Physical Therapy Documentation & Medical Billing INTOUCHEMR

Obamacare – The Problem it is Trying to Solve

by Nitin Chhoda PT, DPT | Sep 14, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

The goal of the Patient Protection and Affordable Health Care Act was fourfold: to increase access to healthcare, reduce healthcare costs, institute more consumer benefits and protections, and improve efficiency. As different portions of the Act go into effect, it will have a major impact on virtually every individual in the U.S.

The Act has both a human and financial component.

According to the Center for Disease Control (CDC) more than 45 million people had no type of health insurance in 2012.

Individuals at the lower end of the financial spectrum were the most likely to lack coverage.

The Congressional Budget Office estimates the Act will reduce the number of uninsured by 27 million between now and 2023, but will still leave approximately 26 million Americans uninsured and financially unable to purchase coverage.

Increasing Access to Healthcare

Obamacare establishes healthcare exchanges and provides subsidies for low income individuals to help them purchase coverage. Millions of Americans can stop living in fear of becoming ill.

They will no longer be turned down for a preexisting condition and children can remain on parental policies through the age of 26.

The downside is an influx of new patients to practices that are already working to capacity. A poll for the Physicians Foundation showed that 40 percent of medical professionals intend to sell their practice or retire early due to Obamacare, resulting in a shortage of available clinicians and longer wait times to obtain an appointment.

Reducing The Cost of Healthcare

One of the tenants of Obamacare was the control and reduction of skyrocketing healthcare costs. The Act reduces the amounts paid by Medicare to practitioners, but allows hospitals to collect more for the same services.

The inequity is prompting many clinicians to stop accepting Medicare patients, further limiting access to care.

Clinicians are under pressure to reduce the number of tests they order and utilize the least expensive modes of treatment whenever possible. Many healthcare professionals fear the drastic reductions in reimbursements will drive potential physicians into other fields.

Healthcare costs also come in the form of copays, premiums and deductibles. Patients are already seeing an increase in all three, as insurance companies raise prices in response to the services the Act forces them to reimburse for.

With insurance companies placing limitations on reimbursements, pharmaceutical firms are reducing or eliminating medications as unprofitable to produce.

The cost of Obamacare comes in other guises. In 2018, a 40 percent tax will be placed on healthcare plans, dependent upon their value, and collected through tax returns. Fines will be assessed on individuals without insurance.

Employers with more than 50 workers must offer insurance or face financial penalties for each person they employ.

Benefits and Protections

Obamacare provides patients with some perks along with coverage. Insurance companies can’t place an annual limit on benefits, nor can they cancel policies for frivolous reasons, but the Act limits the amount individuals can place in Flexible Spending Accounts (FSAs) and purchases that can be made with the funds.

Improving Delivery and Efficiency

The Act’s components are intended to increase the overall efficiency and delivery of healthcare services. To accomplish that goal, the Act mandated use of an electronic medical records (EMR) system.

The technology is expected to allow clinicians to treat a greater number of patients per day and eliminate paper records.

Accountable Care Organizations (ACOs) encourage networks of providers, with financial incentives for clinicians that provide a better level of care.

The focus of healthcare would begin a transition to a system of preventatives measures rather than reacting to treat disease after it occurs.

The Act also creates a panel of individuals to determine and recommend preferred treatment options.

Obamacare has four major goals through the Affordable Healthcare Act. In an effort to solve the glaring problems in the healthcare system, it will change the way clinicians practice their profession and deliver care. Patients will have greater access to clinicians, but only time will tell if Obamacare creates a nation of healthier individuals and more efficient practitioners.

Medical Billers: The Ever Expanding Field of Medical Billing

by Nitin Chhoda PT, DPT | Sep 11, 2013 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Medical billing specialists are in high demand and the need won’t be slowing anytime in the near future. The transition to ICD-10 codes, federally mandated electronic medical record (EMR) software systems and a flood of new patients into the marketplace have all combined to create a perfect storm for skillful, experienced and certified medical billers. In this informative article, Nitin Chhoda examines the expanding field of medical billing.

Work Environments

The biggest draws for medical billers is the ability to start their own business with low overhead, work from home, and a career that can be employed from any location.

Medical billers working from home can set their own hours and the profession doesn’t have the physical requirements demanded by other healthcare fields, making it ideal for those with disabilities and stay at home parents.

Many medical professionals are outsourcing their billing activities, but the need for certified medical billers still isn’t being met. The need for medical billers is expected to increase faster than any other occupational field. A career in billing provides individuals with a decent income in a profession that’s almost recession proof.

Billers can work from home, in clinics, insurance agencies, hospitals, nursing homes and government operated public health facilities.

Easy Education

Individuals will find numerous online educational and certification opportunities that can be completed in as little as two to three months. Many professional organizations for medical billers offer courses, certification and chances to practice what they’ve learned, along with opportunities to learn about EMR technology.

New and Aging Patients

The Affordable Health Care Act changed the playing field and opened up a wealth of new opportunities for medical billers. The legislation is providing health care for millions of potential new patients, leaving providers with less time to deal with the intricacies of “paperwork”. An aging population in need of medical care is contributing to the need for medical billers with knowledge and experience of private and government-operated insurances.

EMR Technology

The use of EMR system software has been federally mandated for any entity that works with patient medical data. EMRs provide advanced methods for meeting the HIPAA standards designated for storing, retrieving and transmitting client information. The technology is changing the way billing is handled and provides medical billers familiar with the software with a multitude of opportunities.

New Medical Codes

The transition to the new ICD-10 codes has many healthcare providers worried about delays in claim reimbursement. Experience with EMRs is going to be a plus for medical billers.

Familiarity with the software will allow medical billers to transmit claims without interruption and keep the flow of cash coming into the practice.

Medical billing is a quickly expanding field that demonstrates little indication of abatement. The need is obvious, with multiple online opportunities for training and certification available. As insurance companies become more determined to avoid or delay reimbursements, skilled medical billers are essential to ensure that medical professionals obtain the payments they deserve.

HIPAA Malpractice and What You Need to Know

by Nitin Chhoda PT, DPT | Sep 8, 2013 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

HIPAA compliance is the most important consideration for medical billing specialists. Billers work with personal, confidential and sensitive patient information and they’re tasked with protecting that data. In this informative article, Nitin Chhoda shares the 18-point HIPAA protected list and how it affects billers and practices.

EMRs and EDI

The privacy laws encompass the way patient records are stored, disclosed and transmitted according to electronic data interchange (EDI) standards.

To accomplish this, integrated electronic medical record (EMR) software is essential. It contains a myriad of security safeguards, along with the ability to identify potential problems with reimbursement claims.

Practices, billers, clearinghouses and healthcare insurance providers that fail to take appropriate precautions when transmitting claims and working with the information can find themselves facing fines and criminal penalties.

An EMR has the ability to identify security breaches and notify those within the software’s network.

Malpractice Insurance

Disclosing personally identifiable information to any unpermitted outside entity can result in malpractice or negligence litigation. What many in the healthcare industry aren’t aware of is that many standard liability and malpractice insurance policies don’t provide coverage for HIPAA violations. The policies may offer coverage for some risk factors, but few insurers are offering policies that reflect changes in HIPAA privacy laws.

Some Exceptions

There are exceptions to every rule and HIPAA standards indicate that some information can be disclosed if it’s scrubbed or re-identified of personal data. One exception is in the pursuit of medical research. Patients who may want to participate in such studies must provide written authorization.

Clients must be provided with a complete, written explanation of the parameters, along with the knowledge that they can revoke their authorization and how to do so. Data may also be disclosed for public health reasons once all of the 18 elements have been removed.

HIPAA’s Top 18

HIPAA has a list of 18 identifiers within patient records that must be safeguarded. The following is a list of the 18 elements within client records that are covered under the HIPAA privacy rule:

Names
Addresses and geographic locations
Age and/or date of death
Dates of treatments, hospitalizations and admissions
Social Security number
Phone or cell phone numbers
Fax numbers
Email addresses
Medical record numbers
Beneficiary and account numbers
Driver license numbers
Vehicle and serial numbers
Device identifiers
Website URLs
IP addresses
Biometric identifiers including fingerprints or voiceprints
Photographic and comparable images
Other personally identifiable information unless permitted through re-identification.

An EMR is a digital link to every facet of a client’s healthcare history and can be accessed by multiple healthcare practice management providers, and offers a superior level of security to safeguard the storage and transmittal of patient records.

It’s essential that any individual or facility that handles client records obtain training and have an in-depth understanding of HIPAA regulations to avoid malpractice lawsuits.

Government Healthcare Programs: Learn Federal and State Run Insurances

by Nitin Chhoda PT, DPT | Sep 5, 2013 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

There’s a great debate going on in the medical community about the financial viability of treating patients covered by government-backed healthcare insurance.Many providers have said publically that they can’t afford to see those patients and will send them elsewhere for treatment.

In this timely article, Nitin Chhoda examines why it’s imperative for clinicians to learn about state and federally operated healthcare plans.

Incentive Payments

The list of federal health insurance plans is impressive. It includes Medicare, Medicaid, Tricare, CHAMPUS, Workman’s Compensation and Medigap plans.

Federal healthcare programs are in operation that provides incentives for clinicians in areas where a shortage of healthcare providers has been demonstrated.

The programs provide payments to recruit and retain practitioners, and awards incentive payments to providers who are already established in those areas. Some states have their own incentive healthcare programs.

Quality healthcare is at a premium in rural areas and patients are often woefully underserved. Clients tend to be older, poorer and have more health problems than their urban counterparts. Medicare maintains supplemental reimbursement healthcare programs for practitioners and clinics in rural areas.

Federal Health Programs Advantages

Each healthcare program has its own set of advantages and federal healthcare plans provide clinicians with a significant patient pool from which to draw. There are 9.64 million patients enrolled in the Tricare program alone.

Medicare pays 80 percent of patient costs and payment for practitioners participating in the Medicare healthcare programs receive reimbursements that are 5 percent higher than non-participating clinicians. Ninety percent of clean claims are processed within 15 days and payments are made within 30 days. Providers can join the Medicare network or accept patients on a case-by-case basis.

State Healthcare Programs

A majority of states operate their own healthcare programs for women and infants, along with children up to a specific age. Plans may offer prenatal and obstetric care for women and infants, along with a myriad of services for children and teens.

Coverage typically includes well child visits, dental and vision care, vaccines, prescriptions and medical supplies, mental health and substance abuse coverage, surgery and hospitalization, and diagnostic tests.

Participating in state run healthcare programs increases a clinic’s client base and many of the services can be accomplished quickly, giving simpler physical therapy documentation process, allowing practitioners to see more patients.

Many practices are choosing to employ nurse practitioners to see this particular demographic. Even after salaries, clinics can double the number of patients being treated and revenues.

Practitioners participating in state and federal healthcare programs increase their patient base and their overall revenues.

Providers practicing in rural areas can further stimulate income through supplemental and incentive programs. Government-operated healthcare programs serve millions of individuals throughout the nation, providing practitioners with a steady stream of revenue.

Modifiers Beyond the Treatment: The OTHER Ways to Legitimately Stimulate Cash Flow

by Nitin Chhoda PT, DPT | Sep 2, 2013 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

Practitioners are always seeking new sources of revenue and skilled medical billing specialists can obtain those additional funds through entirely legitimate means. Medical billing isn’t confined to simple coding procedures alone and in this insightful article, Nitin Chhoda examines ways billers can create greater cash flow for the practice.

Needful and Medically Necessary

There exists a wide range of procedures and modifiers that insurance companies don’t cover. They’re considered cosmetic and viewed as elective treatments.

Depending on the procedure, it may be possible to obtain reimbursement for some of those procedures, such as reconstructive surgery. Obese patients who have lost massive amounts of weight may require loose and excess skin to be removed.

Other clients may need dental work that can be billed as a covered expense, along with rehab services. Practitioners should remember that health concerns aren’t limited to the physical body. Patients may need the services of counselors, psychologists and psychiatrists to treat the mind.

Equipment and Pharmaceuticals

Modifiers are essential if more than one medical provider is involved and can qualify for additional payment. If it’s necessary to obtain lab work, an x-ray, MRI or similar diagnostic services, chances are the patient will be sent to another provider or facility. Equipment owned and maintained by another entity can be billed using modifiers.

Unbundling Advantages

Procedures that require extra skill, effort and time may qualify for additional reimbursement. Medical billing staff can billed specific services separately through the application of the appropriate codes, edits and modifiers. Practitioners may find that they must perform a second procedure while conducting another. Sometimes the two can be linked, but not if the second procedure is essential to the first.

Modifiers and Edits

Sometimes the difference in reimbursement is as simple as adding the correct modifiers to explain the full extent of the clinician’s services.

For instance, clinicians who make a simple diagnosis of a head fracture will receive much less in reimbursements than a practitioner that enters a diagnosis of a closed head fracture with contusions and lacerations. Each diagnosis is correct, but one provides greater detail and modifiers, allowing billers to enter that information in a way that generates a larger reimbursement.

Same Day and Multiple Treatments

Patients no longer rely on a single healthcare provider for all their needs. When a client sees multiple clinicians on the same day, modifiers are sometimes necessary to indicate each practitioner provided different services

Modifiers indicate a change or alteration in how a procedure or service was delivered. When use of modifiers is justified, it can mean a difference in hundreds and even thousands of dollars each year in additional revenues. They must be utilized judiciously. If not, it can result in paybacks and even legal action.

Supplies, Consultation and Time-Based Coding

A bandage may seem like a small concern, but some clinicians are depriving themselves of income by not including medication and supplies that are dispensed in the office.

The same is true when practitioners provide patients with counseling about medications, treatment options, and coordination of care that accounts for 50 percent or more of the patient encounter.

A complete accounting for the time spent must be documented to prove the service was necessary

One of the largest concerns of payers is fraud and inflated claims. They’re job is to find ways not to pay claims, or as little as possible, which often leads to underpayment for clinicians. With justified use of modifiers and edits, unbundling and hour-based billing, billers can legitimately stimulate significant cash flow for any practice.

Billers Working With Payers: Your Pain, Their Gain

by Nitin Chhoda PT, DPT | Aug 26, 2013 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Billers work hard to collect the reimbursements to which clinicians are entitled and healthcare insurance providers work equally hard to delay or reduce those payments.

It requires more data, phone calls and effort on the part of billers to collect even basic amounts. In this revealing article, Nitin Chhoda examines the insurance game and how to be on the winning side.

Insurance companies are in business to make money. When they make reimbursements, they view it as losing money.

As a result, insurance companies have reduced the amounts they pay medical providers for services, have become inventive at delaying reimbursements, and adept at utilizing a variety of techniques to deny payments.

EMR Assistance

Reasons for rejections come in many forms and electronic medical record (EMR) software is the first step in combating short or rejected payments. The software systems transmit claims electronically, ensuring they arrive at clearinghouses promptly and provide billers with an ongoing status record of each claim submitted.

EMRs can detect potential problems that could result in a rejection, allowing billers to submit clean claims that are processed quickly. The systems aid billers in submitting the appropriate forms to the correct clearinghouse and alert billers when a claim has been accepted or rejected. EMRs provide billers with a complete system for claim management.

Learning the Ropes

The techniques used by insurance companies to deny claims or pay at lesser rates are designed to keep money in their coffers for as long as possible. Quick submissions combined with meticulous documentation are essential when submitting claims and disputing rejections.

Collecting full and timely payments is much like a cat and mouse game, but billers that learn the “rules” are able to collect reimbursements quickly and cleanly that requires a minimum of follow-up.

Winning the Insurance Game

Dealing with insurance companies isn’t for the faint of heart. Denials can be issued for legitimate reasons, such as using the wrong form, not including sufficient documentation, a clerical error or a glitch in clearinghouse software. Organization and quick attention to denials often result in a successful conclusion.

Billers must submit claims within 72 hours whenever possible. If the problem is insufficient payment, an error can be corrected and the claim resubmitted. It’s important that the payer is aware that the claim isn’t a duplicate.

Submit documentation to specify what the error was and the correction. Another beneficial tactic is to submit claims ranked by charges and don’t include documentation unless asked. The needed information is included in the claim.

If attempts to rectify the problem are met with silence or delays, make the patient an ally. Inform the client and let him/her take the battle to their insurance company for a quick resolution.

Policy holders expect their insurance company to pay for appropriate expenses and not leave them holding the bag. Unhappy customers talk to others and insurance companies don’t want to lose clients.

Quick medical billing claim submissions, EMRs and enlisting the assistance of patients are legitimate means of winning the reimbursement game with insurance companies that procrastinate and underpay. In most situations, the payer holds all the cards, but billers can turn the tables and make the payer’s pain the clinician’s gain.