The Ins and Outs of Your Clearinghouse

The Ins and Outs of Your Clearinghouse

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.

clearinghouseBefore 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.

Matching Identification

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 - in and out

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.

Claim Appeals 101

Claim Appeals 101

Reimbursement claims can be denied at any time and for any number of reasons. Most problems can be remedied easily, but when talking fails to facilitate a desirable outcome it may be necessary to file an appeal. In this revealing article, Nitin Chhoda addresses the basics of filing an appeal.

clearinghouseMost appeals in the billing process, physical therapy billing included. will involve commercial insurance companies.

How a clinician approaches an appeal has a huge impact on how quickly and smoothly the process is concluded.

Unfortunately, the onus is on the practitioner to prove why a claim wasn’t processed properly for payment. That requires knowledge of the payer and the terms of the contract that was signed with the insurance provider.

Provider Relations

Many contracts include a prompt pay clause that can cost the payer fees and interest on late payments if they didn’t file or process the claim according to the terms of the contract. The first point of contact when filing an appeal will usually be provider relations to ascertain if the claim was received and how it was processed.

A phone call can be all that’s needed to quickly remedy the situation. Some payers provide online reconsideration forms that can be submitted, while others require a formal written appeal. It’s critical to maintain complete documentation of all verbal and written communication associated with the appeals process.

Provider Representative

If the claim wasn’t processed due to the contract loading incorrectly in the payer’s software system, the next step is to speak with the provider representative. This individual is charged with ensuring the contract between the medical provider and payer is correct and loaded in the claims processing software system.

Expect to be vetted and answer specific questions about the claim. The provider representative may be able to locate the problem and solve it.

Representatives also have the power to send the claim back to the payer for reprocessing.

Written Appeals

If a phone call fails to resolve the issue, a written appeal must be submitted. It should include all the pertinent information about the claim and clearly state the expected outcome for settlement. Explain why the actions are being sought and further steps that will be taken, such as referring the matter to the practice’s attorney.

Exercise Control

Appealing a claim rejection is time consuming and frustrating. It’s critical to exercise control and professionalism at all times. claim submission

The appeals process relies on facts for resolution and it’s important to clearly state the problem and the payment expected. Refer to specific clauses in the contract to prove points.

A denied or rejected claim delays payment and appealing the decision can require considerable time and effort.

The process is sometimes necessary to collect the fees to which clinicians are entitled and it’s important to keep a cool head throughout the process.

Most disputes with commercial payers can be solved if practitioners approach the situation armed with the facts and the terms of the payer contract.

Medical Billing Company Is Easier With an EMR

Medical Billing Company Is Easier With an EMR

To make your EMR more convenient, integrating it with a medical billing company is a good option.  NItin Chhoda explains why connecting your EMR system to a medical billing company software will make it easier to use.

medical billing company EMRThere are many advantages of electronic medical records and one of the most often emphasized is the advantage for medical billing staff.

Everyone else in the office can be a bit faster and more efficient, and the medical biller can process information much more smoothly.

But having an EMR isn’t just for those medical practices that do their own billing. Even if you hire a medical billing company, having an EMR will have distinct advantages over processing billing any other way.

Information Integration

The only challenge of hiring a medical billing company is deciding how the critical notes and information will be transferred from your practice to the medical billing company.

The billers will need a lot of information from your practice, and to ensure that information is accurate, you will need to integrate your information systems. It’s possible that this will not be an issue if you have a high quality EMR that records all of your information already.

Make It Digital

If clinicians are recording their appointments and notes using digital media, then the first step is already taken care of. The only question will be how to transfer the information from your practice’s EMR to the medical billing company.

Most medical billing companies will have experience with a number of EMR systems and with figuring out a transfer system. If you hire an independent contractor to handle your medical billing, rather than a medical billing company, they may be willing to adopt your software, making the process incredibly simple. And of course, if your EMR is online, then all the biller will need is access to the site.

Software Developed by Medical Billing Companies

There are also a number of medical billing companies that have decided to design their own medical billing software. This has distinct advantages for the medical billing company.

They can customize the software to suit their needs and preferences. Customized software can be a bit harder to get used to, but in the end it should work better than any other solution on the market because it will be designed with very specific needs in mind.

It’s possible that your practice will need to integrate your system with the custom system that the medical billing company is running.

medical billing companyIntegrated Solutions

Usually, they will have the solution already, offering a satellite feature of the software that can be used in your office. If their software solution is integrated with the Internet, you may be able to access it online.

No matter what you end up doing, having an EMR ready in place will allow you to transfer information quickly and efficiently.

In fact, when choosing a medical EMR, consider the reporting capabilities and features that will allow you to work with a medical billing company. There are plenty of EMR solutions out there that are designed to make medical billing easy, whether you do the medical billing in-house or you hire the work out to a medical billing company.

Physical Therapy Software: Relationship Between EMR, Clearing Houses, Payers and Your Wallet

Physical Therapy Software: Relationship Between EMR, Clearing Houses, Payers and Your Wallet

The major roles of EMR, clearing houses, and billing are very important because the flow of the business depends on it.  Nitin Chhoda explains these relationships and the impact it has on your practice’ income.

physical therapy software Reimbursements from private insurance, Medicare, Medicaid and Workers’ Compensation are the primary sources from which physical therapists collect revenues.

Those income sources pay the bills and salaries, fund expansion and equipment.

In an age where payments are being limited, capped and questioned, physical therapy software EMR offers assistance in locating the best payers that directly affects a practice’s profit margin.

An EMR offers online submissions for quicker turnarounds on payments, along with billing and coding options for greater flexibility. Physical therapy software also provides the means to identify the best payers.

Contracts with Payers

Therapists may have negotiated contracts with primary payers, but that doesn’t mean the dollars are going to start rolling in. Preferred provider organizations (PPOs) often sell their contracts to third party administrators (TPA) or another PPO that reimburses at a lower rate.

Selling contracts to other providers is a common practice, but most probably the one that’s financially disastrous for clinics. EMRs offer physical therapy software analytic tools that can be used to track payments from a wide range of third-party payers.

Therapists can ascertain which organizations pay the highest reimbursement rates and those that don’t limit or cap payments or services. EMRs offer physical therapy software billing and coding options to ensure practice owners are receiving the highest level of compensation for their services.

The Role of Physical Therapy Software

physical therapy software relationshipsPhysical therapy software provides the means for therapists to compare and contrast the financial benefits of working with specific third-party payers.

The current trend in healthcare is toward cost reduction, which directly affects access to established and potential patients.

Cost reduction is beneficial for insurance companies, but the plan doesn’t provide adequate reimbursements for clinic owners and their services. EMRs offer therapists physical therapy software options that help grow their practice.

Any therapist operating their own practice will soon learn about clearinghouses and the role they play in keeping their clinic funded. Millions of claims are filed with carriers each day, all of which would be traveling by mail to the four corners of the earth.

Clearinghouses and More

Clearinghouses were established to facilitate claims processing, resolve reimbursement issues and address physical therapy software errors. An EMR sends a therapist’s claims to clearinghouses electronically where they’re received almost immediately and checked for errors, before making their way to the specified payer.

The entire process can be accomplished in a matter of hours, compared to traditional mail that could take days to reach its destination. With the assistance of an EMR, questions can be answered, errors addressed, and corrections can be accomplished in the blink of an eye for a quicker turnaround on reimbursements.

Before the advent of physical therapy software EMRs, it could take weeks or even months of paper-based communications to clear a claim question and deposit the funds in a clinic’s account.

Physical therapy software provides the means to submit claims and obtain reimbursements quicker, offering better cash flow for any clinic.

An EMR saves long, tedious hours of phone time with individual insurance providers clarifying claims, allowing therapists to spend more time treating patients and less time waiting for reimbursements. They also contain the essential components needed for compliant physical therapy documentation to protect practice owners from a variety of legal ills.

Physical Therapy Billing: On-Site Patient Credit Card Processing

Physical Therapy Billing: On-Site Patient Credit Card Processing

The ability to accept credit or debit cards as a form of payment for physical therapy services rendered can boost practice revenue.

Presenting patients with simple, convenient ways to make payments and recurring payments if necessary is a way for a practice to minimize accounts receivables and increase cashflow, according to Nitin Chhoda

physical therapy billing process

Credit and debit cards represent one of the most convenient and easy way for patients to pay their bills, while providing practices with a point-of-purchase solution to collect funds before the client exits the clinic.

Physical therapy billing allows patients to make one time and recurring payments at the office and online to boost revenues. Patients are much more likely to relinquish co-pays and fund their healthcare costs if all they must do is provide their credit or debit card information.

Ease of Access

Convenience is the keyword for the 21st century clinic. Today’s population is busy and mobile, with little time left after meeting, work, and family obligations. Few clients carry cash with them nowadays, but virtually everyone has a credit, debit or pre-paid card.

It’s a trend that therapists can utilize to their physical therapy billing advantage. For those who want to move into the electronic age of physical therapy billing,coding and collections, an EMR is the first step. Financial institutions have offered online payment options as a courtesy for their members for years.

EMRs provide the same service through patient portals where clients can make a one-time or recurring payment without the need to enter extensive billing information.

Payments Made Simple With the Help of EMR

EMRs allow patients to make physical therapy billing payments from home or from their mobile devices, and funds can be transferred into the clinic’s account in as little as 48 hours. Practice owners can offer a variety of incentives to patients who pay with their cards, from special discounts to membership programs.

Many credit card issuers offer their own incentives, and when combined with offers from a practice, it provides additional motivation to pay early and often. physical therapy billing patient cardA physical therapy practice is a business and clinic owners must look at every available avenue to collect for their services.

Therapists can immediately determine if funds from physical therapy billing are available so as to initiate a transfer if payments are made at the office.

An EMR with a patient portal allows individuals to pay their bills and manage their financial obligations to the practice more effectively.

The ability to accept credit and debit cards can increase revenue by as much as 23 percent. Instead of waiting up to 90 days for a check to clear, funds can be deposited directly into the clinic’s account for better cash flow. Credit card processing becomes an automatic physical therapy billing process for savings in time and effort.

The Convenience of Using Credit Card 

Accepting credit cards via an EMR is an environmentally desirable solution that saves natural resources and cuts costs for practices. The ability to accept credit cards provides a speedy, flexible and convenient means of delivering a superior level of customer service.

Clinics also gain credibility from established and potential patients. Therapists utilizing physical therapy billing software contained within an EMR are perceived as the most modern and desired therapists. An EMR with physical therapy billing capabilities provides convenience for patients and increased cash flow for clinics.

Credit and debit card processing for one time and recurring payments enables practices to collect quickly for their physical therapy billing services and are perceived better by patients, leading to clients who enthusiastically recommend the practice to family, friends and co-workers. Combined with real time, automatic claim submissions, therapists can significantly boost their cash flow, even in a vexing economic climate.

Physical Therapy Billing: Real Time, Automatic Claim Submission to Boost Cash Flow Reiterated

Physical Therapy Billing: Real Time, Automatic Claim Submission to Boost Cash Flow Reiterated

Paper-based physical therapy billing not only consumes a lot of time but is also prone to claim submission errors that will affect the practice’s revenue.

Nitin Chhoda shares how an integrated physical therapy EMR can produced automated claim submissions and boost cash flow for your business.

physical therapy billingA steady cash flow is a primary concern for any physical therapy practice and it’s one of the most difficult aspects for clinic owners to predict.

Coding errors, claim denials and time spent exchanging correspondence via the postal service reduce the turnaround time on physical therapy billing reimbursements and can quickly place a clinic in the red.

Billing with EMR

The future for physical therapy practices of all sizes is good physical therapy billing through the utilization of an EMR.

They offer superior coding options to reduce denials and errors, while providing paperless electronic claim submissions that reach their destination almost instantly.

Submissions can be transmitted individually as clients are seen or set for a batch submission at the end of the day.

One of the biggest problems facing practices is the need for proper coding and documentation in the claims process to ensure clinics receive the reimbursements to which they’re entitled. Information management is a hallmark of automatic claim submissions, providing crucial physical therapy billing and documentation to facilitate and accelerate the reimbursement process.

Paper Submissions are Reduced

Electronic submissions reduce the need for paper physical therapy billing and invoicing for significant savings and can reduce associated costs by up to 15 percent over traditional methods. Electronic submissions are environmentally friendly, highly efficient and enable therapists to collect for their services in hours instead of weeks.

Funds are automatically deposited in the practice’s account. Coding errors are the bane of a physical therapy clinic and electronic claim submissions offers a wide variety of options to accommodate physical therapy billing by the session, services rendered or treatment setting.

Electronic claim submissions via EMRs are secure and HIPAA-compliant. Claims can be sent virtually to any agency or payer with which therapists work, from private insurance, Workers’ Compensation and TRICARE for veterans to Medicare, Medicaid and clearinghouses.

Software for Physical Therapy Billing

physical therapy billing claims submissionPhysical therapy billing software can virtually eliminate coding errors and drastically reduces the number of denials, post-payment audits and requests for clarification.

When an instance does occur, disputes can be handled quickly and efficiently through electronic methods.

EMR documentation software provides a clear record of the patient’s visit so therapists don’t inadvertently submit claims that contradict coding and billing rules or lack specific billing codes.

Electronic claim submission capabilities allow clinic owners to file for reimbursement from any location with Internet access. The system enables payers to deliver crucial correspondence and responses through the same claim submission system.

Automated Physical Therapy Billing

An automatic physical therapy billing record is created of what was filed and when, along with the current status of the claim. Ceilings on payments and reduced benefits for employee insurance programs are costing practices dearly.

Physical therapy billing software enables clinic staff to verify a patient’s insurance eligibility and range of coverage before they arrive at the office. Therapists can utilize that information to develop a treatment plan that falls within the constraints of the client’s available coverage.

Automatic claim submissions provide enhanced coding options to boost reimbursement levels. Submissions can be set to send individually, or as a batch at the end of the day for added convenience.

Physical therapy billing allows therapists to receive payments in hours or a matter of days instead of weeks for better overall cash flow. Superior speed and documentation significantly reduces errors, denials and audits, while placing more cash in clinic coffers where it can do the most good for the practice and patients.