Physical Therapy Billing

Medical Billing Professionals Working With the Health Care Management

by Nitin Chhoda PT, DPT | Apr 16, 2018 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

There should always be an open communication between the medical billers and the healthcare practice management. Nitin Chhoda further explains how good communication will help to resolve any type of issues faster and more efficiently.

Medical billing professionals have plenty to worry about on a day to day basis; sometimes those bigger picture problems never get attention because there’s no time to think about anything but getting today’s work completed.

And medical billing isn’t the only profession that encounters this kind of challenge.

In most every field of work, there are people who spend time doing the work and then there are the managers who have a broader view and can make decisions for the entire practice.

Medical Billers and Management

Medical billers and health care management have to work together to find a balance between efficiency and becoming swamped. Many medical billing staff feel they have an unending set of tasks. By the time they get caught up with one thing, something else has come up and they have no time to step back and review their workflow or make things better for themselves.

On the other hand health care management may not realize that some of the most expensive problems with efficiency occur when medical billing people are overwhelmed. Health care management has the responsibility of reviewing the operations of the entire practice.

Having an Open Communication is Important

But indicators like rate of rejection or denial for insurance claims, or the accounts receivable aging reports don’t always tell enough of a story. Medical billers and health care management must work together to find solutions to the efficiency problems that exist.

When indicators are discovered, it may be time for a review of workflow and schedule pressures that the medical billing staff experience. Health care management can be a catalyst for improvements if the medical billing staff is approached in the right way.

Common Problems That Medical Billers and Health Care Management Can Solve Together

One of the most common problems that medical billing staff experience is the lack of a schedule for performing tasks. When things are just a little too busy, a medical biller may be forced to deal with whatever is most pressing at the moment.

But medical billers and health care managers should both know that the most efficient medical billing training of practices involve keeping a schedule and dealing with responsibilities in an organized way.

Rather than simply giving the medical billing staff more time, health care management should be able to talk to medical billers about what is slowing them down or inhibiting their ability to check and correct their work.

Working out times when the medical billing staff can focus on drafting claims and making it a priority to review claims can actually save medical billers in the long run.

Most mistakes lead to rejected or denied claims, which is a huge problem for the entire practice. A rejected or denied claim has to be reviewed for mistakes and then re-filed. If the medical billing staff has time to review before sending, fewer mistakes will get through and fewer re-filing will be done. This saves everyone time and therefore it will save the practice money and relieve stress.

Health Coverage in the New Economy

by Nitin Chhoda PT, DPT | Feb 4, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

With many disputes our economy is facing today, increasing payments for healthcare services can be challenging. Nitin Chhoda explains why discussing with patients about their health coverage is important. Making the patient feel prepared and ready will help improve the practice-patient relationship.

The idea of the “new economy” has come from a change in the way the United States economy functions.

For a long time, most jobs were in manufacturing, the making of goods that were then sold on the market.

But today, more and more manufacturing jobs are moving overseas to countries where labor is much cheaper. The economy has been moving in a direction of being service-based rather than manufacturing-based.

The New Economy

The new economy is an economy where most jobs do not come from the buying or selling of products, but of services.

Healthcare is a service industry. Both healthcare and insurance are services rather than goods or products. The challenge in the U.S. right now is that service providers for health coverage cannot raise prices without becoming significantly overpriced for the majority of the population.

Health coverage right now is unaffordable to most Americans, and even health insurance is too expensive if you do not work in a traditional, full-time job. As a result, providers of health coverage, even with proper physical therapy documentation, must balance their practices in a new way.

Improving Efficiency for Better Economies of Scale

One way that health coverage can be better balanced in the new economy is to improve efficiency. Economy of scale is a term that describes how it is easier to make money from low prices if you have more clients, customers, or patients.

For example, if your practice pays rent, hires staff, and covers utilities every month, those costs stay the same month after month – these are the expenses. If you can only treat a certain number of patients, your income is capped.

But if you can find ways to improve efficiency so that you can take on more patients each month, you can increase income. Finding the balance is a challenge, and most practices rely on trial and error. For example, many practices of health coverage bill low prices to entice more patients. By increasing the number of patients, they increase their overall revenue, even if they lower prices.

Most people cannot afford health coverage, which means that they do not go to the doctor as often as they probably should to stay healthy. For a practice like a physical therapy practice, they may find that patients of health coverage limit the number of visits so they don’t have to pay the co-pay so many times. But that reduces the favorable outcomes and many patients do not recover or stay as strong as they should.

Encouraging Patients to Take Care of Themselves

There is no arguing that preventative care is not a bad thing. One way that a practice can improve their efficiency is to improve technology and find ways within the practice to be more time efficient.

Another way is to provide a service to patients that they do not get anywhere else. When the patient feels they are getting more for their money, they are more willing to pay.

Many practices with health coverage are now taking a more holistic approach and encouraging clinicians to help educate patients so they stay healthy. Then when the patient isn’t feeling well, they come back because they trust the clinicians and feel it is worthwhile to pay for health coverage plans at that practice.

Insurance and Benefits and How They Relate To Good Health

by Nitin Chhoda PT, DPT | Jan 16, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

The future of healthcare and insurance is still uncertain. Nitin Chhoda imparts how major changes are needed to be made in order to help policy holders maximize the use of their insurance policies.

Without a good understanding of health insurance and benefits and physical therapy billing process, many patients make big mistakes that end up costing them money.

These are mistakes that also cost their healthcare providers time and money in the form of billing, rejected claims management, and late payment of fees.

Because so many people don’t understand that even with insurance and benefits they will still have to pay for some healthcare, the system can be very inefficient.

Some People Do Not Understand Their Insurance

But what about the cost to the health of people who have insurance and benefits but do not understand how the system works? Some people who do not understand will have certain healthcare procedures done without realizing that they will have to pay.

When they find out that they actually have a deductible of insurance and benefits which they are responsible for, they are shocked and disappointed to be suddenly in medical debt.

And even for patients who do understand the system, making these decisions is dangerous to health.

For a patient who has a problem with their skin and is wondering if they might have a melanoma, the correct and safe thing to do is go to the doctor right away. When skin cancer is caught early it is much easier and cheaper to treat and treatment is more likely to be effective without having to use paid insurance and benefits.

If a patient knows that they will have to pay up to a $3000 deductible, they may be nervous about going to the doctor for financial reasons. What good is an insurance and benefits plan if you still have to pay for medical care that you can’t afford?

What Patients Should Know Before Selecting Insurance and Benefits

The best way to avoid a bad situation is to educate patients before they choose their insurance and benefits plan.

That way, patients can choose a plan with a deductible that they can afford and that makes sense for their health history.

Of course, for people working in the healthcare industry, it is usually too late by the time they see patients.

In many practices today, the induction process for new patients includes a somewhat sobering educational experience.

Rather than waiting until the billing process starts and services have already been provided, the reception staff or nurses will actually find out exactly what is covered by a patient’s insurance and benefits plan, and they will find out if the deductible has been reached yet.

Financial Future

This may take more time at the beginning, but in the long run it saves time and money for the practice. As a patient, if a practice wants to figure out how much financial responsibility you have, it is best to indulge them so you also know what you will be responsible for paying.

By working together, patients and medical practices can determine what the best course of medical treatment will be based on both the financial resources and insurance and benefits that the patient has.

Healthcare and Insurance and Its Future

by Nitin Chhoda PT, DPT | Jan 8, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

The future of healthcare and insurance is still uncertain. Nitin Chhoda imparts how major changes are needed to be made in order to help policy holders maximize the use of their insurance policies.

For a long time, the healthcare and insurance industry has been entirely unregulated.

Insurance companies have been allowed to drop paying customers who suddenly become ill or injured, based on technicalities.

People who are diagnosed with cancer are often suddenly reviewed by their healthcare and insurance providers and if anything is outside the policy, even if it is unrelated to the diagnosis of cancer and has an effective physical therapy documentation, the insurance company will drop the patient, leaving them with the responsibility of paying hundreds of thousands of dollars for treatment.

Medical Care Is Unaffordable

Most people in the United States cannot afford the high cost healthcare and insurance of medical care. The option for most patients in this situation is very bleak.

On the one hand they can forego treatment and die from the disease, but nobody expects a patient to make that choice. On the other hand, if they go forward with treatment they will be committing to financial debt that will most likely cause them to declare medical bankruptcy.

Not only does diagnosis with a serious disease like cancer put you in a bad financial position, it can also cause you to miss work and even lose your job. Treatment is often very uncomfortable and has side effects that make patients unable to do their work.

Just because someone is diagnosed with cancer, they should be condemned to medical debt, job loss, and potential financial ruin. Cancer is bad enough on its own.

Even if a healthcare and insurance company does not drop a patient, the policy may only cover up to a certain amount. Most insurance plans have a cap, and most caps are too low to actually cover the costs of treatment for a disease like cancer.

How Will This Situation Improve?

There are many potential improvements that can be made to the current system. In the government’s role to protect the people, laws are being introduced that restrict the way healthcare and insurance companies can drop patients without cause.

There are also provisions which restrict insurance companies from putting unfair caps on their insurance pay-outs for healthcare and insurance plans. We have seen that without legal protections for consumers, healthcare and insurance companies will go to great lengths to save money, at the cost of their policy holders.

The Reality of Healthcare and Insurance

Even if someone pays their healthcare and insurance premiums for ten years, a health insurance company will not hesitate to find a loophole when the times comes to actually pay for some healthcare of their policy holder.

Some healthcare and insurance providers have simply changed the way they bill to adjust for people who need healthcare but don’t have insurance.

Or they do not assume they will collect any money from patients and increase prices so that the insurance company’s share of each bill is higher than it would have been otherwise.

These are desperate and unethical, if not completely illegal, ways to deal with the current situation. But the reality is that major changes will have to take place before healthcare and insurance become affordable for the average American.

Healthcare and Insurance Solutions in the United States

by Nitin Chhoda PT, DPT | Jan 2, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Healthcare and insurance issues in the United States remain unsolved. However, Nitin Chhoda shares how the Affordable Care Act is planning to revise the provisions of insurance by changing the age limit of dependents, and amending the law when it comes to pre-existing conditions of a potential policy holder.

There is no single, simple solution to the problems with physical therapy documentation of healthcare and insurance in the United States. In fact, the problems have become circular in a way that feels like a loop; nobody knows if there is a way out.

We have been traveling in a direction that is destructive and unhealthy for a long time, and turning around is not going to be easy.

However, there are plenty of healthcare and insurance systems in many other countries that do work. With some research and open-mindedness, the U.S. could start to invest in new strategies and at the same time the American people could get better healthcare and insurance, leading to better health overall.

There will not be a perfect solution anywhere else, because every country is different. But for the price that the U.S. government pays in tax breaks to the health care industry, a better solution could probably be designed.

The Near Future

In the near future, we may see some improvements if the Affordable Care Act is implemented well. Some provisions which have already become effective have ensured that 3.1 million young Americans have healthcare and insurance.

Previously, as soon as a child reached the age of 18, they were no longer eligible to remain on their parents’ healthcare and insurance policy. The Affordable Care Act changes that age to 26, so that students and young people looking for work can still be included in their parents’ plans.

Additionally, the Affordable Care Act has made it illegal for healthcare and insurance companies to institute lifetime limits on healthcare benefits. For parents with children who become ill with life threatening diseases, the lifetime limit was like a death sentence.

Insurance Limit

If at the age of 7 a child is no longer insurable because they have reached a lifetime limit, the parents must somehow pay for healthcare and insurance on their own, which is impossible for the majority of Americans.

And finally, one more perk about the Affordable Care Act is that insurance companies can no longer reject a potential policy holder because they have a pre-existing condition.

In the past, if someone lost their job and subsequently their healthcare and insurance, any pre-existing condition could be reason enough to reject an application for insurance.

If you have diabetes, a mental illness, or any other disease that will cost money to treat, no insurance company will provide insurance for you. But because of the new healthcare and insurance law, insurance companies can no longer deny people with pre-existing conditions.

The Bigger Picture

While these changes are exciting and potentially life-saving for the people who benefit from more protective laws, they are really only patches for a system that has not really been working.

The bigger picture shows that the price of healthcare and insurance in this country is unaffordable to the majority of Americans. The question that will need to be answered eventually is whether or not it is worth it for the people of the United States to be given high quality healthcare and insurance.

Medical Billing Company: Everything You Need To Know

by Nitin Chhoda PT, DPT | Sep 4, 2017 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

When it comes to your billing needs, hiring a medical billing company may be the best option. Nitin Chhoda shares the important factors that you need to consider whether you’re going to hire a medical billing company or an independent contractor, and how your preferred billing system plays a key role in that decision.

Medical billing company is not easy to find and medical billing is no easy job. But for many small medical practices, adding billing to your list of things to do can be overwhelming.

Especially for practices that are just getting started, hiring a medical billing company can be cost-effective and will take a lot of stress out of the process of starting and running a business.

Just like hiring an accountant to do your taxes, when you hire a medical billing company, you are handing off a very important task to an expert in the field.

Price Isn’t Everything

Of course, when you hire a medical billing company, the hope is that you will be paying them less than you would pay a full time medical biller as part of your staff. Giving yourself some financial ground rules or even estimates will help you to determine how much money you should pay a medical billing company for the services they provide.

Medical Billing Companies Should Provide Typical Rates

But in addition to doing the job, they’d better do the job really well. Many medical billing companies will guarantee a certain rate of accepted claims. If they don’t actually guarantee a certain rate, they may at least give you their typical rates of rejected and denied claims so you can tell what kind of job they are doing.

Typically, insurance companies will reject about half of all claims, so even with a professional medical billing company, your expectations shouldn’t be too high. And remember that the time and effort that it takes to handle medical billing really is worth more to you than the cost of hiring a medical billing company to do the work for you.

Medical Billing Company or Independent Contractor

Some smaller practices may have the option of hiring an independent contractor who works part time and remotely. This option can also be cost effective, especially if the price is right.

In many ways, you will have to work out the details more thoroughly with an independent contractor, which may result in better outcomes for billing. But the convenience of medical billing companies is often a big factor in making the decision of who to hire.

More important than the size of the medical billing company, be sure to hire someone or a company that has a lot of experience and a proven track record.

Your Options

If you are trying to choose between an independent contractor with ten years of experience or a brand new medical billing company that has been around for less than a year, make sure that the employees at the medical billing company have more experience before you take that route.

A medical billing company may have a more standardized system and it may be easier to integrate your data system with theirs, but if they are new to the work and do not bring in the payments that are owed to you, nothing else will matter.

Make sure that whoever you hire can send you reports from their previous work as well as reports for the work they do for you, so you can see how the work is going, too
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