Healthcare Insurance and Health Insurance – What Are They?

Healthcare Insurance and Health Insurance – What Are They?

Nitin Chhoda explains the health care insurance, its providers, the Insurance coverages and the Affordable Care Act for patients.

He also discusses the importance of knowing the limitations of patients’ insurance so that patients and service providers know what to expect at the time of treatment.

healthcareHealthcare practice management costs that continue to rise and unforeseen medical emergencies are the two overriding reasons individuals buy healthcare insurance.

Essentially, patients purchase insurance against the risk of becoming ill or encountering a potentially expensive and unforeseen medical need.

Accidents and catastrophic medical emergencies happen in the blink of an eye. Healthcare insurance helps defray patient costs and insures healthcare providers receive payment for their services.

Insurance Provider

Patient healthcare insurance is most often provided through an individual’s employer. Business owners contract with insurance companies to provide an established range of healthcare services that can include hospitalization, vision and dental coverage, along with office visits, prescriptions and lab tests.

Available coverage varies widely, with employers shouldering a major portion of the costs while the individual is responsible for co-pays, deductibles and monthly premiums. Medicaid and Medicare represent another form of healthcare insurance. Medicare is administered through the federal government.

Medicaid is funded through federal and state governments and distributed at the discretion of each state. Medicare is accessible by retirees and the disabled. Medicaid typically covers low-income children and adults with no other available options.

Insurance Coverages

Dwindling funds and budgetary concerns have led to coverage limits in both Medicaid and Medicare, making it essential for therapists to verify a patient’s coverage before treatment.

There’s been a push by healthcare insurance providers and employers for patients to shoulder more of the monetary burden of their healthcare, giving rise to a wide variety of special clauses and exclusions in healthcare policies.

Cancer, long-term healthcare needs and disability claims are costly for insurance providers and many policies now require clients to purchase additional, specific coverage for certain conditions. The result of shifts in healthcare insurance policies and practices has resulted in a lack of sufficient coverage for much of the population.

Underinsured clients and those with no coverage present a major problem for therapists who must balance the desire to practice their profession and render aid to those in need, with operating a practice that remains solvent and profitable. The first line of collections when a patient receives treatment is the healthcare provider.

To ensure reimbursements are received in a timely manner, practitioners submit claims to the patient’s insurance provider.

Any amount not covered through the client’s healthcare plan is the responsibility of the patient. It’s essential for therapists to determine a client’s coverage before the time of treatment to ensure the patient receives necessary services and clinicians obtain the payment to which they’re entitled.

The Affordable Care Act

healthcare and health insuranceThe Affordable Care Act extended medical coverage to millions of individuals who previously had no insurance, but significant limitations and gaps in available services still exist.

Clinicians must ensure they have current insurance information for every client they treat before the patient arrives at the office.

It’s an unfortunate reality, but the direction of current insurance company policies may force therapists to decline patients with limited or no coverage to ensure their practice isn’t at financial risk.

Insurance companies represent the first line of reimbursements for clinics, followed by state and government programs, and self-pay patients. Changing and evolving healthcare insurance will require practice owners to examine the state of their businesses and the patients they treat with an increasingly stringent set of criteria.

Physical Therapy Documentation: The Importance of Personalization in Your Physical Therapy EMR system

Physical Therapy Documentation: The Importance of Personalization in Your Physical Therapy EMR system

Personalization is critical when choosing the right physical therapy documentation or EMR for your practice.

Nitin  Chhoda discusses the importance of personalization and customization in the physical therapy documentation process, and how it should affect your selection of a physical therapy EMR.

physical therapy documentation personalizationThe best limbo dancers are extremely flexible and that same quality is essential in a physical therapy documentation system.

The majority of EMRs were developed and written with a specific user in mind, from hospitals and physicians to surgeons.

EMRs reflect the reasoning of the creator rather than the end user. It’s essential to select an EMR developed by or for a physical therapy practice to ensure the EMR doesn’t begin dictating how the clinic conducts business.

Selecting the Best Physical Therapy Documentation System

When selecting a physical therapy documentation system, the two key factors are flexibility and control. The system must offer the flexibility to meet the individual needs of the practice for the present and the future.

Therapists must be able to control every aspect of the physical therapy documentation process without interference from the EMR. Documentation software provides the means to achieve a more efficient and profitable practice.

It should never intrude on or force therapists to compromise on the way they operate their business.

Have an Effective EMR

Many EMRs look and sound good in theory, but ignore the practical concerns of the clinical environment. Physical therapy practices vary widely in the services offered, professional experience and work environment and an EMR must be able to adapt to the diverse needs of the individual practice.

A good physical therapy documentation system offers additional options as needed to grow with the practice.

An effective EMR integrates easily with existing office systems to expedite physical therapy documentation of patient records, enhance marketing endeavors, and provide patient portals for additional functionality. EMRs automate many of the time consuming tasks typically handled by staff members, freeing them to engage in pursuits that promote the clinic, acquire new patients, and increase the level of the practice’s customer care.

Customized Pattern

The ability to create customized templates, without restriction, that accurately reflects the services and treatment options of the individual practice is essential. Therapists should be able to create their own templates, without hiring a tech specialist to navigate the system.

Not all patients respond the same way to treatment, requiring therapists to be creative to achieve the best results for the client. Any EMR should include the ability to combine any number of physical therapy documentation services and bill accordingly.

Reimbursements

physical therapy documentation processPhysical therapy documentation, billing and coding options specifically designed for use by therapists help navigate the increasingly complex requirements for reimbursements.

The ability to submit claims electronically should be a function of physical therapy documentation software.

Reimbursements are received quicker and additional information and clarification can be accomplished almost immediately. EMRs also allow therapists to work with an extensive number of payers for the best reimbursements.

As more complex and innovative treatments are developed, physical therapy documentation must be able to change and evolve to meet the needs of practices.

Flexibility in all facets of EMR software is needed, from time stamps to avoid legal issues to the ability to create custom forms that reflect the special requirements associated with physical therapy clinics. Both web-based and server-based EMRs are available, but the key to successful implementation is always the ultimate flexibility of the selected software and its ability to facilitate clinic expansion and profitability.

Physical Therapy Marketing: Limiting Exposure to Bad Payers

Physical Therapy Marketing: Limiting Exposure to Bad Payers

Searching for the best insurance companies maybe hard to find, but it doesn’t mean that they do not exist. Nitin Chhoda exposes simple techniques on how to identify and contract with the best payers so that your practice will have continuous income.

Knowing the bad payers when it comes to your physical therapy practice is not as hard as you might think. Nitin Chhoda reveals ways you can recognize bad payers in order to avoid them, and spend more of your time caring for patients.

physical therapy marketing limitsEvery physical therapy marketing in a practice goes through the process of determining which are the best paying insurance companies. You may find that one of the best ways to learn about bad payers is by asking around.

Of course, you may not feel like going into the competitor’s office as part of the physical therapy marketing plan, but there are ways to get information that don’t involve any risk.

Call Around to Other Healthcare Service Providers

The best information will come from other physical therapy marketing services and practices. Some insurance companies may have better policies for certain types of medical care than others.

However, if you are unsure about contacting other physical therapy managers and owners, you can also talk to those healthcare providers that you already have a relationship with.

Are there other physical therapy marketing and management offices where you refer your patients to when they need a different kind of care? Do surgeons or specialists send their patients to you when they need physical therapy?

Get in touch with the people you know and ask them a few questions about their best payers and their worst. Most professionals will be happy to share the information.

Same State, Different City

Another way to get good information is to get in touch with other physical therapy marketing services of other practices that are in the same state as you, but in a different city or town. This may feel a bit awkward at first, but the benefits of learning about bad payers are well worth a little confusion.

Remember to talk to the other managers as your peers. Remind them that you’re all in the same boat and you think this kind of information should be shared so that you can all avoid insurance companies that are bad at paying their bills.

In fact, you may find that someone has started to compile a list already. There tend to be way more resources out there than you expect – it’s just a question of finding them.

It may be that a local physical therapy marketing business group has already identified some of the worst and best payers and they might be willing to share the list with you. You never know if you don’t try.

physical therapy marketing payersStart a List of Your Own

Of course as you go, you will learn which companies you prefer and which seem to always reject your claims.

Keep track of those companies, mostly for your own physical therapy marketing practice and so you can adjust who you contract with, but also because perhaps one day someone will call your office asking for advice.

Physical therapy marketing in a practice can benefit from working together, and in some cases a good deed will pay dividends. If a practice becomes overwhelmed with new patients, perhaps they will send some your way if you’ve done them a favor in the past.

Running a healthy and thriving physical therapy practice is a lot of work. There are some very important decisions to make, and they will keep coming. The more you can work with others and build relationships with those payers that are good, the better off your physical therapy marketing practice will be.

Medical EMR Can Simplify Healthcare

Medical EMR Can Simplify Healthcare

Medical EMR can simplify healthcare in many different ways. The best part is that it can streamline the whole physical therapy documentation process from start to finish without consuming too much time from the staff. Nitin Chhoda explains how this is all possible.

medical EMR healthcareThere are many ways that an integrated medical EMR system can help a practice to save money and become more efficient. But one benefit of EMRs that is often overlooked is the way a good system can simplify healthcare in general.

There are benefits to patients as well as clinicians that can help even the most confused patient to get the care they need at a better price, without costing the practice more money.

Billing Advantages

Healthcare providers already know how an integrated electronic medical record can make billing more accurate and efficient.

If everyone in the practice is using the same system, and all data are available through that system at any time, medical billing staff can pull the data they need and bill on a timely schedule.

Coding can also be easier, with a specific set of billable tasks and diagnoses, clinicians can provide medical EMR coding staff with the precise information they need to get the medical coding done more quickly and easily.

The billers can then take the information and file claims with the insurance companies and bill patients for their share of the cost. The improvement in efficiency that medical coding and billing departments are experiencing has been exciting for those practices that have implemented a medical EMR.

So how does this simplify healthcare and understanding the healthcare and insurance system in the United States? First of all, if the billing system requires specific information from patients, the billing department can implement procedures for determining what a patient will owe even before services are provided.

Patients Need Help

The fact is that the majority of patients who come into a medical practice do not quite understand how the healthcare system works in the U.S. They probably don’t know what their own deductible and co-pay will be, and it is likely that they will not expect a bill a few weeks or a month after their appointment.

So rather than taking the time to bill the insurance company, only to be rejected or denied based on a co-pay or deductible issue, the medical EMR billing staff can find out the details before billing.

medical EMR simplicityNaturally, this can be done even without a medical EMR, but to set up a system would be more of a challenge than purchasing it as part of an integrated medical EMR.

In fact, because medical EMRs companies are set up to handle exactly this sort of adjustment to a biller’s workflow, the transition is made smooth and simple.

Improving Outcomes

Additionally, a medical EMR can help improve patient outcomes. It may sound funny to say that a computer program or software will have an effect on how well patients respond to treatment.

But the fact is that with a medical EMR, it is possible to track treatments and outcomes much more closely. Reports can be generated quickly. The results of certain treatments are better than others, and at the practice level it is possible to identify advantageous treatment decisions with a medical EMR.

Health Care Management at Its Best

Health Care Management at Its Best

Producing reports for health care management in order to monitor efficiency of therapists and staff are now possible.

Nitin Chhoda explains how physical therapy EMR changes the productivity and efficiency of physical therapy practice by reviewing the number of patients who have been treated during a certain period of time. 

best health care managementWith an incredible array of technological tools at the ready, there is no reason why health care practice management can’t undergo a renaissance.

In a small practice, the office manager can also serve as patient relations, interpersonal coach, HR manager, and accountant.

But with electronic medical records, the health care manager may become the financial analyst as well. In fact, analyzing efficiency, strengths, and weaknesses of the practice may be the top priority for the health care management field.

How Reporting Improves Efficiency

Both internally and with patients, an EMR can improve efficiency just by virtue of eliminating the majority of paperwork. Communication is streamlined and things like medical billing and coding can be handled more quickly and with fewer mistakes. But for health care management, EMRs are introducing tools that change the way we think about managing a practice.

An EMR with reporting capabilities can tell health care management professionals a lot about how the practice is doing. Outcomes and performance of clinicians and patients can be compared with a few clicks.

In the past, it would have been almost insurmountable to extract data on visits per referral and visits per day for each clinician. With the new practice management technology, those reports can be run quickly and simply.

In fact, there are a whole host of important indicators that are being monitored by the software solutions designed for health care management. Most of these indicators can help office managers to see where the lags in efficiency are hiding.

Inefficiencies degrease profitability, and decreased profitability is bad for everyone. The information gathered can be shared with staff members and solutions can be discussed with health care management.

If used appropriately, technological management tools can help turn a practice that is just getting by into a profitable enterprise. From changing the way that medical billing is handled to using proven techniques to speed up recovery and improve outcomes, health care management tools are going to go a long way towards revolutionizing the business side of medicine.

Educational Experiencehealth care management staff

With an increased emphasis on technology, more and more individuals who want to pursue a career in health care management are going back to school.

The job has no educational requirements, but a bachelor’s degree and even a master’s degree are not uncommon.

There are specific programs now that will education students about the pitfalls and advantages available to adaptable health care management.

As the job market widens, these are the professionals that will be handling health care management jobs. And because the role of health care management professionals is changing so quickly, there is a lot of room for improvement in most health care practices.

The office manager has the job of ensuring that things run smoothly and if there are problems, the office manager needs to work with staff to find solutions. A health care management professional who understands the benefits of current technology will have more tools for finding solutions than ever before.

Medical Billing And Coding Outsourced

Medical Billing And Coding Outsourced

Medical billing and coding are indeed a very complex subject.  It is important to analyze whether your practice will need an in-house medical biller and coder or have it outsourced.

Nitin Chhoda gives some factors to consider in order to guide your physical therapy practice when it comes to your medical billing needs.

medical billing and codingOutsourcing often increases efficiency, especially in technical fields like accounting and medical billing and coding.

Within a single office, a number of practices can be serviced by a handful of highly skilled professional medical billers and coders.

They can focus all of their resources and attention on efficiency and a system that works. At a medical clinic, the primary focus is often the patients, as it should be.

Reasons to Outsource Your Medical Billing and Coding

Here are some very good reasons that a practice should consider outsourcing medical billing and coding. For the most part, the decision will be financial. But to determine whether or not it will be worthwhile for your practice to outsource can be so complex that identifying key reasons to outsource will help.

You’re New

New clinicians or health care providers have a whole host of things to worry about. How do you maintain a steady stream of patients?

Does your practice have the in-house testing capabilities necessary for the needs of the community? How do you balance the business side with patient care? How many hours per day should you be seeing patients?

Probably the top concern is how your patients are doing, how they feel about you, and whether or not you’re helping them. Managing a business at the same time as you’re learning what it means to run a private practice can be overwhelming.

Staff Turnover is High

If you are handling in-house medical billing and coding, but have to hire a new biller or coder regularly, your practice will suffer.

The learning curve for medical billing and coding is unforgiving and even a skilled medical billing and coding professional is going to be slow to start as they figure out your particular system. For practices that can’t seem to keep medical billing and coding staff members, a consistent service from elsewhere will be more efficient.

Inefficiency is Obvious medical billing and coding oursourced

Outsourcing has a couple of major benefits, and one of them is that rejections and denials are usually decreased when you outsource medical billing and coding.

If you are experiencing problems with collections and your rejection and denial rate is high, it may be time to consider giving the job to a service that specializes in getting claims accepted.

You Don’t Want to Focus on Billing

Chances are, you don’t want to think about medical billing and coding. As critical as getting paid is to the health of your practice, if you became a doctor because you want to help people feel better, billing is probably an annoying part of your job.

Not to mention the fact that an incredible amount of tech savvy and skill is required to make your medical billing and coding system efficient and effective. Many clinicians decide that the billing side is the part they don’t want to know about – they’d prefer to let someone else worry about the medical billing and coding courses so they can continue to provide a service to the community.