep things flexible and reasonable, but everyone is still trying not to spend any more money than they absolutely have to.

On the other hand, medical coding has made it possible for trends in diseases and public health and safety problems to be tracked at local and national and even international levels. This kind of information and the data collected through medical coding can help to improve medical care.