practice management

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 and Medical Billing Relationships

by Nitin Chhoda PT, DPT | Apr 22, 2018 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

The relationships between the healthcare management and medical billers are important. It involves the whole process of physical therapy billing.

Nitin Chhoda reveals certain areas where healthcare management and medical billers should support each other for the success of the practice.

Depending on your first hand experience with medical billing, it may be completely obvious that health care management and medical billing are very closely integrated.

However, many health care practice management professionals who have no experience in medical billing can cause problems for medical billers if they do not educate themselves on the relationship between the two.

Small Practice Medical Billing

In a small practice, it’s very likely that the medical billing will either be hired out to a separate company, or that it will be handled by the health care management staff.

These days it is easier to both hire out as well as accomplish medical billing jobs in-house as part of a position with other responsibilities. But this can cause a lot of problems when that single staff member starts to get overwhelmed.

Medical billing is the most important part of running a medical practice, besides actually treating patients. Health care management involves being able to detect the signs of an overwhelmed medical biller before it causes serious problems. Everyone in the office relies on the medical biller to bring in the payments that keep the practice running.

Health Care Management Indicators

There are a number of indicators which may tell health care management that the medical biller needs more support or more time to do their job correctly. Sometimes changes in workflow can bring efficiency up, but often it is more a problem of being overworked than anything else.

Health care managers who don’t realize how much time it takes to complete the medical billing in the way it should be handled are likely to overwhelm their staff unknowingly.

One way that health care management can identify a problem is by looking at rejections and denials from insurance companies.

This is a tough indicator, because the average rejection and denial rate is about 50% of claims. However, with an advanced EMR you can get more detailed information.

Why has a claim been rejected? How often are rejections and denials due to clerical error, time restriction problems, or incorrect medical coding and health care management? These are the kinds of errors that occur when the medical biller doesn’t have the time to review their work before submitting claims.

Aging Reports

Another indicator are accounts receivable aging reports. Aging reports will tell you how long it takes for claims to be paid. It can also tell you whether or not medical billing and health care management staff is taking the time to review the accounts receivable aging reports regularly enough.

Sometimes payments are delayed or even overlooked because the claim has been sent, but was never received by the insurance company.

Sometimes the rejection or denial is sent incorrectly and the practice will have no way of knowing that this is what happened. Unless someone runs an aging report and checks with the insurance company to determine the status of the claim.

Medical billing involves a lot of duplicate work and communication. Health care management principles can ensure that this work is done correctly by giving medical billers the time to do their job.

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.