Physical Therapy Management & Physical Therapy Documentation

Medical Management Streamlined with EMR

by Nitin Chhoda PT, DPT | Jul 1, 2018 | Electronic Medical Records, Physical Therapy Documentation, Physical Therapy Management

Streamlining medical management is now possible with the use of EMR. Nitin Chhoda enumerates the benefits of EMR including the efficiency of billing, scheduling and managing productivity reports.

Clinicians, practitioners, and other private practice owners that use medical management are being forced to take certain steps toward efficiency.

The financial pressures of an increasingly hostile and uncooperative health insurance industry, combined with the fact that more and more patients are unable to pay their bills, has put clinicians in an uncomfortable bind.

How can you provide the best medical care possible if you are restricted by financial considerations? The transition may be a bit rough, but it looks as though private practices are going to get some major help by adopting electronic medical records.

Electronic medical records cut down on administrative costs, making it just a bit less expensive to run the clinic. But more importantly, they can streamline medical management and help the practice to run more efficiently.

Billing and Scheduling: Efficiency Traps

It turns out that much of an clinic’s efficiency is decreased because of errors and delays in billing and scheduling. The ways that EMRs can streamline the billing aspects of medical management may be obvious to some.

A billing system that tracks unpaid bills and sets reminders for the medical management personnel responsible for billing will increase the likelihood that bills will not be forgotten.

This is true for patients as well as health insurance companies. Most medical management and health insurance companies have very particular requirements for the filing of claims. These forms can be time intensive and frustrating to complete. EMRs that are designed to streamline medical management will include options for filing the appropriate paperwork and will include reminders so the paperwork is filed in the required timeframe.

Increased efficiency in scheduling is less obvious at first, but the benefits are certainly easy to understand. When a patient cancels an appointment, that time slot is easily lost and left empty. Scheduling components of EMR programs will ensure that all empty slots are filled when possible. They also allow for re-scheduling with a few clicks of the mouse.

Reporting and Medical Management

On the other hand, medical management professionals will tell you that one of the biggest challenges to improving efficiency is the lack of useful data.

On paper, it is overwhelming to attempt to compile reports that detail how many appointments have been missed, how many bills are left unpaid or the collection percentage, and productivity as measured by the number of patients scheduled for each medical professional.

EMRs offer reporting tools and instruments for medical management systems that make evaluation of the practice quick and efficient. Imagine if you could print a referrals report with a few clicks or figure out how many visits each patient typically schedules.

More Productive and Efficient

Medical management can be more productive and more efficient if these kinds of figures can be analyzed. Without EMR and reporting capabilities, this kind of analysis is overwhelmingly challenging and presents time barriers that are insurmountable.

Rather than relying on the business to continue as usual, medical management professionals and EMR systems learn what is working at your practice and what is not working. Once you know how things are actually going, you can take action to change it for the better.

Medical Billing Basics

by Nitin Chhoda PT, DPT | Jun 10, 2018 | Medical Billing, Physical Therapy Billing, Physical Therapy Management

The basics of medical billing and its role in the physical therapy business are shared by the licensed physical therapist, Nitin Chhoda. He emphasizes the difference between medical billing and regular businesse billing.

Closely followed by the process of medical coding is the medical billing step. These two important parts of any practice are closely related and intertwined.

They work together like the contract administrator and the biller who must base billing on the details of the contract.

In small practices, the medical coding staff member is the same person as the medical biller. It is likely that this trend will continue as medical coding and medical billing systems become more efficient and more integrated.

What is medical billing and why is it different from other forms of billing?

The primary difference between medical billing and any other billing is that medical billing requires an incredible amount of attention to detail and specific codes for each procedure. Naturally, there are other billing processes that are similar, but medical billing seems to be one of the most complex of them all.

Medical billing is what health care providers and health insurance companies go through to get medical expenses paid to the health care provider. The first step is the visit of a patient to the health care provider. The clinician will attempt to diagnose the problem the patient is having in an attempt to classify the exchange for the health insurance company.

Medical Coding and Billing

The billable services are then coded by the medical coding staff member and those codes are used for medical billing to the health insurance company. The rates for services are pre-set by the insurance company and the clinic, which is why clinics only take certain types of health insurance.

They have to negotiate prices with each company they work with. If there are any mistakes in the medical billing service and process, the insurance company will reject or deny the claim.

A rejected claim is a bill that has some clerical, invalid codes, or any other minor detail that can be a cause for rejection. Rejected claims must be researched by the medical biller and re-submitted correctly.

Denied claims have been processed but the insurance company has deemed them unpayable. A denied claim can be re-submitted or appealed if the medical biller believed the denial was unfounded.

Medical Billers and EMR

Medical billers have to deal with about a 50% rejection and denial rate. There are so many opportunities to make mistakes and insurers are much quicker to deny or reject a claim than they are to pay one.

The back and forth can be frustrating and exhausting. But more importantly, this paperwork headache is incredibly time consuming. Medical billing has turned into a very inefficient process and medical billers can start to feel that they are wasting incredible amounts of time just because of a tiny mistake. Medical billing can be a tough job.

Electronic medical records are attempting to streamline the process, however, and the job of the medical biller may get easier in the very near future. Many EMR systems are actively marketed as easy-to-use for medical billing. They can decrease the occurrence of mistakes and speed up the corrections process.

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.

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.