Physical Therapy Billing: How to Reduce (and Contest) Payment Denials

Physical Therapy Billing: How to Reduce (and Contest) Payment Denials

Since payments from insurance companies provide vital cashflow, it’s essential to have a system in place to minimize denials. Once a denial does happen, a system must be in place to contest those denials.

Nitin Chhoda explains how to minimize denials and also contest them successfully. This is one of the most essential elements of a successful, cash-rich practice.

physical therapy billing codesOne thing is certain, no matter how hard you work to perfect your physical therapy billing practices, you will still be faced with denials and rejections from insurance companies.

Every physical therapy private practice experiences a high rate of denials and rejections and unless the entire system changes dramatically, this is going to continue to be part of the deal.

Find the Solutions

Rather than getting frustrated with denials, it’s time to think about minimizing them and finding ways to contest them successfully. When we think about problems and attempt to find solutions, the place to start is in the practice.

Minimizing denials is the job of physical therapy billing professionals, and in many cases they simply need the structure and the space to do just that.

Reporting for Physical Therapy Billing Improvements 

The best way to avoid making mistakes is to start with the mistakes that have been made in the past. The reporting capabilities of physical therapy documentation software can make the process of physical therapy billing much more accountable.

Rejected or denied claims can be tracked with reasons and time stamps, and by using reporting functions physical therapy management can determine just what goes wrong and how much time it is costing the practice in re-submittal of claims.

The back to basics approach of reinventing physical therapy billing is critical to finding solutions. Any system that has grown and changed as much as health care billing and insurance payments, is going to have inefficiencies built right into the process.

To get rid of those inefficiencies, the whole system may need to be torn down and re-built.

Start at the Beginning to Avoid Mistakes

A physical therapy EMR is going to allow for reporting and documentation that has previously been nearly impossible to extract and use. This is great news for physical therapy management.

billing for physical therapy services

But for physical therapy billing staff, it’s going to be a tough adjustment. Rather than focusing on the mistakes of individual billers, changing over to an EMR can help turn the process of re-education into a whole-office re-education.

Training the physical therapists to document their patient visits a little differently will be made easier if the entire staff is learning to document differently and use the information differently.

The burden of making adjustments of physical therapy billing to reduce the chances of claim denials and rejections will be shifted to the whole staff, rather than focused on billers who only have control over one portion of the process.

Responsibility is Key

At the same time, physical therapy billing staff are responsible for a certain portion of mistakes, and finding and eliminating those kinds of mistakes is going to be a big part of reducing denials. If you find that insurance companies are blanket denying claims, and it’s not the fault of billers, you can address the problem differently.

It may turn out that billing staff are actually spending time contesting denials because an insurance company is not worth working with. But you’ll never know that unless you have a system for recording the processes of physical therapy billing, documentation, and claims denials.

Physical Therapy Billing: Revenue Cycle Management and Profitability

Physical Therapy Billing: Revenue Cycle Management and Profitability

Receiving payment from insurance companies and payers does not always translate into a profit for a practice owner. In order to generate income, a revenue cycle management system (software) managed by billing professionals (in-house or outsourced) should be in place.

Nitin Chhoda explains what to look for in a revenue cycle management and how to increase profitability in your practice.

physical therapy billing codingThe revenue cycle is the process of bringing in revenue, starting from the sale and ending with revenue recognition, or the receipt of payment.

In a simple café setting, the revenue cycle starts when the guests order their food and drinks and is completed when they pay their bill.

Revenue Cycle in Physical Therapy

In physical therapy billing and management, the process is much more complex and can be drawn out over much longer periods of time. Any time your practice is waiting for money, you are losing money.

Revenue cycle management is the process of looking closely at your revenue cycle and determining where there are problems. The most obvious kind of problem is errors in physical therapy billing, but there can be much more subtle problems which pose similar threats to the revenue cycle.

Problems with contracts, recurring billing issues, and regulatory compliance problems can also pose a threat to the practice’s ability to collect the revenue that is due.

Evaluating Issues Within the Revenue Cycle 

The first place to start if you want to improve the efficiency of the revenue cycle is with time management.

Many of the tasks that physical therapy billing staff completes are quick and simple. A few clicks here, check the numbers there, print and send.

But it is precisely these kinds of tasks that can take up more time than is necessary if an employee is not managing their time well. Here are a few questions that will start the process of improving both time management and efficiency within the revenue cycle:

  • How much time does it take to fix mistakes?
  • What percentage of revenue is not reported just in case?
  • How much time does it take to compute physical therapy billing revenue?
  • Are staff members forced to do a lot of duplicate entry?
  • How confident are you that you can find mistakes?
  • Are you taking risks by reporting inaccurate revenue?
  • How realistic are your recognized revenue numbers each month?

physical therapy billing softwareImproving Profitability

There are many ways that evaluating your revenue cycle can improve profitability, but the process will require that your physical therapy billing staff make some changes.

Problems with revenue mistakes are a big one for physical therapy billing, because a tiny mistake can cause a huge delay in revenue recognition.

But another way that the system can be improved for physical therapy billing is to remove the duplicate and sometimes triplicate entry that staff members perform.

Avoid Redundancy

Redundant tasks are almost as bad for the revenue cycle as errors in physical therapy billing. For many billing departments, the process of eliminating duplicate entry can add hours to each day in free time. And free time is time that can be spent on other tasks, otherwise known as an increase in productivity.

Evaluation and action are essential if your practice is going to improve productivity in the physical therapy billing process. But the real benefit to the staff and the practice will come when you introduce revenue cycle management software.

Physical Therapy Documentation: The Essential Components of Compliance

Physical Therapy Documentation: The Essential Components of Compliance

What makes a physical therapy and medical documentation system compliant? In this revealing article, Nitin Chhoda explains the  key components to look for in any EMR system.

physical therapy documentation guidelinesThe issues associated with remaining compliant are many, varied and can be tricky to navigate. Federal regulations and payer requirements constantly change and therapists must remain vigilant to avoid stiff civil and criminal penalties.

Remaining in compliance is a challenge that faces any practice owner and there are key components therapists should seek in any EMR physical therapy documentation system they decide to use.

A Very Important Matter

The primary concern of any EMR is the protection, privacy and security of patient information. Any physical therapy documentation system must contain sufficient safeguards to ensure individually identifiable health information is secure, and that appropriate efforts have been taken in that direction.

That includes electronically submitted claims, referral authorizations, and eligibility inquiries to insurance providers, clearinghouses and medical professionals.

The Heath Insurance Portability and Accountability Act (HIPPA) spells out in detail the security and safeguards necessary to remain in compliance and establishes the policies, procedures and conditions under which medical information can be disclosed without specific authorization from patients.

Administrative safeguards and controls must be in place that limits access to patient information to authorized physical therapy documentation personnel only.

EMR As A Tool

An EMR is an important tool for therapists, enabling them to remain current on laws and maintain compliance. Individual login capabilities and the ability to validate the credentials of those accessing information are an essential element of any EMR.

Physical therapy documentation staff must also be trained in the rules and guidelines governing the management of medical records and an EMR can be utilized to accomplish that. EMRs encompass the ability to provide powerful security at all levels of access to maintain the confidentiality of patient records, reimbursement submissions and administration of the practice.

Date and time stamps are especially helpful in a physical therapy documentation system, providing detailed reports of when patient records were accessed and by whom. If another healthcare provider discovers a breach in the system, the medical professional can quickly notify the therapist through a variety of means with an EMR.

physical therapy documentation requirementsAdopting EMR System

The adoption of an EMR allows for almost instantaneous interaction among physical therapy documentation healthcare providers.

This ability ensures the highest level of treatment possible through extreme accuracy, while addressing privacy concerns.

Patients who believe that their medical data is safe with their therapist are more likely to provide complete health information that could mean the difference in a life and death situation.

The adoption of an EMR is part of the American Recovery and Reinvestment Act and requires any EMR to meet Meaningful Use standards and certification. An EMR helps physical therapy documentation therapists in all areas of their practice, from ensuring secure access of medical records to the submission of reimbursement requests.

An EMR significantly reduces the possibility of errors.

Security is the primary component of any EMR. Physical therapy documentation software helps therapists maintain the integrity and privacy of patient medical information, and healthcare providers can easily report the instance of a breach should a situation occur.

Therapists seeking an EMR should also ensure their chosen software includes sufficient flexibility in the documentation process to protect the patient and the practice in the event of a lawsuit or audit.

Physical Therapy Billing: How to Create Your Own In-House Medical Billing and Coding Service

Physical Therapy Billing: How to Create Your Own In-House Medical Billing and Coding Service

If you want to save money by creating your own in-house medical billing and coding services without affecting too much time of your staff’s workflow, then this article will walk you through the process.

physical therapy billing softwareFor a small private practice, hiring a contractor to handle physical therapy billing and coding can take a lot of the set-up and training costs away from the practice.

The process of physical therapy billing is simplified and you know that the individual or company that you hire is invested in getting good results on your behalf.

But at some point, you will want your practice to graduate to the next level of efficiency and self-sufficiency. That’s when you’ll decide that your physical therapy billing and coding should happen in-house.

Greater Control

The main reason that having the physical therapy billing staff in-house is preferable is that physical therapy management will have greater control over the revenue cycle and revenue cycle management.

If the billing company is inefficient in any way, there will be no way to find out why and there will certainly be no way to make improvements. At a certain capacity, being able to periodically review the revenue cycle is a very big advantage.

Tools Exists, It’s Time to Use Them 

And with the existing tools today, there’s no reason not to take control of your own revenue cycle. Creating your own in-house physical therapy billing and coding service is as simple as purchasing and implementing a fully-integrated physical therapy EMR.

As you probably know, there are some more details to consider, such as how to go forward with implementation so that the process is successful. But with an implementation plan and proper preparation of staff, a good EMR will change your revenue stream for the better.

Physical Therapy Billing Role

Physical therapy billing and management involves a lot of big picture viewpoints. You’ve got to be able to see how a small change to one staff member’s workflow will affect the entire office.

physical therapy billing serviceYou’ve also got to be able to identify inefficiencies that are worth tackling with an EMR, and those that are better tackled with a bit more training and some positive reinforcement.

With an EMR, you can streamline the billing and coding process so that when a clinician enters notes, they do so directly into the system.

They can choose from a drop-down menu and their choices will make physical therapy coding automated.

The job of physical therapy billing will change from a process of looking up information, filling out forms, and reviewing hand-written clinician notes, and become a process of quick reviews of fully-automated claims ready for submission.

You can make the entire process of physical therapy billing more procedural, with most of the work focused on entering contract details from insurance companies and details of a treatment plan for each patient. That one-time entry for each patient creates an automated physical therapy billing process.

The cost of having your own in-house medical billing and coding service becomes significantly lower. And the benefits of having control over the revenue cycle will allow your staff to make adjustments which will improve efficiency and productivity even further.

Physical Therapy Billing: Engineering the Ideal Physical Therapy Practice

Physical Therapy Billing: Engineering the Ideal Physical Therapy Practice

With the right information, strategy and coaching, it is possible to build a successful physical therapy private practice.

Nitin Chhoda explains how an automated physical therapy documentation and billing system can play an important role and help your practice succeed, allowing you to achieve the “ideal physical therapy practice” that drove you to start your practice in the first place.

physical therapy billing servicesTechnology has changed the way that many industries and businesses work and succeed.

The benefit of implementing new physical therapy billing technology is that it allows us to make leaps and bounds forward, adjusting not just the little things but changing the way we work in a fundamental way.

It always helps to go back to the example of email because it is so stark.

Physical Therapy Billing — Before

Before email, all correspondence was sent on paper or communicated via telephone. Anything important had to be written down over and over again to ensure that the information was not lost.

Couriers bringing important physical therapy billing documents in a single day were the fastest way to exchange important documents, besides actually setting meetings and sitting down together.

Today, information travels instantly. Email has changed the way that every single business performs, bringing incredible efficiency and speed to even the most mundane jobs.

Physical Therapy Billing — Today

Physical therapy billing software has the potential to make that kind of dramatic change for physical therapy practices. Making the changes that are possible with physical therapy billing software will not be quick or simple. In fact, the more time you take and the more focused you can be, the better the results when you make the change.

But in the long term, there is no alternative for physical therapy billing and practice owners and management. Success in the future is going to depend on keeping up with the standards. Right now, you have the opportunity to set the standard and be ahead of the crowd.

The Ideal Practice

physical therapy billing codesStart by imagining what the ideal physical therapy practice would look like if you could use physical therapy billing software that was fully integrated into the entire practice, from patient intake to treatment plans to patient discharge.

How would you implement a program if you could automate as much of the physical therapy billing process as possible? Can you imagine a system that is proactive rather than reactive?

There are many ways that an ideal physical therapy billing practice could function. Of course, the primary concern of every physical therapy manager or owner is to provide excellent care to all patients who walk through the door. Today, excellent care and streamlined technology are intertwined.

The Advantage of Having an Automated Physical Therapy Billing

If the therapist has all patient information at their fingertips, presented in a highly intuitive and efficient manner, the therapist can provide better care.

If the treatment plan is lined up and set in advance, with everyone on board, the patient knows what to expect.

And if the physical therapy billing staff can work together to ensure that the patient’s treatment plan is covered by their insurance company, the patient can relax and know that each time they visit your office, they are not risking a surprise bill in the mail a week or two later.

Technological physical therapy billing advances can be burdensome if the staff is not ready. But if you can imagine a better work environment for everyone, you can communicate the advantages to the staff. As a group, you can get excited about making big, positive changes. As a practice, success and growth will be realistic goals.

Physical Therapy Billing: How to Use Software To Minimize Physical Therapy and Medical Claim Denials

Physical Therapy Billing: How to Use Software To Minimize Physical Therapy and Medical Claim Denials

There are many possible reasons for physical therapy and medical claims denial. Using physical therapy billing software, claim denials can be minimized, allowing you to improve cash flow and grow your practice.

physical therapy billing softwareEvery physical therapy billing precaution can be taken and extensive documentation provided, but at some point, physical therapists will experience a denial for payment.

Claims are denied for any number of reasons, from incorrect physical therapy billing coding and services that aren’t covered to medications that were prescribed.

Patients may have exhausted a lifetime benefit cap on services or received what’s deemed as an experimental treatment by their insurance carrier.

Billing Affects Profitability

Navigating the labyrinth of rules and regulations of physical therapy billing each payer maintains can be extremely confusing, but it can also severely affect the profitability of a practice.

In an effort to cut costs, many insurance providers are requiring preauthorization for treatments and procedures that were never questioned in the past. Each insurer has their own appeal process, complete with deadlines and specific types of documentation that’s required.

EMR Advantage

One of the advantages of an EMR is being able to verify a patient’s insurance coverage long before they come to the office. The availability of time stamping provides documentation of when the treatment was received, who did the therapy, why a particular treatment was used and the patient’s response.

Physical therapy billing software also provides information about the referring physician and the client’s past history, which can play a critical part in contesting a denial.

Those who have implemented physical therapy billing software have an advantage. Therapists utilizing an EMR receive information and updates about denied claims in hours or days instead of weeks.

The same software system allows therapists to quickly submit required documentation, explanations or correct coding errors. EMRs offer billing and coding options and flexibility that actually reduces the number of denials.

Claims Procedure

Claims for reimbursement go through a rigorous physical therapy billing documentation process before payers approve or deny a claim.

In some instances, a particular procedure may be used to treat more than one type of complaint and the payer will automatically deny a request for reimbursement unless the therapist can prove it was medically necessary.

Therapists must be prepared with appropriate physical therapy billing documentation if they’re to receive reimbursement and provide the patient with needed care.

An insurer may also question a curative treatment versus a palliative one. One of the great mysteries in healthcare is why one insurer is willing to pay for months or even years of palliative treatment without a “cure,” while others are more likely to approve curative remedies.

physical therapy billing codes

Once treatment has commenced, physical therapy billing insurers expect the therapist to continue, even if a denial has been issued. These expectations raise serious questions about reimbursement for the practice owner.

Therapists can continue to submit claims for the patient during the time the request is being contested, but ultimately, there’s no guarantee that they will be paid.

Physical Therapy Software

Physical therapy billing software offers clear and concise documentation to help therapists reduce and minimize reimbursement denials, and contest them when they occur. While denials can arise for a number of reasons, most can be traced to errors in the manner the claim was submitted or the coding used.

EMRs are a therapist’s best friend, offering extensive documentation, time stamping and copious amounts of information, all of which can be submitted electronically to quickly and efficiently address reimbursement denials.

Page 1 of 3012345...102030...Last »