Insurance Eligibility Determination

Insurance Eligibility Determination

Nitin Chhoda shares why verifying insurance eligibility should happen before and not after treating patients.

insurance eligibility determinationThe biggest challenges for medical coders and billers come from health insurance companies and its insurance eligibility.

With such high rates of rejection and denial of claims, the medical biller or coder, or physical therapy billing staff can be responsible for significant losses and a reduction in efficiency that can be damaging to the practice.

Claims submission rules change from company to company, not to mention for federal, state, and local programs. To reduce rejections and denials, take these steps to make sure you determine insurance eligibility.

Determining insurance eligibility should be done at the very beginning of any patient induction process. Ideally, before the patient even shows up for their appointment, so that you and the patient will already know what is covered and what is not.

Goals to Focus On

Remember that the purpose of checking for insurance eligibility will help you stay focused. Your goals should be to minimize claim denials and re-submittals, as well as eliminate any unpaid balances that patients owe. If you can keep those goals in mind, you will have an easier time controlling the aspects of the process that you can control.

Change Workflows

Another key thing to remember when it comes to insurance eligibility verification is that your patients likely have no idea what their insurance plan covers and does not cover. Many practices institute a pre-screening process to get some basic information from the client and learn what their expectations are before they have any bills to pay.

Pre-screening for insurance eligibility may be hard to get used to at first, because it will require that the medical biller actively spends time finding out information. That time will be hard to find for most medical billers.

On the other hand, consider the amount of time that you spend dealing with rejections, denials, and re-submittals of forms. How much is it hurting the practice to carry a large balance in accounts receivable?

And wouldn’t it be more time and cost effective if you got that part of determining insurance eligibility out of the way from the beginning? The answer to that last question is a definite yes! So consider starting with a workflow that adds a bit of time at the beginning but cuts a lot of time on the other end of the billing and insurance eligibility process.

Communication is Keyinsurance eligibility requirements

It may be difficult at first, but you will get used to talking to clients regularly about their insurance status. New patients will be easy.

If you use the approach that you are trying to help them, they should be amenable to giving you answers where they can.

Let them know that you understand how complicated it is, but that it will be easier for them and for you if you both figure it out now.

But it’s not only new patients you need to worry about. Patients whose coverage changes or who you haven’t seen in a while will also need verification of insurance eligibility.

If you can make some small changes, you can figure out just how much a patient will owe even before you file any claims. Ideally, you can even ask patients about their insurance eligibility and have them pay their portion up-front, entirely eliminating unpaid balances from accounts receivable.

Claims Submission Made Easy

Claims Submission Made Easy

Timely claim submission is an important role of medical billing staff. Nitin Chhoda discusses why regularly submitting accurate claims are vital and should be the first priority of any billing staff.

claims submission goalsPerhaps because claims submission will take up the largest proportion of a medical billers time, claims submission is also one of the most frustrating parts of the job.

Getting rejected or denied 50% of the time can start to wear on a medical biller pretty quickly.

And yet, that is a normal rate of rejection. So how can you make the job of medical biller easier? It turns out that a few simple steps can change not only the way you feel about claims submission, but you may be able to improve results, too.

Priority #1

The importance of timely and accurate medicare claims submission cannot be undervalued. For anyone in the medical coding or billing fields, the job of ensuring that the practice is paid for service and in a timely manner should be the first priority.

Not surprisingly, most physical therapy documentation staff members responsible for this important job are likely to rush through it and do the billing only when they feel they have time. This is the opposite from the best way to get good results.

By recognizing that billing should be your first priority, you can lower the amount of pressure on yourself. In fact, you should be able to feel good about every time that you sit down to handle claims submissions.

The best way to re-prioritize claims submission is to dedicate a certain amount of time every day or every week to just submitting claims. When you’re handling claims submission, that should be the only thing you worry about.

claim submission processAccuracy Checks

The worst time to re-check your work is right after you’ve completed it. In some practices, accuracy is checked because two or more people are responsible for medical coding and medical billing.

But in a small practice, that may not be the case. Consider checking accuracy in specifically allotted times, too. For example, let’s say you process claims every day.

Dedicate a couple of hours in the morning to organizing and preparing your claims and then the first thing after lunch go back and check and then handle any claims submissions. If you prefer to submit claims once a week, you can prepare claims during the week and file them for review and claims submission at the end of the week.

Insurance Eligibility Checks Before Claims Submission

Another key to increasing efficiency and success, and making claims submission less of a burden is to do your insurance eligibility checks in advance. Find out what the patient’s plan actually covers and ask them to pay the balance up front.

Changing outcomes from claims submissions may require that you change the way the medical biller does their job. This can be a hard adjustment to make, especially for an established biller with a workflow they are used to.

But improving the rate of accepted submissions is critical to the success of any practice. The more you prepare and schedule claims submission, the better the process will feel and the more successful you will be.

Health Care Management Overview

Health Care Management Overview

EMR reports can help assist management on deciding whether or not to add more staff. Nitin Chhoda shows managers how EMR can help uncover issues by providing reports based on the needs of the physical therapy practice.

health care management overviewWe don’t tend to think of health care practice management as all that different from any other kind of management.

But it turns out that health care management has to adapt and change policies more quickly than almost any other field.

The business side of running a practice involves a complex billing structure, high regulation, and constant updates.

Health Care Management at its Most Basic 

The most basic definition of health care management can be summed up as the role an office manager plays in a health care practice. An office manager must be aware of the tasks of every staff member; they should be able to re-assign tasks or jobs as necessary.

Often it is the health care management that keeps a practice running smoothly. A health care manager may simply be the person in the office who does not see patients or handle a easy-to-define work load, simply so that when problems arise, there is someone to take care of things.

Today, the health care management role has changed to include monitoring efficiency and making administrative changes. With the introduction of electronic medical records, electronic health records, and technology that can track financial indicators, improving efficiency is not only possible, it has been made much more simple.

Health care management is often in charge of deciding what kind of technology to invest in. Increasingly, this means conducting analysis on current systems and workflows.

The Future of Health Care Management

Health care management is not only changing in the way tasks are delegated, but it is also experiencing the same growth as every other aspect of health care. The health care industry is rapidly approaching a level of demand that has never been seen before, thanks to the baby boomers.

This means demand for skilled employees is going up, too. This is true of certified positions such as x-ray technicians and ultrasound tech, but it is also true for management positions.

As the industry becomes more and more streamlined and efficient due to technology, each added employee turns into a significant benefit to the practice. If demand for services is overwhelming, then the only way to increase capacity is to hire more staff. Health care managers have to analyze the benefit of added staff and then manage the integration of new team members.

health care management outline

Technology is Changing Everything

For health care management programs, technology improvements are both a blessing and a curse.

On the one hand, office managers have to be adaptive, tech savvy, and they have to know how to implement software improvements. On the other hand, the job is changing so fast that it can be hard to know what it means to be hired as the office manager.

With EMRs tracking the number of cancelled appointments that never get rescheduled as well as statistics on referrals and number of visits per patient, health care management is turning into a more technical job. Drawing up reports on efficiency can show health care management how much work needs to be done to reach the goals of the practice.

Health Care Practice Management Present and Future

Health Care Practice Management Present and Future

Nitin Chhoda shares the state of health care practice management from the past and how it will affect the future. He shows how the role of management and its staff are evolving as technology enters the physical therapy business.

health care practice management futureEven though the tasks assigned to health care practice management staff have been around for as long as hospitals have existed, the job of health care administrators is relatively new and is constantly changing.

Handling medical records and medical billing is a big job. For very small practices, these jobs used to be the tasks of the health care practice management, usually in the form of an office manager.

But today, health care practice management involves so much more, and tasks like medical billing and coding are handled by specialists.

The current role of the health care practice management staff involves a lot more analysis and efficiency management than ever before, largely due to changes and improvements in technology.

The role of electronic medical records (EMR) in this change cannot be emphasized enough. Electronic health care practice management technology has allowed health care management to take advantage of data that was previously too time consuming to extract.

Health Care Management Focuses on Patients

Of course, all these technological improvements might lead health care practice management consulting professionals to spend more time with charts and graphs than dealing with patient concerns. But that is not entirely the case. In fact, analyzing performance of the clinic will serve two purposes.

Firstly, identifying problems with efficiency will provide many advantages to the doctors, nurses, clinicians, and entire staff of a hospital or practice. Many health care practice management professionals will be quick to look for ways to save money, which is another advantage of EMRs and using the technology that is available today. But most of the changes that help the practice’s bottom line have other benefits, too.

The second purpose of looking for inefficiencies by using data on outcomes, re-scheduling rates, and visits per patient is to identify where patients can be better served. This is the tangible benefit that technology can bring when used the right way.

Number of Patient Visits

As an example, imagine that some clinicians only see a patient three times before the patient can go back to life as usual but other clinicians spend at least five visits with each patient.

healthcare practice management presentUsually, in a busy office, you would never even notice a pattern of health care practice management like that.

Clinicians tend to know just how often they need to see patients, based on past experiences and what they were taught.

But if you could see that patients with the same complaint were given a more effective treatment or series of treatments, you could find out what it is that efficient clinician is doing.

Health Care Practice Management, a Delicate Balance

It’s easy enough to see how this kind of information could be misused. And it is likely that we’ll see plenty of cases of disgruntled staff members who are frustrated by statistical analysis and being treated as if they aren’t doing a good job.

Health care practice management in the future is going to be more and more a job focused on efficiency. But there are important human elements that must always be kept in mind so a practice is really running the best it can. Unhappy staff are not the way to make things better.

Health Care Management and Medical Billing Relationships

Health Care Management and Medical Billing Relationships

The relationships between the healthcare management and medical billers are important. It involves the whole process of physical therapy billing.

Nitin Chhoda reveals certain areas where healthcare management and medical billers should support each other for the success of the practice.

health care management and billing relationshipsDepending on your first hand experience with medical billing, it may be completely obvious that health care management and medical billing are very closely integrated.

However, many health care practice management professionals who have no experience in medical billing can cause problems for medical billers if they do not educate themselves on the relationship between the two.

Small Practice Medical Billing

In a small practice, it’s very likely that the medical billing will either be hired out to a separate company, or that it will be handled by the health care management staff.

These days it is easier to both hire out as well as accomplish medical billing jobs in-house as part of a position with other responsibilities. But this can cause a lot of problems when that single staff member starts to get overwhelmed.

Medical billing is the most important part of running a medical practice, besides actually treating patients. Health care management involves being able to detect the signs of an overwhelmed medical biller before it causes serious problems. Everyone in the office relies on the medical biller to bring in the payments that keep the practice running.

Health Care Management Indicators

There are a number of indicators which may tell health care management that the medical biller needs more support or more time to do their job correctly. Sometimes changes in workflow can bring efficiency up, but often it is more a problem of being overworked than anything else.

Health care managers who don’t realize how much time it takes to complete the medical billing in the way it should be handled are likely to overwhelm their staff unknowingly.

health care management relationshipsOne way that health care management can identify a problem is by looking at rejections and denials from insurance companies.

This is a tough indicator, because the average rejection and denial rate is about 50% of claims. However, with an advanced EMR you can get more detailed information.

Why has a claim been rejected? How often are rejections and denials due to clerical error, time restriction problems, or incorrect medical coding and health care management? These are the kinds of errors that occur when the medical biller doesn’t have the time to review their work before submitting claims.

Aging Reports

Another indicator are accounts receivable aging reports. Aging reports will tell you how long it takes for claims to be paid. It can also tell you whether or not medical billing and health care management staff is taking the time to review the accounts receivable aging reports regularly enough.

Sometimes payments are delayed or even overlooked because the claim has been sent, but was never received by the insurance company.

Sometimes the rejection or denial is sent incorrectly and the practice will have no way of knowing that this is what happened. Unless someone runs an aging report and checks with the insurance company to determine the status of the claim.

Medical billing involves a lot of duplicate work and communication. Health care management principles can ensure that this work is done correctly by giving medical billers the time to do their job.

Medical Billing Professionals Working With the Health Care Management

Medical Billing Professionals Working With the Health Care Management

There should always be an open communication between the medical billers and the healthcare practice management.  Nitin Chhoda further explains how good communication will help to resolve any type of issues faster and more efficiently.

medical billing professionalsMedical billing professionals have plenty to worry about on a day to day basis; sometimes those bigger picture problems never get attention because there’s no time to think about anything but getting today’s work completed.

And medical billing isn’t the only profession that encounters this kind of challenge.

In most every field of work, there are people who spend time doing the work and then there are the managers who have a broader view and can make decisions for the entire practice.

Medical Billers and Management

Medical billers and health care management have to work together to find a balance between efficiency and becoming swamped. Many medical billing staff feel they have an unending set of tasks. By the time they get caught up with one thing, something else has come up and they have no time to step back and review their workflow or make things better for themselves.

On the other hand health care management may not realize that some of the most expensive problems with efficiency occur when medical billing people are overwhelmed. Health care management has the responsibility of reviewing the operations of the entire practice.

Having an Open Communication is Important

But indicators like rate of rejection or denial for insurance claims, or the accounts receivable aging reports don’t always tell enough of a story. Medical billers and health care management must work together to find solutions to the efficiency problems that exist.

When indicators are discovered, it may be time for a review of workflow and schedule pressures that the medical billing staff experience. Health care management can be a catalyst for improvements if the medical billing staff is approached in the right way.

Common Problems That Medical Billers and Health Care Management Can Solve Together

One of the most common problems that medical billing staff experience is the lack of a schedule for performing tasks. When things are just a little too busy, a medical biller may be forced to deal with whatever is most pressing at the moment.

But medical billers and health care managers should both know that the most efficient medical billing training of practices involve keeping a schedule and dealing with responsibilities in an organized way.

medical billing managementRather than simply giving the medical billing staff more time, health care management should be able to talk to medical billers about what is slowing them down or inhibiting their ability to check and correct their work.

Working out times when the medical billing staff can focus on drafting claims and making it a priority to review claims can actually save medical billers in the long run.

Most mistakes lead to rejected or denied claims, which is a huge problem for the entire practice. A rejected or denied claim has to be reviewed for mistakes and then re-filed. If the medical billing staff has time to review before sending, fewer mistakes will get through and fewer re-filing will be done. This saves everyone time and therefore it will save the practice money and relieve stress.

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