There are times when it appears that insurance companies are in the business of denying claims, not paying them.

As a private practice owner, the solution is simple – minimize errors in claim submissions. Nitin Chhoda reveals how to minimize such errors so your practice can get paid faster.

Submitting insurance claims for physical therapy billing and services can be a frustrating and challenging job, no matter how much experience your physical therapy billing staff has.

Insurance companies are so quick to reject or deny a claim, and since they have all the power and a lot of money, it feels like physical therapy practices can do very little to influence the outcome of each claim.

Fortunately, EMRs and physical therapy documentation software have been designed with these challenges in mind. As physical therapy billing professionals have struggled to find solutions, some key aspects of the billing process have been identified as problematic when it comes to claims acceptance.

Errors in Submission

One of the top reasons for rejected or denied claims is an error in the submission. The error can be as simple as a typo in the code or in the name of the patient, or a less-than-perfectly legible claim form.

Usually, these errors result when the physical therapy billing staff doesn’t have the time to carefully fill out and review the claim. These kinds of errors are avoidable, but it usually takes a change of workflow and priorities before errors can be reduced significantly.

The other kind of error that is highly common are errors due to an incorrect or insufficient understanding of the insurance plan. If a patient believes they are covered for physical therapy, the physical therapy billing staff will submit a claim for the entire amount.

But if it turns out that the particular procedures are not covered, or if the patient has yet to pay the entire deductible on their plan, the claim will not be filled as requested. This often leads to partial payment, too, which is not a terrible outcome. However, because the biller did not know that the partial payment would come, research must be done to review what the patient owes and then a bill must be sent to the patient.

An additional problem that plagues physical therapy management is the timing of physical therapy billing. If a claim submission is accepted and paid, that is good news.

Timing of Submission

But if the claim is paid three weeks after the patient visit, the practice is losing money. Many claims are not submitted in a timely manner, either because all of the details about treatment of the patient are not available to the biller, or because making time for physical therapy billing each week is hard for a biller who is somewhat overwhelmed.

Many of the solutions to these problems may seem automatic or intuitive at this point. If the problem is insufficient patient information or clinician notes, a better system of physical therapy billing and documentation is needed.

Solutions

If partial payments due to incorrect billing are slowing down the entire process, learning what each patient owes in advance would help speed things up and ensure that the patient is not surprised by a bill. Of course, EMRs offer many of these benefits for physical therapy billing.

There was a time when claim submission was an ardous, manual process. With the emergence of electronic claim submission, a claim can be submitted in seconds.

Nitin Chhoda describes the technology of real-time, automatic claim submissions and why it’s here to stay. More importantly, Nitin advises you how to find an EMR that integrates this critical feature to help you streamline and automate your practice.

Ideally, every claim sent to an insurance company would be submitted as soon as the practice knew it was time to send a claim.

In reality, claims are delayed by many factors, including problems with clinician notes or weighted procedures, insufficient patient information, and mediocre time management and physical therapy billing.

With a physical therapy EMR, claims for regular patients to consistent insurance companies can be generated in real time. They also take much less time to prepare and send, something that will help improve overall efficiency of physical therapy billing.

Cash Flow Stumbling Blocks

Insurance claims are one of the biggest stumbling blocks for generating consistent cash flow at a physical therapy practice. Health care providers are at the mercy of insurance companies when it comes to getting paid, and insurance companies certainly don’t try to make it easier.

But if you can identify where your problems with physical therapy billing cash flow are, you can start to work on solutions to solve those problems.

The goal of a physical therapy billing solution using an EMR is to make the majority of claims automatic and instantly submitted. The majority of visits from patients are recurring. The initial visit involves some extra steps for collection of patient history and insurance information.

However, after that first visit, the physical therapy billing plan should be somewhat predictable. And yet, without an EMR, each time a claim must be filed for each patient, the biller must fill out new paperwork and submit the claim as if it was the first time.

Real Time Claim Submission

With an integrated EMR, the possibilities for efficiency improvement in physical therapy billing are quite stunning.

To even imagine that insurance claims could be submitted in real time seems like a bit of a fantasy. But for the majority of claims, this kind of streamlined process is quickly becoming a reality.

The trick to submitting claims automatically is preparation and planning. With a detailed treatment plan for each patient, it should be possible for physical therapy billing professionals to know what they will bill after each visit for each patient.

The clinician must follow the treatment plan closely and record each visit according to the agreed-upon plan. The biller can then review an automatically generated claim based on the treatment plan and submit claims in real time.

Big Changes Take Big Work

The hardest part of implementing a physical therapy billing change to workflow like the one described above is getting everyone to do things differently.

We get into routines and then we stay in them – humans are very good at that. But we are also very good at adjusting when something outside of our control changes.

To bring about serious cash flow improvements will take some serious changes. Implementation of an EMR will help to shift the thinking of all staff so they can work from a new perspective. Physical therapy billing staff can begin to benefit from these changes immediately, and the practice as a whole will see greater cash flow efficiency.

To grow your practice, you need people, and systems. When it comes to physical therapy billing and medical billing, structure is critical.

In this article, Nitin Chhoda.reveals how an EMR can create structure for your billing systems, and the importance of using an EMR that is completely integrated with billing and payment collections.

Structure is essential for a successful physical therapy billing department. With any financial job, the secret is in creating recurring practices that lead to consistency and success.

The truth is that anyone who works in physical therapy billing is going to have to repeat the same tasks over and over again, with slight differences every time.

Make Physical Therapy Billing A Success

To make sure that each time physical therapy billing happens it is successful, a system of communication, review, and follow-up should be put into place.

For some physical therapy billers, the system will already be in place even without help and cooperation from the rest of the staff. But getting staff members, especially therapists, on board will make the system more efficient and more successful.

Using an EMR to Create Structure

A complete and integrated EMR can help put into place certain structures and workflow standards that might be difficult at first. But getting some structure into the physical therapy billing process is essential, and without an EMR it could be much harder.

The structure that holds up the practice is successful billing and consistent cash flow – that structure relies on a system for physical therapy billing and documentation that is consistent alongside good contracts with payers.

If the problem you are trying to solve is a high denial rate from insurance companies, the first step will be to analyze the most common reasons for denial. Is your physical therapy billing high in errors?

Errors to Avoid Denials 

Human error is one of the most common and the most avoidable reasons that insurance claims are denied. An incorrect code, inaccurate diagnosis, or errors related to an insufficient understanding of the terms of the contract between the insurance company and your practice can cause a lot of wasted time and energy. And time and energy in this business are the same as money.

The structure of your physical therapy billing practice should take into account the full process of caring for and billing for a patient.

Starting with the intake process and diagnosis, every aspect of the process should be recordable in a standardized way and using a system that all relevant staff members can access and understand.

The reason that so many physical therapy practices turn to physical therapy billing and documentation software is that with an integrated EMR, everything your practice already does will be integrated into a structured database.

Integrate EMR With Physical Therapy Billing

Since payments from insurance companies provide vital cashflow, it’s essential to have a system in place to minimize denials. Once a denial does happen, a system must be in place to contest those denials.

Nitin Chhoda explains how to minimize denials and also contest them successfully. This is one of the most essential elements of a successful, cash-rich practice.

One thing is certain, no matter how hard you work to perfect your physical therapy billing practices, you will still be faced with denials and rejections from insurance companies.

Every physical therapy private practice experiences a high rate of denials and rejections and unless the entire system changes dramatically, this is going to continue to be part of the deal.

Find the Solutions

Rather than getting frustrated with denials, it’s time to think about minimizing them and finding ways to contest them successfully. When we think about problems and attempt to find solutions, the place to start is in the practice.

Minimizing denials is the job of physical therapy billing professionals, and in many cases they simply need the structure and the space to do just that.

Reporting for Physical Therapy Billing Improvements 

The best way to avoid making mistakes is to start with the mistakes that have been made in the past. The reporting capabilities of physical therapy documentation software can make the process of physical therapy billing much more accountable.

Rejected or denied claims can be tracked with reasons and time stamps, and by using reporting functions physical therapy management can determine just what goes wrong and how much time it is costing the practice in re-submittal of claims.

The back to basics approach of reinventing physical therapy billing is critical to finding solutions. Any system that has grown and changed as much as health care billing and insurance payments, is going to have inefficiencies built right into the process.

To get rid of those inefficiencies, the whole system may need to be torn down and re-built.

Start at the Beginning to Avoid Mistakes

A physical therapy EMR is going to allow for reporting and documentation that has previously been nearly impossible to extract and use. This is great news for physical therapy management.

But for physical therapy billing staff, it’s going to be a tough adjustment. Rather than focusing on the mistakes of individual billers, changing over to an EMR can help turn the process of re-education into a whole-office re-education.

Training the physical therapists to document their patient visits a little differently will be made easier if the entire staff is learning to document differently and use the information differently.

The burden of making adjustments of physical therapy billing to reduce the chances of claim denials and rejections will be shifted to the whole staff, rather than focused on billers who only have control over one portion of the process.

Responsibility is Key

At the same time, physical therapy billing staff are responsible for a certain portion of mistakes, and finding and eliminating those kinds of mistakes is going to be a big part of reducing denials. If you find that insurance companies are blanket denying claims, and it’s not the fault of billers, you can address the problem differently.

It may turn out that billing staff are actually spending time contesting denials because an insurance company is not worth working with. But you’ll never know that unless you have a system for recording the processes of physical therapy billing, documentation, and claims denials.

What makes a physical therapy and medical documentation system compliant? In this revealing article, Nitin Chhoda explains the  key components to look for in any EMR system.

The issues associated with remaining compliant are many, varied and can be tricky to navigate. Federal regulations and payer requirements constantly change and therapists must remain vigilant to avoid stiff civil and criminal penalties.

Remaining in compliance is a challenge that faces any practice owner and there are key components therapists should seek in any EMR physical therapy documentation system they decide to use.

A Very Important Matter

The primary concern of any EMR is the protection, privacy and security of patient information. Any physical therapy documentation system must contain sufficient safeguards to ensure individually identifiable health information is secure, and that appropriate efforts have been taken in that direction.

That includes electronically submitted claims, referral authorizations, and eligibility inquiries to insurance providers, clearinghouses and medical professionals.

The Heath Insurance Portability and Accountability Act (HIPPA) spells out in detail the security and safeguards necessary to remain in compliance and establishes the policies, procedures and conditions under which medical information can be disclosed without specific authorization from patients.

Administrative safeguards and controls must be in place that limits access to patient information to authorized physical therapy documentation personnel only.

EMR As A Tool

An EMR is an important tool for therapists, enabling them to remain current on laws and maintain compliance. Individual login capabilities and the ability to validate the credentials of those accessing information are an essential element of any EMR.

Physical therapy documentation staff must also be trained in the rules and guidelines governing the management of medical records and an EMR can be utilized to accomplish that. EMRs encompass the ability to provide powerful security at all levels of access to maintain the confidentiality of patient records, reimbursement submissions and administration of the practice.

Date and time stamps are especially helpful in a physical therapy documentation system, providing detailed reports of when patient records were accessed and by whom. If another healthcare provider discovers a breach in the system, the medical professional can quickly notify the therapist through a variety of means with an EMR.

Adopting EMR System

The adoption of an EMR allows for almost instantaneous interaction among physical therapy documentation healthcare providers.

This ability ensures the highest level of treatment possible through extreme accuracy, while addressing privacy concerns.

Patients who believe that their medical data is safe with their therapist are more likely to provide complete health information that could mean the difference in a life and death situation.

The adoption of an EMR is part of the American Recovery and Reinvestment Act and requires any EMR to meet Meaningful Use standards and certification. An EMR helps physical therapy documentation therapists in all areas of their practice, from ensuring secure access of medical records to the submission of reimbursement requests.

An EMR significantly reduces the possibility of errors.

Security is the primary component of any EMR. Physical therapy documentation software helps therapists maintain the integrity and privacy of patient medical information, and healthcare providers can easily report the instance of a breach should a situation occur.

Therapists seeking an EMR should also ensure their chosen software includes sufficient flexibility in the documentation process to protect the patient and the practice in the event of a lawsuit or audit.