There are times when it appears that insurance companies are in the business of denying claims, not paying them.
As a private practice owner, the solution is simple – minimize errors in claim submissions. Nitin Chhoda reveals how to minimize such errors so your practice can get paid faster.
Insurance companies are so quick to reject or deny a claim, and since they have all the power and a lot of money, it feels like physical therapy practices can do very little to influence the outcome of each claim.
Fortunately, EMRs and physical therapy documentation software have been designed with these challenges in mind. As physical therapy billing professionals have struggled to find solutions, some key aspects of the billing process have been identified as problematic when it comes to claims acceptance.
Errors in Submission
One of the top reasons for rejected or denied claims is an error in the submission. The error can be as simple as a typo in the code or in the name of the patient, or a less-than-perfectly legible claim form.
Usually, these errors result when the physical therapy billing staff doesn’t have the time to carefully fill out and review the claim. These kinds of errors are avoidable, but it usually takes a change of workflow and priorities before errors can be reduced significantly.
The other kind of error that is highly common are errors due to an incorrect or insufficient understanding of the insurance plan. If a patient believes they are covered for physical therapy, the physical therapy billing staff will submit a claim for the entire amount.
But if it turns out that the particular procedures are not covered, or if the patient has yet to pay the entire deductible on their plan, the claim will not be filled as requested. This often leads to partial payment, too, which is not a terrible outcome. However, because the biller did not know that the partial payment would come, research must be done to review what the patient owes and then a bill must be sent to the patient.
An additional problem that plagues physical therapy management is the timing of physical therapy billing. If a claim submission is accepted and paid, that is good news.
Timing of Submission
But if the claim is paid three weeks after the patient visit, the practice is losing money. Many claims are not submitted in a timely manner, either because all of the details about treatment of the patient are not available to the biller, or because making time for physical therapy billing each week is hard for a biller who is somewhat overwhelmed.
Many of the solutions to these problems may seem automatic or intuitive at this point. If the problem is insufficient patient information or clinician notes, a better system of physical therapy billing and documentation is needed.
If partial payments due to incorrect billing are slowing down the entire process, learning what each patient owes in advance would help speed things up and ensure that the patient is not surprised by a bill. Of course, EMRs offer many of these benefits for physical therapy billing.