Claim Reimbursement — The Billing Scenario

Claim Reimbursement — The Billing Scenario

Building a clean claim is a concerted effort. It begins with the office staff that gathers demographic information and comes to fruition when the funds are deposited in the practice’s account.

Much can happen to a claim on its way to becoming a payment and in this informative article, Nitin Chhoda provides unique insights into the pitfalls that face even perfectly prepared claims and elements that affect payment.

claimWhere’s the Claim?

Aside from coding errors, reimbursement claims can go awry in many ways. The insurance provider may not be known at the clearinghouse or the clearinghouse software may glitch and submit the claim to the wrong provider.

In some instances, the payer may not be using electronic medical records (EMRs) software necessitating submission of a paper claim.


Practices that utilize EMR technology receive a report in real time when a claim has been submitted. These receipts provide billers with critical information in the event of a problem. Occasionally, a claim will appear to vanish into the ether.

Clearinghouse reports tell billers when the claim was received, its status and if any problems were identified. If payment isn’t received in a reasonable time or it doesn’t appear on the biller’s daily verification, that data be used to track down the claim and rectify any problems.

Reimbursement Amounts

The whole point of submitting claims is to get paid, but the amount charged can conflict with what the payer is willing to reimburse. When differences occur, billers can easily refer to the contract the clinician has with the payer to define the reimbursable amount.

CTP codes are assigned a relative value that determines reimbursement amounts, derived from the Resource Based Relative Value Scale (RBRVS).  The value assigned is based on the work required, the cost of maintaining a practice and the malpractice/liability for which the practitioner is responsible.

A formula is then employed that takes into account geographical locations to calculate the reimbursement rate.


Some contracts are RBRVS based, some aren’t, and the differences in each can be immense. Depending on how the contract is written, procedures may be paid based on RBRVS standards or discounts applied for secondary procedures done at the same time.

Some may be paid at a higher rate determined by prioritization, while others are billed according to expected payment. If the contact doesn’t state which procedure is prioritized, it’s up to the biller.

The Deciding Vote

The ultimate decision lies in the hands of the company that provides the patient’s healthcare insurance. Once the clearinghouse completes its search for errors, it forwards the claim to the payer. When reimbursements are less than expected, billers must refer to contract terms to obtain the maximum payment allowed.

reimbursement claims

Many hazards await claims, from submission to the wrong payer to glitches in clearinghouse software.

EMRs facilitate the process by submitting claims in real time and documenting receipts from the clearinghouse.

Billing specialists can help clinicians boost revenues by carefully monitoring claims and referring often to contract details. Practitioners must negotiate their contracts carefully to ensure their services are adequately reimbursed.

Web-Based Billing and EMR – The Cutting Edge

Web-Based Billing and EMR – The Cutting Edge

Electronic medical record (EMR) systems have changed billing standards with cutting edge technology. EMR systems allow for cloud-based billing that’s quick, efficient and clinicians can receive payment in as little as 10 days.

In this insightful article, Nitin Chhoda explains how an EMR facilitates the reimbursement process.

web-based billingThe use of an EMR allows practices to conduct business in the cloud, also known as web-based billing. It eliminates the need for files full of paperwork and the space to maintain them.

With web-based billing software, claims can be filed, payments delivered and records accessed any time of the day or night for greater productivity. It’s an environmentally friendly solution.

Identifying Problems and ICD-10 Codes

Perhaps one of the biggest advantages of a web-based billing EMR is its ability to identify mistakes and potential problems. It’s a simple matter to make the appropriate corrections, ensuring clean claims that progress quickly through the system. An EMR can assist providers with up to a 91 percent payment rate the first time claims are submitted.

When a claim is questioned, an EMR makes it easy to address the problem online. The transition to ICD-10 codes can cause significant problems for practices that aren’t using an EMR. The web-based billing software system is capable of handling all the new codes with clarity and ease.

Equipment Costs and Savings

Practitioners save money and eliminate costs associated with web-based billing software, equipment and the need for upgrades. There are excellent EMR programs available for free that provide medical practices with a full service billing and management system. They keep monthly fees low, offer 24/7 customer support and online training for staff.

The vendor is responsible for all facets of the infrastructure.

Digital Delivery

Every medical practice is familiar with clearinghouses. They check claims for errors and forward them to the patient’s healthcare insurance carrier. A web-based billing EMRs transmit reimbursement claims electronically in real time and maintain an ongoing record of each claim, its details and current status in the chain of reimbursement.

An EMR is crucial for medical providers who want to work with government-sponsored healthcare insurance plans. They require claims to be submitted electronically and prefer to pay via electronic fund transfer. Submissions can be sent individually or as a batch. Real time adjudication and notice of denials or acceptance are received in moments when a web-based billing system is at hand.

Portability and New Venues

Integrated and web-based billing EMR software can be implemented on laptops and tablets. It provides practitioners with portability and the opportunity to forge trails into new venues for new revenue streams. Web-based billing software can be submitted from any location an Internet connection is available and remain in compliance with HIPAA security standards.

Other Services

Electronic medical records facilitate the payment process with cloud-based billing, but they offer a comprehensive variety of other advantages. They store information in a secure environment and allow staff to verify insurance coverage prior to treatment.

Electronic patient statements can be sent, payments made and clients can complete a variety of essential information online. Patients can be contacted by multiple methods, test results can be posted for clients and medications can be billing

Web-based billing offers clinicians the ability to receive payments quicker, opportunities to extend their circle of revenues and submit bills in real time.

The web-based billing software systems represent the future for medical practices and billing procedures. Practitioners without an EMR face a loss of efficiency, productivity and revenues.

What to Look for (and be Wary of) When Choosing Billing Software

What to Look for (and be Wary of) When Choosing Billing Software

Billing software will play a large part in the success of the billing process and getting paid. As an early implementer of medical software and an expert on electronic medical record (EMR) technology, Nitin Chhoda addresses what clinicians should seek in medical billing software.

billing softwareThe goal is to bill accurately and quickly. Ordinary billing software will work, but an EMR is recommended. It’s the new standard in medical billing software.

EMRs have functionalities ranging from submitting more clean claims to verifying patient insurance coverage. Billing software allows clinicians to collect payments quicker and provide an enhanced level of patient care.


Medical billing programs can cost from $500 to $5,000. The cost of an EMR that is integrated with billing software can reach $50,000, but the good news is that comprehensive EMR systems are available for free. Due diligence should be exercised and sufficient research conducted before purchasing any program.

Digital Delivery

While some insurance companies still require paper claims, the vast majority use digital delivery. Using billing software is fast, efficient and transmits claims to their destination in real time, allowing practitioners to get paid in as little as 10 days. It’s a requirement for government-operated insurance programs that include Medicare and Medicaid.


Today’s patients communicate in a variety of ways, from old-fashioned mail to voice messages. It’s critical for a practice’s billing software to be able to do the same. Billing programs should have the ability to contact clients by voice and text message, mail, phone and mobile device and email.

Access On the Go

Billing software places all of a patient’s information in a central location, but the programs also provide users with the ability to access client information from any location where an Internet connection is available.

Billers can update information from multiple locations, a particularly useful feature for practitioners with more than one office and those who participate in corporate wellness programs.


Even though an integrated EMR can take the place of virtually any office system, some clinicians are enamored of their existing programs and can’t bear to part with them. Any billing software program should integrate smoothly with other systems already being used in the office.

Clean Claims

A good billing software program significantly reduces the possibility of claim errors by identifying common mistakes before the reimbursement request is sent. Clean claims can be submitted to clearinghouses that are processed quickly and efficiently for quicker payment collection.

Tech Support

A key feature of medical billing software is the ability to access tech support 24/7. A bug or glitch in the software program can mean significant losses for the practice and payment delays. Billers should be able to work with tech support any time of the day or night to fix problems.


Maintaining HIPAA compliance is serious business and billing software helps practices avoid running afoul of state and federal regulations. Patient information is confidential and billing software assists users ensure that data and submissions are transmitted securely.billing software program

Billing software runs the gamut from basic systems to those with a comprehensive array of built-in abilities. Don’t purchase the first system that’s explored.

Do take time to examine each billing software program to ensure it will grow along with the practice and can be customized to accommodate the individual needs of the clinic.

Electronic Medical Records and Its Role in Patient Billing

Electronic Medical Records and Its Role in Patient Billing

Convenience is the keyword for the 21st century clinic. Today’s population is busy and mobile, with little time left after meeting, work, and family obligations. Nitin Chhoda discusses how electronic medical records system (EMRs) simplifies billing for both physical therapists and patients in a variety of ways.

electronic medical recordsPatient income has long been the lifeblood of medical providers.  Effective physical therapy billing is a highly necessary procedure for physical therapists in particular, as some patients may have sessions last over a period of several months.

Versatile Billing

Electronic medical records allow patients to make payments on their own time with a push of a button. Today’s consumers are used to online billing for various services.

However, some medical providers still insist on paper bills. Online billing through an electronic medical records system allows patients to make either one-time payments, ongoing payments, and sometimes participate in automatic billing via credit or debit card.

EMRs make it easier for both patient and physical therapist.  If a physical therapist would like to move into online billing, electronic medical records system is a logical step.

Instant Transactions

Prior to online billing, physical therapist billing used to involve mailed checks or credit card payments taken over the phone. Both of these practices took office assistants’ time to manage billing, and involved a lot of upkeep.

However, with electronic medical records, physical therapists can receive their funding in as little as 48 hours.  Consumers are also able to pay on a variety of devices, such as phone or tablet, without waiting for a paper bill. Providers can increase their income by 23% by adding the ability to receive credit card payments, and EMRs provides that opportunity.

Electronic medical records represent a new wave in improved patient care and physical therapist billing.  electronic medical records

Physical therapists who are looking to streamline their practice in income and medical records should consider using EMRs.

As one of the facets of the changing face of healthcare, electronic medical records are an essential tool for the survival of a physical therapist office.

Facilitating Effective Billing and Coding with Electronic Medical Records

Facilitating Effective Billing and Coding with Electronic Medical Records

Medical billing and coding has always been a complicated procedure, but one that is necessary for physical therapists. Nitin Chhoda discusses how each code is attributed to a certain diagnosis, treatment, and etc., making the billing and coding process simplified and effective.

billing and codingThe correct analysis of billing and coding is imperative to patients’ care, and insurance agencies depend on accurate medical code billing so that medical providers can accurately reimburse the payment for their services.

The ease and availability of electronic medical records (EMRs) improves physical therapist billing and coding by eliminating the disconnection between the provider and insurance agency.

Ensures High Level of Patient Care

EMRs can help patients receive the best care possible.  Physical therapists and other providers are able to share records via EMRs, thus, receive up-to-date information.  The clarification allows providers to see the best picture yet of patient care, and enables them to make more informed decisions regarding treatment.

Employees and doctors do no longer have to deal with ineffective billing and coding. They can focus and give more attention to patient care. 

Increases Income for Practice

Healthcare management depends on quality medical billing and coding to properly invoice patients and their insurance carriers. However, this process is time-consuming and tedious. Sometimes codes are written down incorrectly or a wrong number is read due to poor handwriting.

For years, providers have reimbursement denied by insurance agencies from code errors.  EMRs lessen the chance of errors, and ease the claim submission process.

medical billing and codingBecause all billing and coding must be accompanied by proper documents, EMRs also allow for an easier physical therapy documentation system.

Some insurance agencies are overwhelmed with claims as much as the providers, and the reimbursements may be canceled, lost, or otherwise not received, and this may go unnoticed by the practice.

However, EMRs give a physical therapist the ability to track claims and monitor any discrepancies. EMRs allow a provider to accept payments electronically, thus ensuring quicker billing and coding reimbursement than the traditional check method.