physical therapy documentation

Claim Appeals 101

by Nitin Chhoda PT, DPT | Sep 15, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Reimbursement claims can be denied at any time and for any number of reasons. Most problems can be remedied easily, but when talking fails to facilitate a desirable outcome it may be necessary to file an appeal. In this revealing article, Nitin Chhoda addresses the basics of filing an appeal.

Most appeals in the billing process, physical therapy billing included. will involve commercial insurance companies.

How a clinician approaches an appeal has a huge impact on how quickly and smoothly the process is concluded.

Unfortunately, the onus is on the practitioner to prove why a claim wasn’t processed properly for payment. That requires knowledge of the payer and the terms of the contract that was signed with the insurance provider.

Provider Relations

Many contracts include a prompt pay clause that can cost the payer fees and interest on late payments if they didn’t file or process the claim according to the terms of the contract. The first point of contact when filing an appeal will usually be provider relations to ascertain if the claim was received and how it was processed.

A phone call can be all that’s needed to quickly remedy the situation. Some payers provide online reconsideration forms that can be submitted, while others require a formal written appeal. It’s critical to maintain complete documentation of all verbal and written communication associated with the appeals process.

Provider Representative

If the claim wasn’t processed due to the contract loading incorrectly in the payer’s software system, the next step is to speak with the provider representative. This individual is charged with ensuring the contract between the medical provider and payer is correct and loaded in the claims processing software system.

Expect to be vetted and answer specific questions about the claim. The provider representative may be able to locate the problem and solve it.

Representatives also have the power to send the claim back to the payer for reprocessing.

Written Appeals

If a phone call fails to resolve the issue, a written appeal must be submitted. It should include all the pertinent information about the claim and clearly state the expected outcome for settlement. Explain why the actions are being sought and further steps that will be taken, such as referring the matter to the practice’s attorney.

Exercise Control

Appealing a claim rejection is time consuming and frustrating. It’s critical to exercise control and professionalism at all times.

The appeals process relies on facts for resolution and it’s important to clearly state the problem and the payment expected. Refer to specific clauses in the contract to prove points.

A denied or rejected claim delays payment and appealing the decision can require considerable time and effort.

The process is sometimes necessary to collect the fees to which clinicians are entitled and it’s important to keep a cool head throughout the process.

Most disputes with commercial payers can be solved if practitioners approach the situation armed with the facts and the terms of the payer contract.

The Life of a Claim: How You Get Paid

by Nitin Chhoda PT, DPT | Aug 4, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The clock starts ticking on the life of an insurance claim the moment a patient makes an appointment and doesn’t end until the practitioner is paid. To better understand the life cycle of an insurance claim, Nitin Chhoda offers a first-hand look at the process.

First Contact
When clients contact a practice, it sets in motion a process in which it can take up to three months for the clinician to be paid.

Before patient arrives at the office, staff should already have obtained and verified the individual’s healthcare insurance information to ensure the policy is in force, hasn’t lapsed and who is covered, along with any limitations or restrictions.

Insurance benefits can be tricky to navigate. Clinicians must ascertain exactly what’s covered under the patient’s claim insurance, their deductible and co-pay when they make an appointment. It will impact the client’s available treatment options. Some individuals have coverage under more than one insurance provider. Both policies must undergo the same rigorous verification.

Patients will also be required to sign consent forms allowing the practitioner to bill the insurance company and be paid directly, release information for billing, and for the client to pay any amount not covered by insurance claim. A copy of the client’s identification and insurance card is required, along with a complete health and medical history.

Enter the EMR
All the client’s information must be entered in the practice’s EMR for medical billing. Incorrect or incomplete information will delay reimbursements to the clinic, as will failure to obtain an authorization for procedures. Insurance providers will deny a payment if the correct forms aren’t used, information is incomplete and for other breaches of the company’s particular set of rules.

To document the client’s visit, clinicians will create an encounter form that provides pertinent information about the patient’s complaint, exam, diagnosis and procedures performed. Any secondary problems that are observed must be documented and all the information entered into the EMR. Each diagnosis and procedure code must match or the claim will be denied.

Calculating Fees
Clinicians can now enter the cost of the visit utilizing their schedule of fees. Each procedure and all materials must be calculated into the final cost, from the use of the exam room to bandages. It’s also time for the patient to determine how they’ll pay for any portion of the cost for which they’re responsible.

That can take the form of cash, check, debit or credit cards, or a payment plan. Collect at least a portion of the payment before the client leaves the office.

Submitting the Claim
A reimbursement claim must be prepared and sent to the client’s insurance carrier, complete with documentation of the patient’s financial and clinical information from their visit. Each claim should be double checked to ensure that codes and patient information match, and that there are no omissions, or the claim will be delayed.

The claim will examined in extensive detail by the insurance company to ensure the client is covered, any restrictions and limitations were adhered to, accurate coding was included and information is complete.

If a problem arises, the clinician will be asked for additional information or to resubmit the claim.

Practitioners can appeal the decision, collect any unpaid amount from the client or write off remaining costs.

It can take a typical claim up to three months to be reimbursed, even without any difficulties. Using an EMR ensures HIPAA compliance, protects against loss, decreases processing time and accelerates the entire process for quicker deposits and better cash flow.

Physical Therapy Documentation: The Importance of Personalization in Your Physical Therapy EMR system

by Nitin Chhoda PT, DPT | Mar 31, 2019 | Physical Therapy Documentation, Physical Therapy Management

Personalization is critical when choosing the right physical therapy documentation or EMR for your practice.

Nitin Chhoda discusses the importance of personalization and customization in the physical therapy documentation process, and how it should affect your selection of a physical therapy EMR.

The best limbo dancers are extremely flexible and that same quality is essential in a physical therapy documentation system.

The majority of EMRs were developed and written with a specific user in mind, from hospitals and physicians to surgeons.

EMRs reflect the reasoning of the creator rather than the end user. It’s essential to select an EMR developed by or for a physical therapy practice to ensure the EMR doesn’t begin dictating how the clinic conducts business.

Selecting the Best Physical Therapy Documentation System

When selecting a physical therapy documentation system, the two key factors are flexibility and control. The system must offer the flexibility to meet the individual needs of the practice for the present and the future.

Therapists must be able to control every aspect of the physical therapy documentation process without interference from the EMR. Documentation software provides the means to achieve a more efficient and profitable practice.

It should never intrude on or force therapists to compromise on the way they operate their business.

Have an Effective EMR

Many EMRs look and sound good in theory, but ignore the practical concerns of the clinical environment. Physical therapy practices vary widely in the services offered, professional experience and work environment and an EMR must be able to adapt to the diverse needs of the individual practice.

A good physical therapy documentation system offers additional options as needed to grow with the practice.

An effective EMR integrates easily with existing office systems to expedite physical therapy documentation of patient records, enhance marketing endeavors, and provide patient portals for additional functionality. EMRs automate many of the time consuming tasks typically handled by staff members, freeing them to engage in pursuits that promote the clinic, acquire new patients, and increase the level of the practice’s customer care.

Customized Pattern

The ability to create customized templates, without restriction, that accurately reflects the services and treatment options of the individual practice is essential. Therapists should be able to create their own templates, without hiring a tech specialist to navigate the system.

Not all patients respond the same way to treatment, requiring therapists to be creative to achieve the best results for the client. Any EMR should include the ability to combine any number of physical therapy documentation services and bill accordingly.

Reimbursements

Physical therapy documentation, billing and coding options specifically designed for use by therapists help navigate the increasingly complex requirements for reimbursements.

The ability to submit claims electronically should be a function of physical therapy documentation software.

Reimbursements are received quicker and additional information and clarification can be accomplished almost immediately. EMRs also allow therapists to work with an extensive number of payers for the best reimbursements.

As more complex and innovative treatments are developed, physical therapy documentation must be able to change and evolve to meet the needs of practices.

Flexibility in all facets of EMR software is needed, from time stamps to avoid legal issues to the ability to create custom forms that reflect the special requirements associated with physical therapy clinics. Both web-based and server-based EMRs are available, but the key to successful implementation is always the ultimate flexibility of the selected software and its ability to facilitate clinic expansion and profitability.

Medical EMR Can Simplify Healthcare

by Nitin Chhoda PT, DPT | Mar 10, 2019 | Electronic Medical Records, Physical Therapy Documentation

Medical EMR can simplify healthcare in many different ways. The best part is that it can streamline the whole physical therapy documentation process from start to finish without consuming too much time from the staff. Nitin Chhoda explains how this is all possible.

There are many ways that an integrated medical EMR system can help a practice to save money and become more efficient. But one benefit of EMRs that is often overlooked is the way a good system can simplify healthcare in general.

There are benefits to patients as well as clinicians that can help even the most confused patient to get the care they need at a better price, without costing the practice more money.

Billing Advantages

Healthcare providers already know how an integrated electronic medical record can make billing more accurate and efficient.

If everyone in the practice is using the same system, and all data are available through that system at any time, medical billing staff can pull the data they need and bill on a timely schedule.

Coding can also be easier, with a specific set of billable tasks and diagnoses, clinicians can provide medical EMR coding staff with the precise information they need to get the medical coding done more quickly and easily.

The billers can then take the information and file claims with the insurance companies and bill patients for their share of the cost. The improvement in efficiency that medical coding and billing departments are experiencing has been exciting for those practices that have implemented a medical EMR.

So how does this simplify healthcare and understanding the healthcare and insurance system in the United States? First of all, if the billing system requires specific information from patients, the billing department can implement procedures for determining what a patient will owe even before services are provided.

Patients Need Help

The fact is that the majority of patients who come into a medical practice do not quite understand how the healthcare system works in the U.S. They probably don’t know what their own deductible and co-pay will be, and it is likely that they will not expect a bill a few weeks or a month after their appointment.

So rather than taking the time to bill the insurance company, only to be rejected or denied based on a co-pay or deductible issue, the medical EMR billing staff can find out the details before billing.

Naturally, this can be done even without a medical EMR, but to set up a system would be more of a challenge than purchasing it as part of an integrated medical EMR.

In fact, because medical EMRs companies are set up to handle exactly this sort of adjustment to a biller’s workflow, the transition is made smooth and simple.

Improving Outcomes

Additionally, a medical EMR can help improve patient outcomes. It may sound funny to say that a computer program or software will have an effect on how well patients respond to treatment.

But the fact is that with a medical EMR, it is possible to track treatments and outcomes much more closely. Reports can be generated quickly. The results of certain treatments are better than others, and at the practice level it is possible to identify advantageous treatment decisions with a medical EMR.

Health Care Management at Its Best

by Nitin Chhoda PT, DPT | Mar 7, 2019 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Producing reports for health care management in order to monitor efficiency of therapists and staff are now possible.

Nitin Chhoda explains how physical therapy EMR changes the productivity and efficiency of physical therapy practice by reviewing the number of patients who have been treated during a certain period of time.

With an incredible array of technological tools at the ready, there is no reason why health care practice management can’t undergo a renaissance.

In a small practice, the office manager can also serve as patient relations, interpersonal coach, HR manager, and accountant.

But with electronic medical records, the health care manager may become the financial analyst as well. In fact, analyzing efficiency, strengths, and weaknesses of the practice may be the top priority for the health care management field.

How Reporting Improves Efficiency

Both internally and with patients, an EMR can improve efficiency just by virtue of eliminating the majority of paperwork. Communication is streamlined and things like medical billing and coding can be handled more quickly and with fewer mistakes. But for health care management, EMRs are introducing tools that change the way we think about managing a practice.

An EMR with reporting capabilities can tell health care management professionals a lot about how the practice is doing. Outcomes and performance of clinicians and patients can be compared with a few clicks.

In the past, it would have been almost insurmountable to extract data on visits per referral and visits per day for each clinician. With the new practice management technology, those reports can be run quickly and simply.

In fact, there are a whole host of important indicators that are being monitored by the software solutions designed for health care management. Most of these indicators can help office managers to see where the lags in efficiency are hiding.

Inefficiencies degrease profitability, and decreased profitability is bad for everyone. The information gathered can be shared with staff members and solutions can be discussed with health care management.

If used appropriately, technological management tools can help turn a practice that is just getting by into a profitable enterprise. From changing the way that medical billing is handled to using proven techniques to speed up recovery and improve outcomes, health care management tools are going to go a long way towards revolutionizing the business side of medicine.

Educational Experience

With an increased emphasis on technology, more and more individuals who want to pursue a career in health care management are going back to school.

The job has no educational requirements, but a bachelor’s degree and even a master’s degree are not uncommon.

There are specific programs now that will education students about the pitfalls and advantages available to adaptable health care management.

As the job market widens, these are the professionals that will be handling health care management jobs. And because the role of health care management professionals is changing so quickly, there is a lot of room for improvement in most health care practices.

The office manager has the job of ensuring that things run smoothly and if there are problems, the office manager needs to work with staff to find solutions. A health care management professional who understands the benefits of current technology will have more tools for finding solutions than ever before.

Physical Therapy EMR Checklist For Your Practice

by Nitin Chhoda PT, DPT | Feb 10, 2019 | Electronic Medical Records, Physical Therapy Documentation

You have made the decision to convert your documentation into a physical therapy EMR software, now what? How can you be sure that you’re getting the best product at the best price, and one that will help maximize your documentation process?

Nitin Choda provides you with a checklist that outlines key areas you will need to consider in order to choose the best and the right software for your practice.

Physical therapy electronic medical records solution is sometimes hard to find. The same is true when picking a restaurant to eat at. We need help in finding the right product.

If you are feeling a little lost and confused by all the options available for a physical therapy EMR products, don’t worry: picking a good solution isn’t as hard as it might seem.

Just keep your eye on the goal, and your hands on this checklist.

Find a decent price. Price is important. A lower price doesn’t always mean a worse product, and a low price also means you will have more money in your bank for other things. Try to find the cheapest physical therapy EMR that you are comfortable with, and that does everything you need, but not at the expense of inefficiency.

Does it fulfill your needs? Physical therapy EMR has different requirements from other electronic medical records. After all, you are dealing with physical activities more often than drug dosages. Look for a product that makes documentation simple because much of what you will be doing is documentation.

You need to make sure that the physical therapy EMR you picked is actually capable of doing what you need it to do. That means getting your hands on a copy and simulating the activities you would do throughout the day. If you find that part of your process has been left out by the solution, well, you know it isn’t for you.

Is billing integrated? This might seem like a minor thing, but keeping billing integrated with patient information is the best possible way to ensure that you handle billing as efficiently as possible.

Billing is never fun, but you shouldn’t have to keep an extra database just to deal with it. Make sure that physical therapy EMR billing is integrated with your documentation software. And you will be glad you did.

Can you document your patients quickly? The fewer clicks, the better. How quickly can you document what is happening with your patient? The tool should be capable of handling rapid note taking.

It should be able to handle you recording your every observation, and archive those observations in a way that you can get to quickly. In short, your physical therapy EMR solution should be ready to handle your patient load.

Can you schedule new appointments easily? Appointments are the bread and butter of your practice. Without them, there would be no physical therapy. You won’t even need to use your physical therapy EMR tools. Make sure that your tool is prepared to schedule and manage appointments.

What does your staff think? Let your staff try out the physical therapy EMR software. If they don’t like it, or they can’t use it, then it doesn’t matter how many features it has. A piece of software is only as good as its user interface, especially when it comes to something used every single day.

Is it mobile? Physical therapy involves moving around. You shouldn’t be constrained to a desktop computer when using a physical therapy EMR solution. It should support iPads, so you can carry a single, lightweight computer with you at all times, documenting everything as it happens in real time.