Medical Billing Mistakes to Avoid

Medical Billing Mistakes to Avoid

In this article, Nitin Chhoda reveals the common mistakes in medical billing and coding that can quickly impact the cash flow of a private practice.

Some of the mistakes such as illegible handwriting, use of language and incorrect details can be avoided by using an automated physical therapy documentation system.

medical billing mistakesMedical billing and coding errors, mistakes, oversights and insufficient coding represent the most costly problems that physical therapy practices face, resulting in the loss of thousands of dollars in revenue each year.

The busier the clinic, the more likely it is that the problem will occur. An EMR will help eliminate denials and late payments, but practice owners must make medical billing and coding a priority.

Insurance providers are scrutinizing reimbursement claims more closely than ever before, making it imperative that the person responsible for billing and coding be trained and knowledgeable in the specialized language of the profession and familiar with EMR practices.

Sometimes it’s the simplest codes that create denials and a professional medical billing coder can make a tremendous difference in the revenues collected.


The little things in medical billing and coding can wreak real havoc on revenues and result in denials. Identifying a male client as female, dates that don’t match, using outdated codes and not coding for a multiple diagnosis are just some of the ways therapists slow down their cash flow and generate denials. Illegible handwriting is always a problem and if the writing can’t be read, it can be deemed unbillable. Utilizing an EMR will eliminate such problems.

medical billingLanguage

Coders rely on therapists for the information needed to correctly code claims. The language and terms taught and learned in school aren’t necessarily those used in a real world practice.

It’s important for the therapist to include notes to ensure coders have enough information to bill at the highest acceptable level. Therapists should also impress upon medical billing coders the need to look at the explanation of procedures.


Physical therapists offer a wide range of services and products, but in a busy practice, some may go unnoticed when it’s time for billing. Failure to bill for ancillary services such as, medications and supplies dispensed in the office, along with x-rays and lab work that was performed, are just some of the ways that therapists rob themselves of essential income. Clinicians need to make a conscious effort to ensure that each service, appliance and aid is documented for medical billing purposes.


If the service, treatment or procedure isn’t documented, it can’t be billed. Coders can only work with the information provided, even with a technologically advanced EMR. Relying on the coder to “know” that a specific service was provided is pure folly. Document everything in detail and be clear about the type of service offered, including referrals and consultations. It may take a few extra seconds, but the extra time will pay off in greater revenues even in your medical billing.

Up- and down-coding

Medical billing for services at a higher level than documentation supports is embarrassing in the extreme. Many clinicians choose to down-code, hoping to avoid the specter of an audit, and only succeed in cheating themselves of valuable reimbursements.

Insurance Providers

Insurance providers aren’t infallible and it’s up to the practice owner to carefully oversee the explanation of benefits to catch medical billing mistakes when they occur. There’s a tendency to think once the reimbursement claim has been submitted, that’s the end of the process.

In truth, it’s simply the beginning. Insurance companies can lose or misplace claims, or never receive them at all. Therapists who don’t conduct regular audits on the state of their claims stand to lose significant amounts of money.

In the new economy, it’s essential that physical therapists code correctly to ensure they’re reimbursed for their time, services and supplies. Every precaution must be taken to provide clear and concise documentation. The implementation of a correct medical billing EMR will greatly reduce the number of errors, mistakes and denials for the financial health of any clinic.

Medical Billing and Coding – In-House or Outsourced?

Medical Billing and Coding – In-House or Outsourced?

In-house or outsourced medical billing and coding have their own advantages and disadvantages depending on the size and the needs of the physical therapy practice.

Nitin Chhoda elaborates the differences between these two methods, and how to maximize the billing and coding process for your business.

medical billing and codingMedical billing and coding are one of the most important tasks for practice owners to consider.

However, many are unsure whether to maintain a billing and coding department on-site or outsource the entire operation to a specialty firm.

In-House or Outsourced?

Both methods have their own set of advantages, but many therapists are finding they have the same set of tools available in their EMR as those offered by medical and billing companies.

Therapists have always had the option of outsourcing their medical billing and coding tasks, but it’s a major expense that may not be necessary with the implementation of an EMR. Physical therapy documentation software allows clinicians to submit bills electronically themselves, but they may still want to consider hiring a professional coder to work with the EMR.

Outsourcing Options and Benefits

Outsourcing medical billing and coding needs provide practices with a one-stop solution that takes the reimbursement process out of the office and places it in the hands of companies that employ trained coders who handle all the submissions and details. Such firms can verify insurance information and authorizations, reconcile accounts, and provide code checking and analysis services.

medical billing and coding optionsThe same firms can conduct audits to help clinics operate more efficiently and provide training for staff on medical billing and coding-related issues.

They eliminate the need for purchasing and establishing hardware and software infrastructure.

Outsourcing also negates the need to hire a professional coder and the associated expenses of a salary, insurance and benefits.

Coding and billing firms are HIPAA compliant and feature a rapid turnaround time for reimbursements.

They reduce the work associated with billing, providing therapists with more time to see clients. For some clinics, it’s an ideal situation. For smaller practices, it may be an added expense that the clinician simply can’t afford.

In-House EMR Advantages

Therapists using an EMR can send reimbursement claims individually or via batch filing. Therapists must implement an EMR by 2014 and EMRs contain their own medical billing and coding abilities.

It just makes sense to utilize the technology to handle a task that affects the financial stability and security of a practice. Since therapists must implement an EMR anyway, there’s no good financial reason to spend additional funds contracting with an outside firm.

An EMR provides therapists with all the services offered by a medical billing and coding firm, along with updated ICD-10 coding changes. Electronic submissions allow therapists to collect their fees quicker and they can be automatically deposited in the clinic’s account. EMRs are HIPAA compliant for security and safety, and enables users to conduct audits on the state of the practice.

EMRs offer the ability to verify client insurance information and eligibility, collect one-time and recurring payments from patients, and send balance reminders to clients in the form of email, text and voice messages.Clinicians can conduct medical billing and coding tasks themselves, or hire a certified professional versed in the intricacies of the EMR, new codes and EMR documentation systems.

Balance Cost and Convenience

In the final examination, all therapists must balance cost and convenience. Outsourcing to a medical billing and coding firm eliminates the need for an on-site coder and facilitates a quick turnaround on reimbursements, but the cost may be prohibitive.

EMRs are designed with the ability to manage patient accounts, submit claims electronically, and collect from patients online. Therapists must implement an EMR by 2014 and many are discovering that they don’t need to outsource medical billing and coding when they can accomplish the same tasks with their EMR.

Healthcare Management Defined

Healthcare Management Defined

In this article, Nitin Chhoda defines the healthcare management process and how in past years it had been very complicated.

He will share how electronic medical records can help make the physical therapy management and documentation process easier and simpler to understand.

healthcare managementWhen patients think of healthcare management, they’re referring to their ailments, medications, tests and procedures.

A physical therapist views healthcare management as a total package of client care, practice management, administration, insurers and reimbursements.

Healthcare practice management is a rapidly changing landscape filled with new technology, coding upgrades, innovative treatments and a better understanding of existing conditions.

Healthcare Management

Healthcare management in the 21st century means having the tools, knowledge and methods to provide the best possible care for clients. Therapists must invest in ongoing training, create liaisons with other healthcare providers, market their clinics successfully and educate the public.

It’s an enormous responsibility and one that requires extensive time and effort. The scope of the tasks can seem overwhelming at times, but an EMR facilitates office processes, expedites revenues and enhances the quality of client care.

Healthcare management in the practice setting encompasses working with multiple insurance companies and providers, interacting with patients in a variety of ways in and out of the office, and remaining in compliance with state and federal laws.

It’s a lot to place on anyone’s plate, and smart therapists know that an EMR makes everyday tasks easier, increases productivity and creates a higher level of efficiency throughout the entire practice.

The healthcare management process begins the moment a patient makes an appointment. There are health forms to complete, visits to schedule, and insurance information to verify.

The Process

A client’s insurance eligibility and coverage is an essential part of the healthcare management process. It allows clinicians to provide the best treatments for the client within the boundaries and limitations of their insurance coverage, while ensuring the practice is compensated appropriately.

healthcare management definedIn the electronic age, therapists need the tools to communicate with clients in a variety of ways. In days past, a mailing or a call to a landline will suffice.

Today’s patients live busy, mobile lives and office technology must evolve to reflect those changes.

Superior healthcare management allows therapists to connect conveniently with clients by email, voice mail and text messaging with patient portals. Reminders can be sent about upcoming appointments, balances due, and test results can be posted online for patients to view.

The digital age also allows practice owners to interact with pharmacies, labs, hospitals and other healthcare providers quickly and efficiently. Tests and prescriptions can be ordered using the power of the Internet and consultations with other healthcare professionals is just a click away with an EMR.

The Turnaround

The success of any practice rides on its available cash flow. A great deal of time will be devoted to obtaining and verifying insurance eligibility, ensuring correct coding, and follow ups to ensure funds reach the clinic’s account in a timely manner.

Submitting that information electronically allows claims to reach insurers and clearinghouses almost instantly for a much faster turnaround on reimbursements. A steady cash flow allows clinicians to plan for the future in terms of equipment, training, staffing and expansions.

Today’s patient may have numerous healthcare professionals overseeing their conditions and ailments.

EMRs represent state-of-the-art technology to obtain a clear, concise and complete picture of a client’s medical history that’s updated instantly with an EMR. Therapists can manage their clients’ healthcare more efficiently, without spending valuable time simply waiting for paper records from another facility.

Healthcare management encompasses a wide variety of tasks, from monitoring the efficacy of a patient’s care to ensuring reimbursements reach the clinic in the quickest way possible. Technology provides the means for better patient outcomes and enhanced cash flow. It’s also an environmentally sound solution that will save clinics thousands of dollars each year.

Healthcare Practice Management and Its State (Before, Present and Future)

Healthcare Practice Management and Its State (Before, Present and Future)

Nitin Chhoda shares how the healthcare practice management has evolved from a manual documentation process to an electronic medical records system.

A few more years, and the medical industry will be using a push-button technology that will greatly increase the cash flow of any private practice.

healthcare practice managementHealthcare practice management has changed enormously as technology has evolved throughout the centuries.

A Blast from the Past

Management of a healthcare operation used to involve little more than an exchange of goods for services rendered.

The days of patients bartering a chicken or garden produce for treatments really isn’t that far removed, relatively speaking. Practices were smaller and served a greater geographical area. Patients had few choices in the treatments they received or their provider.

Office management consisted of copious amounts of hand-written records that had to be transcribed and rewritten by the office scribe into a document that could be read by anyone. Records were often lost due to fire, floods and natural disasters, with no way to put them back together into a coherent whole.

The advent of the typewriter improved the overall readability of medical documents, but it was difficult to coordinate care with other healthcare practice management providers. Unless the professional was just across town, it could take weeks or even months for documentation to travel through the postal system, leading to significant delays in treatment.

Cash flow within the practice was unsteady at best. Healthcare providers had to submit reimbursement claims to individual insurers, without the benefit of clearinghouses, and few patients even had insurance.

EMRs Era

healthcare practice management stateToday, EMRs are eliminating the need for paper records with electronic documents. They’re stored in the cloud, can be accessed instantly by multiple medical professionals, and are updated immediately.

Therapists no longer have to endure long waits for reimbursements. Push-button electronic submissions arrive almost instantly and funds are deposited directly into a clinic’s account.

Healthcare practice management can accept one-time and recurring payments online. The clientele of the 21st century is highly mobile, often relocating multiple times to take advantage of employment and educational opportunities.

New healthcare practice management providers can access a patient’s records simply by utilizing the power of the Internet and their EMR, with no interruption or delay in treatment.

The New Technology

Instead of charts, folders and paper records, EMRs of a healthcare practice management can be implemented on laptops and tablets for the ultimate in portability. The systems also allow clinicians to expand into additional therapy-related markets.

Communication is a key aspect of the therapist-patient relationship and patient portals have arisen as the result of technological advances. Clients can schedule appointments, request medication refills, provide insurance information, and view test results, all online. Practices now have multiple ways of interacting with patients via email, texts and voice messages.

Many have speculated about what the future of healthcare practice management holds. While no one knows for sure, it promises to be an interesting journey.

Healthcare providers in all fields could easily find themselves using software programs that assist in the diagnostic and treatment process based on information provided in a patient’s health record.

EMRs in healthcare practice management will continue to evolve and may contain voice recognition capabilities that allow therapists to record their notes and documentation entirely by voice. Technological strides may eliminate the need for certain types of treatments, while opening new vistas in alternative services.

It may be that healthcare delivery will become more uniform across the board. Clients will become more educated about their ailments and conditions, and more time will be expended on preventative measures.

Healthcare practice management professionals in all fields may find themselves engaged in more patient forums to educate clients, while finding new ways to communicate effectively with those they serve. An ever-increasing population in need of services guarantees innovation, with new treatments and means of delivery that will astound even the learned professionals of today.

Healthcare Management and Medical Billing Relationship

Healthcare Management and Medical Billing Relationship

Medical billing and healthcare management are interconnected. The success of the practice relies on these two factors having a good relationship.

Nitin Chhoda explains the correlation between billing and management, and the role it plays in a successful healthcare practice so that the owner will value its importance and avoid recklessness.

healthcare managementTherapists walk a thin line when reconciling the healthcare management of their patients and medical billing.

The process of accurately coding and billing of healthcare practice management can sometimes be at odds with the client’s welfare and their insurance coverage.

Therapists are often dealing with a narrow description of a complicated problem and it’s essential to provide the exact billing codes that describe the diagnosis, symptoms and corrective measures that were taken.

Patients can differ widely in their responses to treatment, making it imperative that therapists provide in-depth documentation to support their actions and conclusions.

Accurate physical therapy billing ensures clients to receive the best possible care and the clinic to reimburse at the highest available level for the services provided.

Healthcare Management and Billing

Billing and healthcare management is a closely interwoven process and it’s the responsibility of clinicians to educate themselves on the intricacies of the two. The result is better billing and coding, expedited reimbursement claims, and staff members that aren’t overwhelmed.

Next to treating patients, billing is the most important position in a practice. A clinic’s profitability rides on the billing professional submitting claims in a timely manner, conducting follow-ups and ensuring payments are received.

healthcare management relationshipPhysical therapy billing is complicated and time consuming, and smaller practices often have a designated biller that has a variety of additional tasks.

The day-to-day workflow doesn’t remain the same and it’s easy for billers to get behind without the appropriate healthcare management support and sufficient time to perform their responsibilities.

An EMR facilitates the process, allowing billers to submit claims quickly, efficiently, and with a lower denial rate.

Billing With EMR

EMRs provide clinic owners with the tools to track reimbursement claims, monitor denials, and identify potential and existing problems. On average, claims are denied approximately 50 percent of the time.

This is due to a variety of factors, from incorrect coding to improperly submitted claims. The burgeoning number of healthcare claims and limitations on services has been the impetus for insurers to scrutinize reimbursements more closely than ever.

Therapists with an EMR for healthcare management can utilize its many capabilities to identify denial rates, ascertain why claims was rejected and discover any patterns that might exist.

Problems may lie with incorrect coding, inefficient healthcare management or time restrictions placed on the biller. Once the cause has been determined, clinicians can work toward a solution that better utilizes the biller’s time.

Revenue Loss Factors

Another factor in revenue loss is the number of old and unpaid accounts the practice is carrying. One of a biller’s priorities is to track payments and ensure they’re deposited in the clinic’s account. Billers must review accounts on a regular basis to ensure payments have been made and make inquiries into their status if needed. Billing and healthcare management requires an individual who is detail oriented, with an agile mind and specialized knowledge.

The financial health of a physical therapy practice hinges on the efforts of its coding and billing expert. A large part of effective healthcare management is ensuring the biller has the time and support needed to maintain a steady cash to the clinic.

Ensuring the individual has superior training and sufficient time to perform the necessary and sometimes redundant tasks of billing will boost the clinic’s revenues and allow clinicians to pursue additional streams of revenue.

Practice Management and Its Fundamentals

Practice Management and Its Fundamentals

Some practitioners forget that regular monitoring of activities plays a vital role in determining the success of the practice. They feel that continuous cash flow is enough to determine that the business is thriving.

Nitin Chhoda reiterates the importance of the practice fundamentals and how reviewing of detailed information on the practice is valuable.

practice managementOne of the fundamentals of health care practice management is working smart, not hard. For many therapists, practice management is one of life’s great mysteries.

Some clinicians hire expensive firms to manage their clinics, while others prefer a hands-on approach.

What EMR Has to Offer?

EMRs offer the tools to manage a practice as efficiently as any high-price practice management firm, while allowing clinic owners to keep a finger on the pulse of their business.

Information is knowledge and EMRs provide a wide array of data, facts and statistics to market any practice successfully.

The goal of any physical therapy practice is to be a financially sound enterprise with growth potential. Practice management and business owners have been taught to offer patients the best treatments possible, but they don’t receive training in how to manage a clinic.

They spend endless nights trying to decipher an array of disjointed information, arrange it into a coherent whole, and decide how to best use it for the clinic’s benefit.

What many don’t want to acknowledge is that their practice is a business and it must be operated as one.

Reimbursement claims have to be submitted in a timely manner, delinquent accounts must be addressed and payments collected from patients.

Even asking for money that’s legitimately owed can be an extremely unpalatable task of therapists of a practice management.

An EMR offers the tools to accomplish all those tasks and provides a whole office solution that will place practices on a pathway to profitability and efficiency.

Lessons to Learn

The first lesson to be learned through practice management is that a clinic may appear to be solvent on paper, even as it’s experiencing an exhausted cash flow. Therapists should view every encounter and opportunity as a marketing tool. Networking with other medical professionals is an important source of referrals and increased revenue streams.

In a well-managed practice, therapists know exactly how much it costs to provide a specific service, attract new patents, and pay the bills each month. EMRs provide the tools to track and monitor the best payers, clients who are most likely to self-terminate treatment, and referral and retention rates.

practice management fundamentalsA practice management and physical therapy documentation systems ensure billing and coding is being conducted that provides clinics with the highest level of reimbursement.

Marketing is an essential part of practice management if a clinician is to grow the business, retain current clients, and persuade new patients who need services only in a specific clinic can provide.

Physical therapists know about the best treatments for their patients, but often feel lost and adrift when contemplating marketing strategies. Practices differ widely and there’s no one-size-fits-all magic formula, but the key ingredient is to stand out above the dozens of clinics vying for the same customers.

Therapists Must Always Keep in Mind

Perhaps the most important rule of practice management is never become complacent. It’s the difference between practices that are simply surviving and those that are expanding and regularly adding new patients.

Complacency has killed more practices than any other factor. Therapists must constantly strive to reach new clients, improve their range of services and become the clinic that others heartily recommend.

Practice management encompasses an extensive number of tasks, from scheduling staff and submitting timely reimbursement claims to communicating with patients and providing treatments. EMRs provide the tools to accomplish all those jobs efficiently and with an increased level of productivity, allowing therapists to work smart, not hard.