It entails using technology to keep track of the claims process at every point of services, so that the healthcare provider can follow the process and address any issues, allowing a steady stream of revenue.
Elements in Physical Therapy Billing
Time management and efficiency play large elements in physical therapy, and a practitioner’s choice of an EMR can be largely centered on how their physical therapy billing is implemented. Some of the processes handled with physical therapy billing software include:
Streamlined scheduling that allows your office to verify patient’s coverage and benefits before the visit. This helps you in deciding whether to use the patient’s insurance coverage or ask for another source of payer.
Faster payments through the check in/out process via patient and medical insurers
Enhanced compliance with up to date standards so thatyour practice stays current with HIPAA rules, regulatory compliance, and implementation deadlines. Updated information is automatically downloaded and is free.
Managing the revenue cycle will bring more visibility, make compliance simpler, and make the physical therapy billing team more productive.
New physical therapy EMRs provide revenue cycle management solutions that are very successful at improving efficiency.
With a fully integrated and mobile EMR and physical therapy billing, 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.
Adopting a multi-faceted approach to running a physical therapy EMR practice allows more streamlined and productive business. Nitin Chhoda shares how an effective scheduling, documentation, billing and marketing, with the help of EMR, are very important in a private practice in order for the business to survive.
Practitioners are also business entrepreneurs and, in most cases, their practices are for profit enterprises, but they are not recognized or treated as such.
Below are the most important factors that practitioners should prioritize so that their businesses will become an effective and profitable one.
For every open appointment slot of each day, there should be a patient coming in to the clinic. Proper management is necessary for this to be achieved. Electronic medical records system is the latest physical therapy software system that organizes and summarizes all appointments or schedule not only for the day, but also for the week or month depending on the user’s preference.
With technological advances like electronic medical records, scheduling has evolved so that filling slots is easier and tracking patient visits becomes automated.
The responsible physical therapy managementstaff must take the time to look over the schedule and pull the correct records each day. An organized physical therapy documentation can be automated and streamlined with the use of physical therapy EMR technology.
Having a proper and correct physical therapy billing and coding with the help of EMR are keys to successful practice operation. The collection of payments from the payer, whether directly from the patient or their health insurance company depend on this part.
Marketing is also important and patients are part of the EMR system. Giving them the best care and service will automatically encourage them to bring referrals. It is important that current or even previous patients should be part of the healthcare practice management plan.
The plan can be easily implemented using a physical therapy software like EMR, where everything is updated and streamlined. Without good marketing, it will be hard to keep your schedule full.
By realizing the important connections between the four major parts of a practice, physical therapy management can easily look for ways to improve, making the practice more efficient.
Utilizing EMR for physical therapy services will greatly help as most of the common tasks found in these approaches can be integrated to this physical therapy documentation software.
Medicare is the biggest government payer practitioners will deal with, but it’s by no means the only one. Government-operated health insurance encompasses many other programs and in this second of a two-part series, Nitin Chhoda addresses other government-sponsored insurance plans.
Healthcare insurance programs operated by the government provide coverage for veterans, low-income adults and injured workers.
Managed by the federal government, some programs are administered at the state level.
All have very specific regulations and can require pre-authorizations, referrals, and proof of medical necessity before they approve reimbursements.
Next to Medicare, Medicaid is one of the best known healthcare insurance programs in the U.S. Designed to provide the poor and low-income individuals with basic health services, it’s administered at the local level. Each state has considerable leeway in the manner in which it administers the program, determines individual eligibility, and what services are provided.
Funding cuts to Medicaid at the federal level has resulted in many states limiting coverage to the most basic levels for adults. The program also provides limited healthcare coverage for those who require nursing home care. Children in the program receive dental and vision services, along with healthcare. Medicaid patients are entitled to surgical procedures, inpatient hospital treatment, and prenatal care.
It’s extremely difficult to verify a patient’s Medicaid eligibility, what portion of the bill the client may be responsible for, and what services are covered until the actual reimbursement claim is submitted. Medicaid maintains a stringent fee schedule, regardless of actual costs.
Funded by the U.S. Department of Defense, Tricare is the healthcare plan that serves active military personnel and their dependents. Tricare encompasses three levels of care – Standard, Prime and Life. Tricare Standard is for active duty, retired and reserve retirees, and their family members. It operates similar to a PPO. Recipients are required to pay a deductible and copay, but can see any civilian healthcare provider.
Tricare Prime resembles an HMO and serves the same segment of the military as the Standard. Patients have more restrictions and must only utilize network providers. Tricare for Life is a supplement plan for former Tricare members that are eligible for Medicare. The plan pays according to a fee schedule similar to Medicare.
The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) serves VA patients and those not eligible for Tricare, along with spouses and dependents of military personnel who were disabled in the line of duty. Surviving spouses and dependents of veterans killed due to military-related injuries are also eligible.
CHAMPUS healthcare plans are usually secondary payers. When it’s the primary payer, the plan functions much like an HMO. It’s imperative that coverage is verified prior to the client’s visit to ascertain if a referral or pre-authorization is required before treatment is provided.
Administered by the U.S. Department of Labor, Workers’ Compensation is available for workers injured while on the job or who develop an occupation-related disease. Practitioners must enroll in the healthcare program and obtain a DOL number.
Workers’ Comp claims always require pre-authorization, but that doesn’t guarantee payment for services.
Before treating a client, verify pertinent information about the disease or injury with the employer. A diagnosis code must be approved by the Workers’ Comp carrier and the medical provider must prove medical necessity.
Clinicians should obtain a pre-authorization for every procedure. Workers’ Compensation claims are paid according to a healthcare pre-determined fee schedule, and funds deposited through electronic fund transfer.
Patients covered by government-operated healthcare programs can add significantly to the revenues of any practice, but clinicians should exercise caution especially with their medical billing and make sure to verify every aspect of the client’s coverage prior to treatment.
Government healthcare plans have numerous rules, regulations and filing requirements and if they’re not followed to the letter, reimbursements won’t be forthcoming.
Clearinghouse represents the first step on a reimbursement claim’s journey toward money in a clinician’s pocket, but a lot can happen once it’s transmitted from the practitioner’s office.
In this revealing article, Nitin Chhoda provides an inside look at factors that can affect a claim and the ultimate reimbursement.
Before And After
A clearinghouse is an essential element of the entire medical or physical therapy billing cycle. They ensure that each claim is routed to the appropriate insurance company for payment.
They perform other useful functions before a patient arrives at the office and afterward. Billers can utilize their services to ascertain a client’s insurance eligibility and coverage prior to treatment. They can also issue a statement of services to patients.
Cleaning the Claim
The first step for a claim after its arrival at the clearinghouse is a thorough scrubbing for errors and inconsistencies. Some mistakes can be quickly corrected online, allowing the claim to continue on its journey. These are typically clerical errors and while they may seem minor, they contribute significantly to the wait time for the claim to be paid.
Other problems aren’t so easily rectified and the entire claim will be returned to the clinician’s office to be corrected and resubmitted. These types of problems can arise when the clearinghouse doesn’t recognize the payer. Many smaller insurance companies don’t accept electronic payments and the claim will be returned, necessitating submission of a paper reimbursement request.
Clearinghouse is responsible for matching payer identification numbers with the right claim, a process that tells the organization where to direct the reimbursement request. The practice’s billing and coding specialist must include the correct payer ID number on the claim or it will be returned to the medical provider, further delaying reimbursement.
Reports and Records
Medical clearinghouse maintains a record of each claim that goes through the facility’s system and generates a status report.
The record can be accessed by the practice and used to monitor the location of the claim, where it was sent and when. Sometimes a claim may seem to disappear. Billers can check their batch report against those generated by the clearinghouse to discover what happened to it.
Clearinghouse provides clinicians with a single location to manage all their reimbursement claims and to do so electronically for speedier payment.
Multiple claims can be submitted at the same time and clearinghouse reports allow clinics to track and monitor the status of any claim 24/7.
Practitioners that contract with clearinghouse have the advantage of fewer rejected and denied claims and quicker reimbursements.
Of all the government-run insurance plans, Medicare is the largest and is comprised of four types of coverage, Part A, B, C and D.
Participation is mandatory for some portions and voluntary for others, leading to confusion for patients.
Congress dictates how Medicare claims are paid. Reimbursement requests must be submitted within a specified time frame and the agency prefers to pay providers via electronic fund transfer.
It’s critical for practitioners to verify which Medicare elements a client participates in before services are rendered.
Medicare Part A
The first part of Medicare coverage pays for inpatient care in hospitals, skilled nursing facilities, home healthcare and hospice, but an overnight stay in a hospital is no guarantee of payment. Clients must meet specific requirements for Medicare to pay for inpatient services.
Medicare Part B
The B portion of Medicare coverage is designed to pay for services, treatments and procedures that are medically necessary. Included are services by physicians, home health services, durable medical equipment and outpatient visits. Some preventative measures are covered, including vaccines.
Part B is optional, but those who don’t enroll according to government guidelines are penalized. Patients often believe they’re automatically enrolled when they retire and are dismayed to discover they have no coverage. Recipients also have an annual deductible and pay a 20 percent copay for services.
Medicare Part C
Part C, also known as Medicare Advantage, is an insurance replacement plan offered by private companies that have been Medicare approved. Part C is favored by individuals who prefer private insurance coverage. Depending on the provider, plans can require beneficiaries to pay out-of-pocket expenses, obtain referrals, and only see network providers.
Replacement plans can be used to cover Part A and B services, and some plans include medication and vision coverage. To avoid medical billing reimbursement difficulties and appeals, always verify the client’s coverage, restrictions and limitations prior to treatment, along with the plan’s fee schedule to determine if it differs from Medicare standards.
Medicare Part D
The Medicare prescription drug plan is Part D. While Part D coverage doesn’t typically cause a problem for medical professionals, a large number of Part D recipients mistakenly believe they’ve enrolled in a Medicare supplement policy. Practitioners may find they’re spending a significant amount of time explaining the difference to their patients.
Medicare Supplement Plans
Patients can enroll in a Medicare supplement program, also known as Medigap plans, to cover the costs that Medicare doesn’t pay. It provides a source of secondary coverage, but doesn’t include any non-approved Medicare expenses. Always verify secondary coverage prior to any patient encounter.
More than 50 million people age 65 or older and younger individuals with disabilities have some type of Medicare coverage.
It represents a large population of patients upon which practitioners can draw that are covered by a reliable payer.
Incentive payments may also be available for clinicians practicing in geographic areas with a demonstrated shortage of medical professionals.
Implementing the EMR technology is essential in the 21st century for clinicians to convert to digital records, submit reimbursement claims and get paid.
EMR expert, Nitin Chhoda, was one of the first to use the software and is sharing his expertise on the many ways an EMR contributes to a practitioner’s personal freedom.
Time is money and an EMR provides savings for clinicians on both fronts.
Verifying Insurance Coverage
From the moment a client makes an appointment to the moment the patient encounter is completed, an EMR is on the job, increasing efficiency and boosting productivity.
An EMR has the tools to verify insurance information prior to the client’s visit, providing practitioners with the information needed to formulate a treatment plan based on insurance limitations, coverage and eligibility.
Fewer Hours and More Money
A fully integrated EMR includes a secure patient portal where individuals can complete a health history online. That information is available prior to the client’s visit, allowing clinicians to familiarize themselves with the patient’s problems before they arrive. The data can decrease the wait times for patients and practice owners by up to 47 percent and reduces time spent gathering information in the exam room.
The information gathered with an EMR allows practice owners to see more patients during the normal work day and manage treatment options, without the need to stay late or conduct extended hours.
Clinicians have more free time and the funds to enjoy personal activities with friends and family.
Patient records are updated instantly with an EMR, anytime the client’s information is retrieved. The systems provide a single resource for all aspects of a practice’s management needs. The records can be accessed from multiple locations and by numerous medical professionals to coordinate care.
If a patient requires treatment in an ER, the on-call physician has all the information needed to assess and treat the patient, without the need to contact the client’s physician.
Space and Time
Office supplies represent a major expense for practices. An EMR saves everything digitally, eliminating the need for paper documents, files, folders and all the related products needed to manage a mountain of paperwork.
EMRs require a fraction of the space needed for file cabinets to house paper records. There’s no need to search and sift through dozens of documents to locate a specific paper and the technology eliminates misplaced files.
Errors and Reimbursements
With an EMR, reimbursement claims are submitted electronically, in real time. The technology contains the ability to identify errors, mistakes and potential difficulties with claims before they’re transmitted.
A complete record of each transaction is maintained, along with patient balances, and payments can be received in as little as 10 days.
Electronic medical record provides the tools for clinicians to work smarter, not harder. They save time through increased efficiency and productivity within all departments, and work to identify errors and mistakes that can virtually eliminate denials and rejections. The result is that clinicians have increased revenues and the freedom to reap the benefits of their labor.