Insurance Eligibility and Claims Submission: Push-Button Type

Insurance Eligibility and Claims Submission: Push-Button Type

Years ago patients’ insurance eligibility took weeks or months to determine. Now, with the help of electronic medical records, verifying insurance claims happen at the touch of a button. 

Nitin Chhoda describes the push-button feature technology that EMRs are providing in order to streamline the physical therapy documentation process.

insurance eligibilitySubmitting reimbursement claims is one of the most important tasks in a physical therapy documentation process.

It’s also one of the most time consuming, fraught with multiple opportunities for audits, denials and requests for additional information.

Those who have implemented an EMR know first-hand that errors and mistakes can be virtually eliminated through push button claim submissions and insurance eligibility.

EMRs Role to Claims Submissions

EMRs offer the most sophisticated means available to submit claims and verify the insurance eligibility of any patient.

A tablet-compatible EMR allows clinicians to tap a button to submit claims singly or as a batch.

Therapists utilizing an EMR can verify the insurance eligibility and coverage of any client with push button functionality. They can also identify claims that could be red-flagged by insurance providers.

Push-button claims submission allows clinic owners to submit reimbursement claims to a wide variety of payers, from private insurance and military insurers to Medicare and Medicaid.

Physical Therapy Software

Physical therapy management software simplifies and expedites the claims process for reimbursements that are less likely to be questioned and payments that reach the practice’s account quicker. An EMR can be integrated into existing insurance eligibility office systems and streamlines the entire billing process and workflow.

Refiling claims, denials, and responding to requests for clarification and more insurance eligibility information cost practices untold hours of work, effort and lost or late revenues. EMRs use the power of the Internet to file claims in real time that arrive almost instantly, allowing the adjudication process to progress quicker for better cash flow to the clinic.

Push-button claim submissions provide the means for practice owners to send reimbursement requests from the office and any venue where clinicians provide their services.

HIPAA Compliant

The insurance eligibility systems are HIPAA compliant and offer an enhanced level of safety and security for sensitive information. EMRs make it possible to have a patient’s office visit ready for billing even before they leave the building. EMRs provide another essential service for physical therapy clinics.

insurance eligibility and claims submissionThey allow practices to verify a patient’s insurance eligibility and coverage for services with push button technology.

In a time of economic flux, insurance companies and other payers are examining claims closer than ever before.

Insurers are reducing available services to clients and placing monetary caps on the amounts for which they’ll pay. Many patients aren’t aware of the limitations associated with their insurance coverage and are taken completely by surprise when they find out.

Push-Button Feature

Practice owners with an EMR can utilize the push-button feature of an EMR to ascertain if a patient is eligible for coverage, if there are limits on services or monetary amounts, and required co-pays. That feature alone can save clinicians thousands of dollars each year.

People change jobs and lose their insurance, and healthcare coverage is at such a premium in the U.S., that there’s even an active market in insurance identity theft. An EMR provides the tools for clinics to immediately verify insurance eligibility and protect themselves from those who would obtain services to which they’re not entitled.

Push-button technology assists therapists verify a client’s healthcare coverage, and submit reimbursement claims with alacrity and ease for practice profitability. Push-button claims submission and insurance eligibility allows practice owners to submit billing in real time, virtually eliminate errors that slow down reimbursements, and increase cash flow.

That same technology helps therapists determine a client’s available coverage to provide better patient care, while protecting themselves from those that would cheat the system and therapists of their rightful payments.

Healthcare and Insurance: The Future

Healthcare and Insurance: The Future

The Affordable Care Act was created in order to help uninsured or underinsured people with regard to their health care insurance.

Nitin Chhoda discusses how the act is evolving from time to time and making the coverage adjacent to the healthcare that the average people need. However, health insurance has become more and more expensive.

healthcare and insuranceThe Affordable Care Act was designed to extend coverage to those who had none, right inequities in coverage and lower healthcare practice management costs across the board, along with improving the quality of care for all Americans.

Some of those goals are beginning to be realized, but the cost of healthcare and insurance continues to increase with no abatement in sight.

The ranks of the uninsured will continue to swell as workers lose their employer-based healthcare insurance through job loss and outsourcing.

Healthcare Insurance are Expensive

The Affordable Care Act penalizes employers that don’t offer a healthcare and insurance option to employees, but the fines are far less than the cost of providing healthcare policies.

A growing number of business owners are choosing to pay a penalty that’s a fraction of what a single healthcare insurance policy would cost. The current state of healthcare reform establishes a system where costs for healthcare insurance continue to increase and benefits decrease.

The Affordable Care Act, created to extend healthcare and insurance to the majority of citizens, still leaves millions of individuals uninsured. It further penalizes individuals for their financial inability to purchase insurance, as well as those who have “high-end” policies.

Taxes on high end insurance programs beginning in 2018 encourages people to select less costly healthcare and insurance plans where they shoulder more of the financial burden with higher premiums, co-pays and deductibles.

To avoid penalties and skyrocketing costs, individuals will choose the most inexpensive policies available and delay seeking medical attention when they can’t afford out-of-pocket expenses.

Part of the provisions in The Affordable Care Act provides programs to encourage clinicians to eliminate waste, improve care and safety for patients, and reduce expensive testing and procedures.

The “less is more” mentality brings the quality of care into question as healthcare and insurance providers attempt to meet the demand of millions of new patients flooding into the system.

The Effect

Therapists and other healthcare and insurance providers are being backed into a corner with the untenable position of sacrificing allotted time with patients in a system where clients have extensive waits for appointments.

Clinicians could be forced to pick and choose patients based on their insurance coverage or ability to self-pay, simply to keep their clinics solvent and continue to practice their profession.

In an effort by insurance companies to reduce their costs, homeopathic solutions could easily become the treatments of choice. Healthcare providers face increasing pressure by insurance companies to eschew a wide variety of tests and provide more extensive documentation to justify their decisions.

healthcare and insurance futureTherapists are effectively being second-guessed by those in organizations that have little or no medical experience, and no idea of the practicalities of a physical therapy clinic.

The Affordable Care Act provides for an array of essential services that new healthcare and insurance policies must provide, but consumers will ultimately pay the price for that coverage through increased out-of-pocket expenses.

Physical therapists will feel the effects through reduced reimbursements, a potential loss of patients, and increased collection costs.

The Future

In a perfect world, access to affordable healthcare would be available to all, insurance companies would forego record-breaking profits in favor of the common good, and clinicians would be free to treat patients as their profession calls them to do.

The future of affordable healthcare and insurance, benefits without penalties, and accessible treatment for all is in jeopardy. As currently written, all avenues lead back to many of the same problems that the Affordable Care Act was created to fix.

EMR Solution: The Importance of Its Portability and Customization

EMR Solution: The Importance of Its Portability and Customization

If you are using, or about to switch to an EMR system, simplicity and portability are essential requirements.

Nitin Chhoda emphasizes the importance of flexibility in your EMR so that it can be used on any device (laptop, PC, iPad, Android device) with an internet connection

EMRConsumers demand portability in the products they purchase to accommodate a mobile lifestyle, and physical therapists should expect the same convenience in their electronic medical records.

EMRs Should Be Flexible

An EMR that doesn’t offer flexibility and portability is even worse than being chained to a bulky computer and using old-fashioned paper records.

An EMR for physical therapy practices is designed to propel clinicians into the 21st century. That includes the ability to customize as needed and take the system wherever it may be required.

Customization is a key element of an EMR. Physical therapy clinics have their own particular documentation needs and requirements, and an EMR should reflect that.

It should be easy to create custom documents that fit into the clinic’s normal workflow, along with other environments that includes billing and coding, patient communications, and registration. Like a one-size-fits-all garment, a general EMR may work for some clinicians, but it will lack critical features and disrupt the productivity and efficiency of every department.

HIPAA Compliant

Maintaining HIPAA compliance can also be a problem. Some clinicians have encountered difficulty with phrasing that prompts the system to produce unwanted results and is counter intuitive to providing care.

Charting a patient’s care, treatment and results shouldn’t require a call to tech support, and many EMR vendors that claim the ability for complete customization have a very strange idea of what customization entails.

EMR customization should reflect the way patients are seen and the way therapists practice their profession. It should import, export, store, save and organize data in standard document formats.

EMR solutionPortability is key when implementing an integrated EMR system and it should be compatible with tablet technology, allowing clinicians to take advantage of a wide range of revenue opportunities.

EMR Transition

An EMR should transition easily from the exam room to the billing department with equal ease.

Therapists provide a wide array of occupational, therapeutic, sensory and sports related services.

There is also a wealth of additional opportunities available to enterprising practice owners in the form of corporate wellness programs, senior citizen facilities, in-home care and even spas.

A portable EMR can be accessed from any location where an Internet connection exists, allowing clinicians to take their tablet on the road to a wide range of far flung venues.

Most patients think in terms of rehabilitation when physical therapy is mentioned, but the importance of therapeutic massage is gaining traction with clients. Spas and health clubs are just some of the businesses that are contracting with professional therapists to offer those services to their clients.

Portability is Always Important

A portable EMR system provides the means to capitalize on those opportunities with complete evaluations, documentation, insurance information and billing from any location.

Therapists provide essential services to assist their patients maintain or regain mobility, end pain and enhance quality of life. A portable and customizable EMR allows clinicians to accomplish those goals through increased efficiency and productivity.

An integrated EMR system will play a growing role in how therapists practice their profession, deliver services and interact with patients. It’s essential that a clinic’s EMR provide the ability to grow with the practice, while allowing clinicians to take advantage of the many income opportunities available.

Medical Billing Company: How It Works

Medical Billing Company: How It Works

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.

medical billing companySelecting 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 21st 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.

medical billing companyBilling, 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

How to Verify if Your Software is ICD-10 Ready

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.


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.


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.


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.


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 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.

Preemptive ICD-10 Documentation – Rewriting Your Notes, Onset and Contributory Factors

Preemptive ICD-10 Documentation – Rewriting Your Notes, Onset and Contributory Factors

One of the biggest challenges for clinicians with the transition to ICD-10 will be coding for items that they would normally include in their notes. In the new world of ICD-10, everything has a code and insurance companies won’t reimburse for anything that’s not coded.

The external causes of injuries should be a focus for clinicians and may be the most difficult to remember. Payers want more intensive information about every aspect of a patient’s visit to their medical professional.Practitioners must code injuries, onset of symptoms, external causes and treatment plans.

It’s absolutely essential that professionals in any branch of the medical profession code to prove medical necessity. In some instances, it may be necessary to rely on records from the referring physician to provide acceptable documentation.

Clinicians should always strive to code at the highest level of specificity and detail that’s possible. Practitioners can no longer code for a probable or suspected diagnosis. Payers just want to know about the facts that can be proven by tests and the clinician’s observation.

The process will be smoother and less troublesome if clinicians identify the codes they most often use and convert them to ICD-10 before the implementation deadline. There are thousands of new codes, but clinicians in private practice will typically only use a small number of those, making it easier to begin converting and using them in dual coding.

Before ICD-10, a clinician’s notes were a tool that was used to create an ongoing record of a patient’s health history. They essentially created a database of knowledge that could be referenced about the client. With the implementation of ICD-10, that same information has been reduced to specific codes that determine what clinicians will receive for reimbursements.

The clinician’s expertise with ICD-10 coding will be a determining factor for practice revenues. The GEMs will assist in those efforts to be more specific, but practitioners will want to engage in some preemptive documentation. It will help medical professionals become familiar with the new coding and facilitate the changeover in patient records.

Professional organizations have predicted a 15 percent increase in documentation requirements. Those entities indicate that 65 percent of clinician notes aren’t specific enough for the new ICD-10 coding and will result in a significant increase in documentation times. The sooner that practitioners become adept at coding with ICD-10, the less time will be required as time progresses.

Payers have always sought reasons to deny claims and place the financial responsibility elsewhere. That’s their job. As comprehensive as the new code set is, medical professionals in all fields should be aware that they may encounter substantial difficulties. Many payers are under the impression that ICD-10 has a code for every possible instance, but that just isn’t true.

The current healthcare environment is one in which the focus is on saving money and ensuring that services are actually being received. Payers are no longer content to reimburse without practitioners without providing detailed to ensure the treatment is appropriate and is actually being carried out.

To accomplish that task, practitioners now have more specific coding, along with additional coding for documenting details about the causes and circumstances surrounding the patient complaint. Notes are no longer sufficient for that purpose and a practice’s revenue stream will directly depend upon the clinician’s ability to locate the appropriate codes to provide proofs in an alphanumeric fashion instead of words contained in notes.

Those who identify their most often used codes and begin rewriting their notes to conform to ICD-10 protocols have a better chance of mitigating denials once the new coding goes into exclusive use. The ICD-10 transition will be difficult enough. Taking the initiative in rewriting notes now will save time in the future.