Healthcare Practice Management

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.

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.