A patient calls it a sore throat, a doctor calls it pharyngitis and healthcare insurance calls it a 462. Each is accurate, but if the correct ICD-9 code isn’t entered or doesn’t match the diagnosis, the physician won’t be paid for his services.
Designating the right ICD-9 codes is essential to collect reimbursement claims and Nitin Chhoda offers a crash course in the coding system.
ICD-9 codes are the internationally recognized three- to five-digit numerical designations for each condition and disease.
The codes are organized into three categories known as volumes that are used by medical professionals across the nation for billing purposes when submitting reimbursements claims.
Medical Codes Development
Developed by the World Health Organization, the system is comprised of volume 1, a compendium of diagnosis codes for diseases and conditions.
Volume 2, arranged in alphabetical order, provides an index to diagnostic procedures and volume 3 lists procedure codes. The system is set to be updated in Oct. 2014 to the new ICD-10 codes.
The new system reflects advances in medical terminology and technology, and enables practitioners to provide more detailed information to insurance companies. Early preparation for the switch is advised, as those in the medical profession are anticipating some disruptions during the transition.
The Coding System
The ICD system links a diagnosis with a procedure for billing purposes. The codes tell insurance companies why the client met with the clinician, the diagnosis, and procedure or treatment that was provided to return the patient to health. The codes are further broken down into subcategories and sub-classifications.
ICD-9 codes offer provisions for making a multiple diagnosis, which can also be entered in an electronic medical records system. The first diagnosis code is used to explain the reason the client was seeking care. Other conditions may be observed during the examination or be part of the patient’s medical history.
Those are placed second and third on claim forms as contributing factors, already existing conditions and complications, providing a source of supporting evidence.
Medical professionals must also be cognizant of the abbreviations, punctuation and symbols used within the codes, known as conventions.
Proper Coding is Essential
It’s critical that the proper coding is entered on reimbursement requests and that a practice’s billing and coding specialist is well versed in their craft. Codes that don’t match the diagnosis or procedures taken will be delayed, denied or questioned as to the medical necessity of the action taken. Even simple mistakes will severely interrupt a clinic’s cash flow.
An integrated electronic medical records system includes revenue management software that can streamline your physical therapy billing.
Nitin Chhoda explains why this type of software can be a critical component of the ‘big picture’, allow your entire physical therapy billing process to become streamlined and profitable.
The first step toward solving a problem is always acknowledging that a problem exists. In physical therapy billing, this means evaluating the revenue cycle and the staff that is responsible for billing.
Nobody likes to have their job evaluated, especially when the goal is to find inefficiencies and problems.
Revenue cycle management software allows the practice to evaluate and make the necessary changes to physical therapy billing processes at the same time as the billing staff gets exciting and powerful new tools.
Giving the Staff Reason for Optimism
Start the process of evaluation of the revenue cycle with one question in your mind: which tasks could the right software take from the billing staff?
In other words, don’t look for what the staff is doing wrong, look for the places where their jobs could be made easier if you implement physical therapy billing software that includes revenue cycle management improvements.
If the staff feels they are being evaluated, you will have a harder time identifying problems, and making improvements will be more of a challenge.
But if the staff understands that the process of evaluation is impersonal, that the hope is that their physical therapy billing job will get easier, then they will cooperate and be upfront about the problems they experience.
It will be easy to get the staff to talk about problems with duplicate entry. However, physical therapy billing staff members will be protective about admitting to error frequency and revenue recognition delays and errors. The best way to get everyone on board is to make sure they don’t feel threatened.
Revenue Cycle Management Software Solutions
There is a lot of good news in the EMR world these days. New physical therapy EMRs provide revenue cycle management solutions that are very successful at improving efficiency.
In particular, you will find that duplicate entry is eliminated and not just within the physical therapy billing department.
With a fully integrated and mobile EMR, you can reduce the entry of patient information to a single occurrence, and it will happen when the patient picks up the tablet computer and enters their information.
Of course the real time saver will be software that handles recurring billing in a streamlined and intuitive way. Physical therapy billing staff still needs access to each claim that is being submitted, so they can review and make changes based on the actual visit.
But if the treatment plan is set and pre-approved, the entire billing schedule can be set up to generate claims automatically. The biller only has to enter the information once, and then their job is to check for errors or inconsistencies.
Changing the job of physical therapy billing staff should be a priority for every physical therapy private practice manager or owner. Even if you hire a billing company, there are incredible advantages to planning and preparing so that each time the company sends a claim, you are much more likely to receive the payment in a timely manner.
Managing the revenue cycle will bring more visibility, make compliance more simple, and make the physical therapy billing team more productive.
There are times when new practices are unable to enroll with major insurance companies. In this article, Nitin Chhoda provides some valuable tips on how to simplify the complicated process of enrollment and get your practice in-network with the payers you wish to work with.
Althoughphysical therapy billing is complicated by the various billing requirements of insurance companies and government programs, some private practices are finding ways to simplify the process.
In fact, physical therapy billing is being redefined by physical therapy documentation software and EMRs.
The changes that are being make streamline the process, improve claims acceptance from insurance companies, and improve the patient experience.
Applications to Insurance Companies
For each insurance company that a physical therapy practice would like to bill, an application process must be completed and even certification may be required. Insurance companies have a lot of power in this regard and the process can be time consuming and costly.
These physical therapy billing applications cannot be taken lightly, and the terms of the final contract with each insurance company should be carefully reviewed.
The contract terms will determine just what you can bill for and what the limits are for each insurance company. Not only will this inform what the physical therapy billing staff does, but it should also be used to instruct physical therapists on how to work with patients to get the most benefit from the limits imposed by the insurance companies.
The Most Efficient Way to Enroll
There are now services that offer to apply on behalf of your practice for a fee. In many cases, this can be worthwhile, as the time and energy it takes to complete this kind of application takes physical therapy billing or management staff away from other duties.
Hiring a specialist to do this temporary work may be the most efficient way to enroll with a number of insurance companies as well as government programs like Medicare and Medicaid.
But this still involves a great deal of attention, at least from physical therapy billing and management. You may want to start by determining exactly which companies you want to enroll with.
Not every insurance company will be worth working with, especially if the limits are particularly low or they have a particularly high rate of rejection and denial of claims. Once you have drafted a list of potential companies and programs, you can work with an application company to get enrolled more quickly and efficiently.
Integrating Insurance Requirements into an EMR
A fully integrated and flexible physical therapy EMR can provide clinicians with the correct weighted procedures and treatment options so that when the information is transferred to the physical therapy billing staff, the billing process can be seamless and smooth.
A physical therapy billing and documentation software solution can help make enrollment smoother for physical therapy billing staff as well as for management. Once the terms are set, the specific can be entered into your EMR.
Without wasting time looking up the details of each insurance contract, the physical therapy billing staff can fill out the necessary claims and submit them more quickly and accurately than ever before. If the requirements are integrated into the EMR, everyone benefits including the practice as a whole.
Accounts receivable is one of the biggest problems for private practices. Across the nation, there’s millions of dollars that practices are still waiting to collect from insurance companies. The problem is twofold. Practices aren’t using integrated software that performs automatic functions and many billers are being forced to enter each bit of data manually. That leaves them less time to concentrate on collecting from payers.
To remain financially secure, clinicians must do everything they can to shorten the revenue cycle for each patient and get paid faster. That means streamlining the biller’s job with software that contains automation and one-touch functionalities, along with scrubbing and editing abilities. Next to the clinician, a biller is the most important person in a practice. They’re highly trained professionals that keep revenue flowing into the practice.
In Touch EMR™ and In Touch Biller PRO are the two most advanced software systems available. The integrated systems work together to provide billers with tools that facilitate the entire billing process from start to finish. Efficiency is extremely important in today’s economic climate and In Touch EMR™ allows practitioners to create a claim and submit it to the biller by the time the patient leaves the office.
The system contains essential time-saving features that notify billers of potential problems that could delay the claim, such as incompatible CPT codes. If an inconsistency exists, billers can edit the claim as needed. The claim is automatically optimized, batched and sent the same day. The biller doesn’t have to manually load and send.
Where’s The Claim?
A critical part of the biller’s job is to track, monitor and follow up on submitted claims. In Touch Biller PRO enables billers to track each claim at every stage of the process. The software tells billers exactly where the claim is and its status, an ability that’s missing in most systems, but one that allows billers to track and process claims seamlessly.
The system automatically posts ERAs to patient accounts without the need for billers to do the task manually. That one ability alone provides an enormous time savings that can add up to $1,200 or more per month and thousands each year.
Next t to the clinician, the biller is the most important person in a practice. Any opportunity to streamline his/her job with automation should be implemented. In Touch EMR™ and In Touch Biller PRO makes the biller’s job easier, shortens the revenue cycle and allows practitioners to get paid faster.
Billing is the cash flow engine of the private practice. It should be simple, streamlined and efficient. Billing software can be used to check patient eligibility and post ERAs, along with sophisticated functions that include scrubbing claims, posting payments and billing secondary insurance with the click of a button.
Perhaps one of the most important functions is the ability to generate detailed yet simple reports. Such reports offer clinicians the means to determine if billers are being as efficient as possible and provide them with an accurate overview of the practice’s financial health.
An aging report provides a wealth of information. It shows therapists how much money that’s owed but hasn’t been collected. Practitioners can look up accounts receivable by payer and break it down utilizing a variety of different metrics ranging from location to procedure.
Practice owners can ascertain which payers reimburse slowly and providers that aren’t billing as much as others. Reports can be created by ICD and CPT codes to discover which procedures earn the most for the practice and which patients generate the most revenue. In Touch EMR™ has the ability to generate reports with sophisticated measures and customization options.
Data And Proofs
In Touch EMR™ provides clinicians with the ability to know exactly where their money is. They can do it themselves without waiting for the biller. Reports can be created for a week, month or even the last six months. The reports can be taken to the biller or the payer if needed. In Touch EMR™ enables practice owners to view their practice from a higher level and gives the clinician ammunition to address payment issues.
The reports provide therapists with the data needed to address biller problems and expedite the billing process. In Touch EMR™ reports show practitioners where potential problems exist and the point of origin. Therapists may find that they need to stop doing business with specific payers and providers.
It can take an average of a month to collect from insurance companies, but clinicians should be aware that it can take longer when working with Workers’ Compensation, out-of-state clients and auto accident claims. Clinics that experience a lot of these types of claims should be aware that the revenue stream may be delayed through no fault of the biller or provider.
The power and potential of In Touch EMR™ provides clinicians with valuable metrics and tools to diagnose the health of their practice and if the billing department is doing a good job. The integrated system gives practitioners the ability to create their own reports independently of the billing department. In Touch EMR™ gives practice owners the tools to run their lifestyle, not a system that runs them.
Quick and efficient billing is a necessity in today’s economic climate. Reduced reimbursements and changes brought about by Obamacare are forcing practices to work smarter and more efficiently to collect the revenues they’re due. The best way to accomplish that goal is through integrated software systems with automatic features.
In Touch Biller PRO has advanced features that allow billers to submit claims that are far less likely to incur a rejection and to submit those claims quicker. In Touch Biller PRO is a completely integrated scheduling, documentation, billing and marketing system available in a single product to shorten the revenue cycle.
With an integrated system, scheduling and documentation should work with the billing software with no need for a separate system. In Touch Biller PRO is designed to communicate with other systems for a seamless solution that carries data through to wherever it’s required. The biller is the most important person in a practice after the clinician and In Touch Biller PRO allows the biller to do his/her job more efficiently to keep funds flowing into the practice. Making the biller’s job easier means more revenue.
Automatic Data Entry & Tracking
In Touch Biller PRO eliminates manual entry of patient data that’s time consuming and robs billers of valuable time that can be better spent tracking and monitoring payments and claims. The software detects potential problems and inconsistencies and allows billers to edit claims before they’re submitted, a feature that’s lacking in other systems. Claims are scrubbed and optimized before they ever leave for the clearinghouse.
The ability to generate sophisticated reports is an essential means of increasing income and determining the health of a practice. In Touch Biller PRO can produce customized reports whenever needed, based on a comprehensive array of criteria. Reports can be generated according to accounts receivable, ICD and CPT codes, payers, providers and referral sources.
To keep revenues high, practitioners require a system with seamless integration, the ability to edit claims, and generate sophisticated reports using multiple criteria. In Touch Biller PRO provides billers with essential tools to shorten the revenue cycle and offers clinicians multiple ways to diagnose the health of their practice.