practice management

Medical Billing Company: Everything You Need To Know

by Nitin Chhoda PT, DPT | Sep 4, 2017 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

When it comes to your billing needs, hiring a medical billing company may be the best option. Nitin Chhoda shares the important factors that you need to consider whether you’re going to hire a medical billing company or an independent contractor, and how your preferred billing system plays a key role in that decision.

Medical billing company is not easy to find and medical billing is no easy job. But for many small medical practices, adding billing to your list of things to do can be overwhelming.

Especially for practices that are just getting started, hiring a medical billing company can be cost-effective and will take a lot of stress out of the process of starting and running a business.

Just like hiring an accountant to do your taxes, when you hire a medical billing company, you are handing off a very important task to an expert in the field.

Price Isn’t Everything

Of course, when you hire a medical billing company, the hope is that you will be paying them less than you would pay a full time medical biller as part of your staff. Giving yourself some financial ground rules or even estimates will help you to determine how much money you should pay a medical billing company for the services they provide.

Medical Billing Companies Should Provide Typical Rates

But in addition to doing the job, they’d better do the job really well. Many medical billing companies will guarantee a certain rate of accepted claims. If they don’t actually guarantee a certain rate, they may at least give you their typical rates of rejected and denied claims so you can tell what kind of job they are doing.

Typically, insurance companies will reject about half of all claims, so even with a professional medical billing company, your expectations shouldn’t be too high. And remember that the time and effort that it takes to handle medical billing really is worth more to you than the cost of hiring a medical billing company to do the work for you.

Medical Billing Company or Independent Contractor

Some smaller practices may have the option of hiring an independent contractor who works part time and remotely. This option can also be cost effective, especially if the price is right.

In many ways, you will have to work out the details more thoroughly with an independent contractor, which may result in better outcomes for billing. But the convenience of medical billing companies is often a big factor in making the decision of who to hire.

More important than the size of the medical billing company, be sure to hire someone or a company that has a lot of experience and a proven track record.

Your Options

If you are trying to choose between an independent contractor with ten years of experience or a brand new medical billing company that has been around for less than a year, make sure that the employees at the medical billing company have more experience before you take that route.

A medical billing company may have a more standardized system and it may be easier to integrate your data system with theirs, but if they are new to the work and do not bring in the payments that are owed to you, nothing else will matter.

Make sure that whoever you hire can send you reports from their previous work as well as reports for the work they do for you, so you can see how the work is going, too
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Physical Therapy Documentation: Revenue Trending Mechanisms and Their Impact on Your Practice Revenue

by Nitin Chhoda PT, DPT | Apr 30, 2017 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Medical documentation and billing is an integrated process, in which minor inefficiencies can cause a ripple effect in the way revenue is collected. Billing in particular, may be an area of concern.

The smallest mistake on an insurance claim can lead to a delay in payment, time wasted by the biller while researching the mistake and re-submitting the claim, and potentially the loss of that revenue altogether. Nitin Chhoda teaches you how to resolve this, and grow your practice in the process.

Revenue assurance is a growing financial and telecommunications field that looks at the devil in the details; inefficiencies that may seem small can cause a ripple effect in the way revenue is collected.

For a very large physical therapy documentation of a business, having a revenue assurance team makes some sense.

Determining Inefficiencies

Usually, the staff working on their jobs does not see inefficiencies or productivity leaks. A revenue assurance team or staff member can take the time to find the problems and can take a wide-angle view when looking for solutions.

In physical therapy practices, finding those revenue leaks is a very new task. Typically, it is up to physical therapy documentation and management staff to identify where revenue is lost and to recommend or require adjustments from the staff.

However, without a medical EMR or other physical therapy documentation software, it can be almost impossible to even identify the problem, let alone work toward a solution.

Revenue Assurance Mechanisms for Medical Billing

It is probably obvious that one of the departments where revenue leaks occur most frequently is within the billing department.

Medical billing and physical therapy documentation is especially prone to inefficiencies, because the smallest mistake on an insurance claim will lead to a delay in payment, time wasted by the biller while researching the mistake and re-submitting the claim, and potentially the loss of that revenue altogether.

Physical therapy documentation software is specifically designed to make it easier for medical coding and billing professionals to avoid mistakes. Because the information is entered directly by clinicians, the notes and weighted procedures can be standardized. Every time a clinician adds something to an EMR, they can choose a line of text that they have entered before.

For medical billing staff, this kind of consistency can improve claim acceptance rates significantly. If the coder knows what to expect, they can simply select the same codes repeatedly. Billers can identify what kinds of claims each insurance company accepts and where problems occur. The process can be streamlined and made more successful with physical therapy documentation software.

Focus on Productivity and Job Satisfaction

The job of the physical therapy documentation manager is complex. You must keep your eye on the big picture, looking for ways to improve the practice overall, but you also need to ensure that each staff member is getting some sense of fulfillment or satisfaction from the work they are doing.

Content, satisfied staff members are more productive and successful. The good news is that combining an effort to improve physical therapy documentation staff satisfaction with improved productivity can be incredibly successful.

Improve Staff Performance

Especially with the addition of physical therapy documentation software, the staff can be given the opportunity to make their jobs better for themselves, while improving their performance for patients and for the practice.

Revenue trending mechanisms that are put into place can feel insidious if implemented improperly. Nobody wants to be told they’re not doing a good enough job and that they are being forced to adjust by using new software.

But if the process is framed in the right way, with the right intentions, everyone can benefit from the new physical therapy documentation system.

Medical Coding and Its Trends

by Nitin Chhoda PT, DPT | Jul 25, 2016 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Medical coding can be done by a skilled professional or by a trained physical therapy billing staff. It is important that who ever is assigned this task is knowledgeable and detail oriented because it affects the billing and revenue cycle for the practice.

Nitin Chhoda shares the latest trends in medical coding and the role of ICD-10 codes to the medical practices.

Incorrect medical coding costs small practices thousands in revenues each year. Medical coding can be a tricky process and requires the expertise of a trained professional, even with an EMR.

Physical therapy billing software will significantly reduce the number of errors and denials, but with upcoming changes in billing codes, clinic owners may want to consider hiring a certified medical coder.

Medical Coding and Billing

Medical coding is a complex and demanding environment requiring someone with special knowledge and expertise, and who is detail oriented. Some practices combine their billing and coding departments under the guidance of a single person.

A good physical therapy documentation system will include billing and coding functionalities that makes a coder’s job easier, but then clinicians must decide if they’re going to hire a certified medical coder or train one themselves.

Even with a top of the line EMR, nothing can replace the expertise that comes with an experienced and certified medical coder. They undergo extensive education and training, build upon their expertise with on-going re-certification courses, and are fully able to navigate changes and updates in the coding system as they occur.

They command more money for their medical coding services, but trying to train a new coder is time consuming and can cost the practice thousands of dollars while they learn.

The Coding Process

The introduction of EMRs adds another level of difficulty to the billing and medical coding process.

An EMR greatly facilitates the job of a professional coder, allowing them to maintain a constant rate of concurrent billing and coding procedures, reducing the ebb and flow of payments that can severely interrupt a practice’s financial health.

A factor that will radically affect the billing and medical coding process is the switch from ICD-9 to ICD-10 codes in October 2013 that will introduce 100,000 new codes into the existing system of 13,600.

medical coding trends Correct coding is difficult enough – the on-going educational requirements for professional coders will make it easy for them to handle the many changes and updates.

The medical coding changes will affect every medical provider in the country and represents the first comprehensive update since 1977.

The coding changes take into account new diseases that have been discovered, a better understanding of old ailments, new medications and vaccines, and the effectiveness of those medications in treatment.

With mutating viruses and diseases that can be communicated among species, the coding change is long overdue. Global travel and journeys to under-developed countries sets the perfect stage for pandemics.

Switching to ICD-10 Codes

The switch to ICD-10 codes will help all practices provide medical coding that more accurately reflect treatments and procedures. The result is better patient care, quicker reimbursements and fewer denials.

The future is bright for professional medical coders. Their extensive medical coding training is a distinct advantage for practice owners who benefit from their expertise. Better medical coding means better and faster reimbursements, fewer denials, mistakes and errors, and issues can be dealt with quickly and efficiently. EMRs will help medical coders accomplish those goals in an expeditious manner.

EMRs will soon be a fact for every physical therapy practice. Clinic owners who implement an EMR system with correct medical coding will be ahead of the game when the coding changes take effect. Professional coders will play a major role in ensuring that clinicians are compensated for their time and services.

Healthcare Management and Medical Billing Relationship

by Nitin Chhoda PT, DPT | Jan 4, 2016 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Medical billing and healthcare management are interconnected. The success of the practice relies on these two factors having a good relationship.

Nitin Chhoda explains the correlation between billing and management, and the role it plays in a successful healthcare practice so that the owner will value its importance and avoid recklessness.

Therapists walk a thin line when reconciling the healthcare management of their patients and medical billing.

The process of accurately coding and billing of healthcare practice management can sometimes be at odds with the client’s welfare and their insurance coverage.

Therapists are often dealing with a narrow description of a complicated problem and it’s essential to provide the exact billing codes that describe the diagnosis, symptoms and corrective measures that were taken.

Patients can differ widely in their responses to treatment, making it imperative that therapists provide in-depth documentation to support their actions and conclusions.

Accurate physical therapy billing ensures clients to receive the best possible care and the clinic to reimburse at the highest available level for the services provided.

Healthcare Management and Billing

Billing and healthcare management is a closely interwoven process and it’s the responsibility of clinicians to educate themselves on the intricacies of the two. The result is better billing and coding, expedited reimbursement claims, and staff members that aren’t overwhelmed.

Next to treating patients, billing is the most important position in a practice. A clinic’s profitability rides on the billing professional submitting claims in a timely manner, conducting follow-ups and ensuring payments are received.

Physical therapy billing is complicated and time consuming, and smaller practices often have a designated biller that has a variety of additional tasks.

The day-to-day workflow doesn’t remain the same and it’s easy for billers to get behind without the appropriate healthcare management support and sufficient time to perform their responsibilities.

An EMR facilitates the process, allowing billers to submit claims quickly, efficiently, and with a lower denial rate.

Billing With EMR

EMRs provide clinic owners with the tools to track reimbursement claims, monitor denials, and identify potential and existing problems. On average, claims are denied approximately 50 percent of the time.

This is due to a variety of factors, from incorrect coding to improperly submitted claims. The burgeoning number of healthcare claims and limitations on services has been the impetus for insurers to scrutinize reimbursements more closely than ever.

Therapists with an EMR for healthcare management can utilize its many capabilities to identify denial rates, ascertain why claims was rejected and discover any patterns that might exist.

Problems may lie with incorrect coding, inefficient healthcare management or time restrictions placed on the biller. Once the cause has been determined, clinicians can work toward a solution that better utilizes the biller’s time.

Revenue Loss Factors

Another factor in revenue loss is the number of old and unpaid accounts the practice is carrying. One of a biller’s priorities is to track payments and ensure they’re deposited in the clinic’s account. Billers must review accounts on a regular basis to ensure payments have been made and make inquiries into their status if needed. Billing and healthcare management requires an individual who is detail oriented, with an agile mind and specialized knowledge.

The financial health of a physical therapy practice hinges on the efforts of its coding and billing expert. A large part of effective healthcare management is ensuring the biller has the time and support needed to maintain a steady cash to the clinic.

Ensuring the individual has superior training and sufficient time to perform the necessary and sometimes redundant tasks of billing will boost the clinic’s revenues and allow clinicians to pursue additional streams of revenue.

Medical Billing Company: How It Works

by Nitin Chhoda PT, DPT | Nov 2, 2015 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

In this article, Nitin Chhoda describes the role of a medical billing company and how it can help a private practice.

There are some important points to consider when deciding about the company you want to work with, whether to outsource and hire a medical billing company, or train in-house personnel.

Selecting a medical billing company is a major decision and one that must be considered carefully.

Some practitioners choose to handle their billing needs on-site through their EMR, while others simply turn that aspect of their business over to a company that specializes in billing, coding, recovery and collections.

Therapists that choose that path should approach the process in much the same way they would to hire an accountant or financial planner.

The Role of Medical Billing

Medical billing is a highly specialized field and clinic owners should seek a medical billing company that employs certified medical billers that have the education and training to understand the more than 120,000 new codes involved when ICD-10 is implemented.

Insurance companies have a wide variety of requirements and restrictions, and the firm’s medical billers should have a working knowledge of them all. Clinicians should also seek a medical billing company that treats their money as if it was their own and has a proven history.

Don’t be afraid to ask for references and proof of recovery percentages, along with the average turnaround time on reimbursements and their annual write-off rates. The medical billing firm must meet and maintain HIPAA standards, work to recover the maximum amount of revenue for the clinic, and provide regular reports on the financial state of the practice.

For many physical therapists, outsourcing their medical billing needs represents considerable savings for the practice. In-house medical billing may require hiring additional staff to handle the complicated and time-intensive process competently and efficiently.

It can also require significant upgrades to the practice’s current hardware and software systems. Smaller practices may benefit most from outsourcing their billing department and it may present the most cost effective solution.The 21^st century practice doesn’t rely on paper records and neither should the clinic’s medical billing company.

Medical Billing Companies

Today’s billing companies offer a variety of services that includes many of the capabilities available with an EMR, encompassing patient scheduling, client reminders, verification of insurance coverage and a 24/7 call center. They also provide therapists with information to track demographic groups, cancellations, referrals, no shows and new patients.

Billing, coding and collections are processes that continue to become more complex.

Hiring a medical billing company relieves therapists of a time consuming task, while providing clinicians with additional time to focus on patients and their care and an improved cash flow for the clinic.

Billing firms have the financial resources to hire the most experienced and knowledgeable staff, and purchase the sophisticated software and hardware systems.

A facet of the medical billing company that many therapists overlook is the quality of the customer care that’s provided. The medical billing company will often be required to deal directly with the clinic’s clients and will represent the “face” of the practice.

Customer Service Standards

It’s imperative that the medical billing company adhere to the highest customer service standards and represent the clinic appropriately.

Ultimately, practice owners must decide if the cost of outsourcing their billing and collection needs outweighs the expenditures of maintaining an in-house billing department. Therapists with an in-house system should examine their practice to ascertain the efficiency of the clinic’s system. If costs are high and collections are low, hiring a medical billing company may be in the practice’s best interests.

How to Verify if Your Software is ICD-10 Ready

by Nitin Chhoda PT, DPT | Oct 12, 2015 | ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

The big day for the ICD-10 transition is just around the corner. Practices should have been using their time to train, install hardware and test their software for compatibility with other entities with which they communicate. However, despite the best laid plans and intentions, clinicians may not be as ready as they think. Software systems are a prime consideration and there are steps that practitioners can take to ensure they’re ready when Oct. 1, 2014 arrives.

EMRs

There are dozens of EMRs available. They have multiple features, but clinicians are often required to pay extra for access to updates and other items that should be included automatically. Practitioners will want to ensure they have an EMR capable of handling the new codes and that they have the latest version available installed.

EMRs must have sufficient security measures for HIPAA compliance to safeguard patient information. Consult with vendors to verify that the EMR is HIPAA compliant, code upgrades are covered in any contracts, and if training will be included.

Crosswalks

A crosswalk offers a means of translating ICD-9 codes to the new ICD-10 version. It’s essential that any software include those crosswalks for translation, especially in the early months of the transition. If the EMR doesn’t support crosswalks, clinicians may need to invest in a program to assist with coding tasks.

GEMs

General Equivalence Mapping isn’t designed for long-term use, but it does provide a valuable resource. It’s a tool that can be used to assist in locating the correct code options and help staff become more fluent and comfortable with the new code selections.

Side-By-Side Coding

Until everyone in the practice is familiar with the new coding system, a side-by-side coding feature will prove very helpful. It will reduce staff frustration and help everyone rest easy knowing they’ve entered the correct diagnosis codes.

A system that allows clinicians and staff to incorporate the new coding into their everyday duties will help everyone become familiar with the new codes before the deadline. They can also begin using the new codes prior to the implementation date with entities that are ready.

Billing

It’s critical that in-house or contracted billing services are prepared for ICD-10. They must be compliant with the new HIPAA transaction standards for transmitting data electronically. Be prepared for a reduction in productivity, even with superior billers and coders.

Testing

Testing should include the ability to submit claims and insurance eligibility. The only way to ensure if a practice’s software is ready for the ICD-10 transition is to conduct exhaustive testing in those areas – then test some more. If any glitches or issues do exist, the more the system is used the more likely they will be to become apparent. It’s also important that inter-office systems can communicate with each other.

The software that transmitted a claim perfectly today has the potential not to work smoothly tomorrow. Continued testing is the only way to ensure that problems are identified and addressed prior to the deadline. If for some reason an issue can’t be fixed by implementation day, be sure to have a contingency plan. Relationships with new vendors may have to be established, so be prepared.

Significant coding changes will take place with implementation, but if the practice’s software can’t communicate successfully with insurance companies and clearinghouses to submit claims, they’re of no use and will cost clinics dearly in revenues. Implementation is more than just a coding change. It affects every department. Ensuring the clinic’s software is working correctly will make the transition easier while maintaining revenue levels.

Almost everyone in the medical profession anticipate a loss of income with the implementation of ICD-10. However, some healthcare management and technology firms have postulated that the switch to ICD-10 will present practitioners with opportunities to increase revenues, as it will be easier to document co-morbidities. They also note that the key to increased revenues depends on greater documentation accuracy, one of the stated goals of ICD-implementation.