Physical Therapy Documentation & Medical Billing INTOUCHEMR

Medical Billing — 5 Mistakes You Must Avoid

by Nitin Chhoda PT, DPT | Jun 3, 2018 | Medical Billing, Physical Therapy Documentation, Physical Therapy Management

Nitin Chhoda reveals the 5 mistakes that a practice owner should avoid when it comes to medical billing. In order to have a successful practice, time management and prioritization are crucial to the billing process.

Medical billing mistakes are easy enough to make, and unfortunately even the smallest mistake can cost a practice a lot of time and money.

While there are some mistakes that simply cannot be avoided, there are some basic rules for avoiding the major mistakes that most medical billers and medical clinics make.

#5: Understand the Explanation of Benefits

The explanation of benefits, or EOB, is going to sound like the final word from the insurance company every time. But the EOB should be used as a tracking tool and should be carefully read and understood each time your practice receives a payment.

Insurance companies take any opportunity to point out the medical billing mistakes being made, which can make it feel like they are detail oriented to an unimaginable degree. But the truth is that they make mistakes, too. And it will be up to you to catch them.

#4: Follow Up on Every Submitted Claim

In the medical billing world, once a claim is submitted, there is often the sense that it has been dealt with and now it’s time to wait and see what happens. Medical billing is hard enough and takes a lot of time, so once the paperwork is in the hands of the insurance company, billers are unlikely to want to spend any more time thinking about the claim.

But time and again insurance companies let things go or don’t receive claims, and the practice suffers the consequences. Large sums of money are lost every year because nobody has run an aging report and reviewed unpaid claims.

#3: Create a System that Works

This may seem obvious, but every practice needs system for photocopying IDs and insurance cards, planning time for regular billing, and ensuring that claims are filed and checked on in a reasonable amount of time.

Delays that medical billing claims experience cost the practice money. Set aside time for each task and make sure that a procedure is followed for every patient and ever visit.

#2: Know Medical Coding Practices

A medical biller may or may not the be the same person as the medical coder, but either way the biller should understand the basics of medical coding.

The medical billing mistakes that cause claims to be denied or rejected often have to do with incorrect codes or insufficient medical coding.

#1: Billing is the Biller’s Top Priority

Especially in smaller practices, the staff member who handles medical billing service may have a whole host of jobs to do. They could also be the medical coder, the receptionist, and the scheduler. The problems arise when the medical billing is not given high enough priority in the list of things to do.

Without efficient and timely medical billing, the practice will suffer. Unfortunately we cannot rely on goodwill and good medicine to ensure that patients and clinicians experience a mutually beneficial outcome. Medical billing has to be a high priority, including the previous four ways to avoid mistakes.

Medical Billing And Coding In-House

by Nitin Chhoda PT, DPT | May 27, 2018 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

Whether your medical billing and coding should be in-housed or outsourced, there are certain things that are worth considering. Nitin Chhoda shares the advantages of an in-house medical billing and coding for a small or new private practice.

One of the biggest considerations for many practices is whether or not to conduct the medical billing and coding in-house or to outsource the work.

The question tends to focus on costs, which makes sense.

If your practice can save money by hiring a company to handle the medical billing and coding for you, why hire someone in-house?

But of course, calculating how you are best served is not all that simple. The determination often depends on the size of the office, how many claims need to be filed per day, how many clinicians work at the practice, and the costs of related hardware and software.

And of course, does in-house medical billing and coding improve the rate at which your claims are accepted and paid, or will outsourcing improve collection rates?

Benefits of In-House Billers

The most obvious decision will have to do with the amount of billing that your in-house billers and coders can handle.

In a very small practice, where the receptionist can handle scheduling, medical coding, and medical billing without being overwhelmed, hiring out medical billing and coding is probably unnecessary. And there are a few benefits to having the medical billing and coding professional right there in the office with clinicians.

When you can talk to your medical billing and coding staff member directly, all the details can be accessed at any time about any claim. One downside of an off-site service is that you have less control over and less access to your billing history.

Some services will provide reporting as a scheduled service or on demand. But timing will still be hampered by the fact that the medical billing and coding staff handling your practice probably has a number of practices to worry about. The process becomes less personal.

Another benefit of in-house medical billing and coding is that the information only has to be communicated once.

In other words, in many ways an outsourced system will require that someone put in a decent amount of work to get the billing accomplished.

In the most efficient scenario, you could simply scan relevant documents and hope they understand what is written.

But outsourcing will not mean that all aspect of medical billing and coding will be handled elsewhere. Someone still needs to be available for communication and transfer of information.

Size Matters When it Comes to Price

As you can imagine, the larger a practice gets, the more efficient an in-house biller can be. If you have a very small office, hiring one or two staff members just to handle medical billing and coding careers will be very expensive. In a private practice, there is a fine line to be drawn between having one staff member to handle everything administrative, and having too much work for a single staff member to handle.

When staff members with lots of responsibilities get overwhelmed, all tasks begin to suffer. And when medical billing and coding suffers, the entire practice is put in jeopardy.

Insurance Eligibility Determination

by Nitin Chhoda PT, DPT | May 21, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Nitin Chhoda shares why verifying insurance eligibility should happen before and not after treating patients.

The biggest challenges for medical coders and billers come from health insurance companies and its insurance eligibility.

With such high rates of rejection and denial of claims, the medical biller or coder, or physical therapy billing staff can be responsible for significant losses and a reduction in efficiency that can be damaging to the practice.

Claims submission rules change from company to company, not to mention for federal, state, and local programs. To reduce rejections and denials, take these steps to make sure you determine insurance eligibility.

Determining insurance eligibility should be done at the very beginning of any patient induction process. Ideally, before the patient even shows up for their appointment, so that you and the patient will already know what is covered and what is not.

Goals to Focus On

Remember that the purpose of checking for insurance eligibility will help you stay focused. Your goals should be to minimize claim denials and re-submittals, as well as eliminate any unpaid balances that patients owe. If you can keep those goals in mind, you will have an easier time controlling the aspects of the process that you can control.

Change Workflows

Another key thing to remember when it comes to insurance eligibility verification is that your patients likely have no idea what their insurance plan covers and does not cover. Many practices institute a pre-screening process to get some basic information from the client and learn what their expectations are before they have any bills to pay.

Pre-screening for insurance eligibility may be hard to get used to at first, because it will require that the medical biller actively spends time finding out information. That time will be hard to find for most medical billers.

On the other hand, consider the amount of time that you spend dealing with rejections, denials, and re-submittals of forms. How much is it hurting the practice to carry a large balance in accounts receivable?

And wouldn’t it be more time and cost effective if you got that part of determining insurance eligibility out of the way from the beginning? The answer to that last question is a definite yes! So consider starting with a workflow that adds a bit of time at the beginning but cuts a lot of time on the other end of the billing and insurance eligibility process.

Communication is Key

It may be difficult at first, but you will get used to talking to clients regularly about their insurance status. New patients will be easy.

If you use the approach that you are trying to help them, they should be amenable to giving you answers where they can.

Let them know that you understand how complicated it is, but that it will be easier for them and for you if you both figure it out now.

But it’s not only new patients you need to worry about. Patients whose coverage changes or who you haven’t seen in a while will also need verification of insurance eligibility.

If you can make some small changes, you can figure out just how much a patient will owe even before you file any claims. Ideally, you can even ask patients about their insurance eligibility and have them pay their portion up-front, entirely eliminating unpaid balances from accounts receivable.

Claims Submission Made Easy

by Nitin Chhoda PT, DPT | May 13, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Timely claim submission is an important role of medical billing staff. Nitin Chhoda discusses why regularly submitting accurate claims are vital and should be the first priority of any billing staff.

Perhaps because claims submission will take up the largest proportion of a medical billers time, claims submission is also one of the most frustrating parts of the job.

Getting rejected or denied 50% of the time can start to wear on a medical biller pretty quickly.

And yet, that is a normal rate of rejection. So how can you make the job of medical biller easier? It turns out that a few simple steps can change not only the way you feel about claims submission, but you may be able to improve results, too.

Priority #1

The importance of timely and accurate medicare claims submission cannot be undervalued. For anyone in the medical coding or billing fields, the job of ensuring that the practice is paid for service and in a timely manner should be the first priority.

Not surprisingly, most physical therapy documentation staff members responsible for this important job are likely to rush through it and do the billing only when they feel they have time. This is the opposite from the best way to get good results.

By recognizing that billing should be your first priority, you can lower the amount of pressure on yourself. In fact, you should be able to feel good about every time that you sit down to handle claims submissions.

The best way to re-prioritize claims submission is to dedicate a certain amount of time every day or every week to just submitting claims. When you’re handling claims submission, that should be the only thing you worry about.

Accuracy Checks

The worst time to re-check your work is right after you’ve completed it. In some practices, accuracy is checked because two or more people are responsible for medical coding and medical billing.

But in a small practice, that may not be the case. Consider checking accuracy in specifically allotted times, too. For example, let’s say you process claims every day.

Dedicate a couple of hours in the morning to organizing and preparing your claims and then the first thing after lunch go back and check and then handle any claims submissions. If you prefer to submit claims once a week, you can prepare claims during the week and file them for review and claims submission at the end of the week.

Insurance Eligibility Checks Before Claims Submission

Another key to increasing efficiency and success, and making claims submission less of a burden is to do your insurance eligibility checks in advance. Find out what the patient’s plan actually covers and ask them to pay the balance up front.

Changing outcomes from claims submissions may require that you change the way the medical biller does their job. This can be a hard adjustment to make, especially for an established biller with a workflow they are used to.

But improving the rate of accepted submissions is critical to the success of any practice. The more you prepare and schedule claims submission, the better the process will feel and the more successful you will be.

Health Care Management Overview

by Nitin Chhoda PT, DPT | May 8, 2018 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

EMR reports can help assist management on deciding whether or not to add more staff. Nitin Chhoda shows managers how EMR can help uncover issues by providing reports based on the needs of the physical therapy practice.

We don’t tend to think of health care practice management as all that different from any other kind of management.

But it turns out that health care management has to adapt and change policies more quickly than almost any other field.

The business side of running a practice involves a complex billing structure, high regulation, and constant updates.

Health Care Management at its Most Basic

The most basic definition of health care management can be summed up as the role an office manager plays in a health care practice. An office manager must be aware of the tasks of every staff member; they should be able to re-assign tasks or jobs as necessary.

Often it is the health care management that keeps a practice running smoothly. A health care manager may simply be the person in the office who does not see patients or handle a easy-to-define work load, simply so that when problems arise, there is someone to take care of things.

Today, the health care management role has changed to include monitoring efficiency and making administrative changes. With the introduction of electronic medical records, electronic health records, and technology that can track financial indicators, improving efficiency is not only possible, it has been made much more simple.

Health care management is often in charge of deciding what kind of technology to invest in. Increasingly, this means conducting analysis on current systems and workflows.

The Future of Health Care Management

Health care management is not only changing in the way tasks are delegated, but it is also experiencing the same growth as every other aspect of health care. The health care industry is rapidly approaching a level of demand that has never been seen before, thanks to the baby boomers.

This means demand for skilled employees is going up, too. This is true of certified positions such as x-ray technicians and ultrasound tech, but it is also true for management positions.

As the industry becomes more and more streamlined and efficient due to technology, each added employee turns into a significant benefit to the practice. If demand for services is overwhelming, then the only way to increase capacity is to hire more staff. Health care managers have to analyze the benefit of added staff and then manage the integration of new team members.

Technology is Changing Everything

For health care management programs, technology improvements are both a blessing and a curse.

On the one hand, office managers have to be adaptive, tech savvy, and they have to know how to implement software improvements. On the other hand, the job is changing so fast that it can be hard to know what it means to be hired as the office manager.

With EMRs tracking the number of cancelled appointments that never get rescheduled as well as statistics on referrals and number of visits per patient, health care management is turning into a more technical job. Drawing up reports on efficiency can show health care management how much work needs to be done to reach the goals of the practice.

Health Care Practice Management Present and Future

by Nitin Chhoda PT, DPT | Apr 30, 2018 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Nitin Chhoda shares the state of health care practice management from the past and how it will affect the future. He shows how the role of management and its staff are evolving as technology enters the physical therapy business.

Even though the tasks assigned to health care practice management staff have been around for as long as hospitals have existed, the job of health care administrators is relatively new and is constantly changing.

Handling medical records and medical billing is a big job. For very small practices, these jobs used to be the tasks of the health care practice management, usually in the form of an office manager.

But today, health care practice management involves so much more, and tasks like medical billing and coding are handled by specialists.

The current role of the health care practice management staff involves a lot more analysis and efficiency management than ever before, largely due to changes and improvements in technology.

The role of electronic medical records (EMR) in this change cannot be emphasized enough. Electronic health care practice management technology has allowed health care management to take advantage of data that was previously too time consuming to extract.

Health Care Management Focuses on Patients

Of course, all these technological improvements might lead health care practice management consulting professionals to spend more time with charts and graphs than dealing with patient concerns. But that is not entirely the case. In fact, analyzing performance of the clinic will serve two purposes.

Firstly, identifying problems with efficiency will provide many advantages to the doctors, nurses, clinicians, and entire staff of a hospital or practice. Many health care practice management professionals will be quick to look for ways to save money, which is another advantage of EMRs and using the technology that is available today. But most of the changes that help the practice’s bottom line have other benefits, too.

The second purpose of looking for inefficiencies by using data on outcomes, re-scheduling rates, and visits per patient is to identify where patients can be better served. This is the tangible benefit that technology can bring when used the right way.

Number of Patient Visits

As an example, imagine that some clinicians only see a patient three times before the patient can go back to life as usual but other clinicians spend at least five visits with each patient.

Usually, in a busy office, you would never even notice a pattern of health care practice management like that.

Clinicians tend to know just how often they need to see patients, based on past experiences and what they were taught.

But if you could see that patients with the same complaint were given a more effective treatment or series of treatments, you could find out what it is that efficient clinician is doing.

Health Care Practice Management, a Delicate Balance

It’s easy enough to see how this kind of information could be misused. And it is likely that we’ll see plenty of cases of disgruntled staff members who are frustrated by statistical analysis and being treated as if they aren’t doing a good job.

Health care practice management in the future is going to be more and more a job focused on efficiency. But there are important human elements that must always be kept in mind so a practice is really running the best it can. Unhappy staff are not the way to make things better.