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.

CPT Codes Defined

CPT Codes Defined

Along with ICD-10 is another term called CPT codes. Nitin Chhoda defines and differentiates these two terms, and explains the impact they will have on the whole physical therapy documentation process.

Practitioners must become familiar with the codes in order to minimize errors upon claim submissions.

CPT codesWhile owners of physical therapy practices are contending with the switch to ICD-10 coding, another term with which clinicians must be familiar with is current procedural terminology (CPT) codes.

CPT Codes

Every procedure, task, service, device and surgery a patient receives is associated with a specific numerical code. Insurance companies utilize CPT codes to determine the amount healthcare providers will be paid and CPT codes must be linked by medical necessity.

The American Medical Association (AMA) develops and copyrights CPT codes. They’re responsible for changing, revising, updating and discarding those that become obsolete as new technology and treatments become available. They encompass thousands of individual codes that are updated annually.

CPT codes, even when used in physical therapy documentation purposes, are uniform and apply to all clients except those with Medicare coverage. Medicare utilizes the Healthcare Common Procedure Coding System (HCPCS) that encompasses three levels of coding.

HCPS Levels

HCPCS Level I is maintained by the AMA and Level II consists of alphanumeric codes. Level III codes were abolished in 2003 and were state-developed for Medicaid and Medicare contractors. Therapists should be aware that the reimbursement amount for each code varies widely among insurers and assigning the correct code to the appropriate treatment is a complex endeavor.

An EMR facilitates the process, but clinic owners will want to ensure their coding and billing expert has the best possible training to manage CPT codes and the upcoming ICD-10 changes, along with a thorough knowledge and understanding of medical terminology. Entering the wrong codes will result in denials and delays in reimbursements.

It’s imperative that physical therapists use the code that most accurately reflects the service or treatment that was provided. It should match the current ICD coding and therapists must provide sufficient documentation to support the CPT code that was entered to avoid denials, audits and requests for more information.

CPT codes definedCPT Codes Standard

CPT codes allow for two-digit modifiers should they be required, but they must conform to standard definitions. Incorrect coding costs valuable clinical time, interrupts cash flow and can delay essential services to clients.

CPT codes provide the means for healthcare providers to communicate effectively with insurance companies about the services, treatments and procedures rendered to any given patient.

Using correct coding is essential if clinicians are to be adequately reimbursed for their expertise and ensures payments reach the clinic in a timely manner.

There is no uniform payment for specific procedures. Each insurance provider has its own fee schedule and reimburses according to the company’s guidelines. Proper coding ensures therapists are reimbursed at the highest possible level.

An EMR provides clinic owners with tools to monitor and track agencies that provide the best reimbursements, allowing them to make informed decisions about the best payers with which to contract.

The use of CPT codes in conjunction with ICD codes directly affects the profitability of practices. It’s a complex system that requires knowledgeable staff, careful attention to detail, and stringent documentation to support every diagnosis, treatment and procedure. An EMR makes the coding and billing process easier, and provides practice owners with the tools to track the best payers for increased revenues.

Healthcare Coding Basics

Healthcare Coding Basics

In the 21st century, paying for visits to healthcare providers is a simple process for patients. They simply present their insurance cards, make a copay and go on their way.

The system can be a nightmare for medical insurance billers (MIBs), who complete hundreds of reimbursement claims each week covering a wide spectrum of treatment. In the following article, Nitin Chhoda examines what MIBs need to know about healthcare coding basics.

healthcare codingMIBs will encounter a multitude of technical terms in healthcare coding that will affect the codes used when preparing a claim for reimbursement.

Billers will need to be fluent in medical terminology and healthcare coding procedures to accurately code claims.

The knowledge enables them to submit claims that are reimbursed quickly, meet the demanding standards required by insurance carriers, and maintain compliance with federal and state standards.

Documentation

Billers will be working with multiple and disparate healthcare coding documentation that provides substantiation to payers that the services, procedures and treatments provided were needful and appropriate to the practitioner’s diagnosis.

Each piece of documentation is the evidence that carriers will utilize for reimbursements and a single omission will result in a denial.

CPT Codes

The acronym CPT stands for current procedural terminology. CPT codes will be used on claims to describe the medical services and procedures provided by the practitioner.

CPT codes must match the services they represent to avoid denials and payment interruptions. This is very important.

ICD-9 Codes

The International Classification of Diseases (ICD) codes will soon be updated to CPT-10 to encompass new diseases and technology.  The alpha-numeric healthcare coding is the primary diagnostic tool used to document and explain the signs, symptoms, illnesses and diseases clinicians will encounter.

The codes provide insurance companies with essential information about a patient’s condition and resulting treatment.

Some billers will encounter alpha-numeric C codes and V codes:

  • C codes are used to identify the external causes of poisonings and injuries.
  • V codes are utilized to categorize factors that have a direct influence on a patient’s health status, along with encounters that aren’t due to an illness or injury.

Modifiers

There are times when a procedure is altered from its original description. Healthcare coding modifiers are used when a procedure requires additional time and expertise, or has extenuating circumstances.

Billers will use the two-digit modifiers in the CPT healthcare coding to report such occurrences. They provide MIBs with the means to bill very specifically and obtain additional revenues to compensate practitioners.

Modifiers are also appropriate when a technical component (TC) is involved.

Sometimes a clinician will need the use of equipment, labor and/or supplies to perform a procedure that is maintained by another specialist or medical facility.

healthcare coding basicsModifiers in healthcare coding are used to explain that those items are billable by entities other than the practitioner.

MIBs will encounter a host of different codes and medical terminology that must be entered on claims accurately to facilitate quick reimbursements and avoid costly denials and delays.

Medical billing staff who are familiar with the healthcare coding basics are well on their way to becoming masters in their profession.

The Typical Insurance Claim Cycle

The Typical Insurance Claim Cycle

The demand for medical insurance billers (MIBs) continues to grow and many individuals are eager to launch a career in the field.

The popularity of medical billing has given rise to a multitude of unfounded claims by scam artists who insist it’s a career path with minimal work and quick rewards. In this informative article, Nitin Chhoda explores the claim cycle and the MIB’s responsibilities.

claim cycleThe insurance claim cycle is the process of billing a third party entity that pays for the medical care of one of its subscribers.

The claim cycle begins the moment a patient makes an appointment with a provider and doesn’t end until the full amount has been deposited in the practitioner’s bank account.

Patient Paperwork

Medical histories, questionnaires and other forms impart necessary data about the patient’s past and current ailments, complaints, procedures and treatments.

A release of information is required so MIBs can file a claim and obtain payment from the patient’s healthcare insurance carrier. During the claim cycle, a release is critical, as MIBs can’t share the needed information with an insurance company without the patient’s permission.

Essential paperwork also includes a copy of the patient’s photo identification and their insurance card. Health insurance fraud is a very real crime for which MIBs must be wary. The insurance card contains information on who is eligible for services, along with exclusions, restrictions, limitations and prerequisites that must be met for payments to be dispersed.

Patients may also have coverage under multiple policies. Each insurance plan will have established deductibles and co-pays that constitute the patient’s portion of the final bill. Make sure that these are all reviewed during the claim cycle process. Always attempt to collect these fees before the patient sees the provider, or have the patient make alternative arrangements for paying.

Computing Power

All of the data must be entered into the MIBs billing software program or electronic medical records (EMRs) system where it can be accessed and retrieved for transmitting, tracking and monitoring reimbursement claims. Care must always be exercised in the claim cycle process to ensure the information is entered correctly to avoid delays and denials.

EMR technology is especially helpful, as it can identify users of potential claim problems.

A patient encounter form must be created and the appropriate ICD and CPT codes entered to substantiate the provider’s diagnosis and subsequent treatment. Any referrals, diagnostic tests and pre-authorizations must be documented, along with follow up visits if needed. The claim cycle process contains a full accounting of medical fees which must be entered and a claim form is always created that will be transmitted electronically to a clearinghouse.

Claims and Follow Ups

Once the claim arrives at the clearinghouse, MIBs will receive electronic verification. Clean claims that are free of errors are forwarded to the payer for remittance. Those with problems will be denied and returned. Clearinghouses and insurance companies are experts at finding even the smallest reason to justify delaying payments. So the billers must not end the claim cycle when they submitted the claims but rather when every claim has been reviewed and accounted for.

Once the claim is approved, it’s the task of the MIB to track the payment, see it securely deposited at the clinician’s chosen banking institution and recorded in the patient’s account.

claims cycle process

Overdue payments must be investigated and appealed when appropriate. Billers will need to contact patients about any outstanding balance, be prepared to send unpaid accounts to collections, or write it off as a loss at the provider’s discretion.

The insurance claim cycle is completed when each portion of the payment is collected from the insurance carrier and the patient.

With EMR technology, receiving remittance from commercial payers can take as little as 10 days, and 30 days for government operated plans. MIBs are a crucial element in the claim cycle process, working to ensure that the practices of their clients receive the funds to which they’re entitled.

Electronic Medical Records and Its Role in Patient Billing

Electronic Medical Records and Its Role in Patient Billing

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. Nitin Chhoda discusses how electronic medical records system (EMRs) simplifies billing for both physical therapists and patients in a variety of ways.

electronic medical recordsPatient income has long been the lifeblood of medical providers.  Effective physical therapy billing is a highly necessary procedure for physical therapists in particular, as some patients may have sessions last over a period of several months.

Versatile Billing

Electronic medical records allow patients to make payments on their own time with a push of a button. Today’s consumers are used to online billing for various services.

However, some medical providers still insist on paper bills. Online billing through an electronic medical records system allows patients to make either one-time payments, ongoing payments, and sometimes participate in automatic billing via credit or debit card.

EMRs make it easier for both patient and physical therapist.  If a physical therapist would like to move into online billing, electronic medical records system is a logical step.

Instant Transactions

Prior to online billing, physical therapist billing used to involve mailed checks or credit card payments taken over the phone. Both of these practices took office assistants’ time to manage billing, and involved a lot of upkeep.

However, with electronic medical records, physical therapists can receive their funding in as little as 48 hours.  Consumers are also able to pay on a variety of devices, such as phone or tablet, without waiting for a paper bill. Providers can increase their income by 23% by adding the ability to receive credit card payments, and EMRs provides that opportunity.

Electronic medical records represent a new wave in improved patient care and physical therapist billing.  electronic medical records

Physical therapists who are looking to streamline their practice in income and medical records should consider using EMRs.

As one of the facets of the changing face of healthcare, electronic medical records are an essential tool for the survival of a physical therapist office.

CPT Codes — from the Medical Coder Perspective

CPT Codes — from the Medical Coder Perspective

Nitin Chhoda explains how medical billing and coding can be simplified with an integrated electronic medical records and billing system. The importance of communicating with patients and elaborating costs and financial responsibilities is also discussed.

CPT codesCPT codes are pretty complex to use if you are unfamiliar with the process.

However, because they are so widely used, there have been many improvements in the way that medical coders and billers can access the codes they need.

Especially in an increasingly electronic age, CPT codes are only getting easier to use. Coding speed and accuracy can be increased with special physical therapy software that allows you to search for the right CPT codes quickly.

The most common reasons that insurance claims are rejected or denied have to do with incorrect coding or policy non-compliance. And every claim that has to be re-done makes the medical coding in your office slower and more costly.

With the Internet and software prices going down, these problems are being reduced for medical coding professionals and for the clinics that they work for. The high-end EMR solutions also include coding databases and can help improve efficiency and accuracy.

In order to draw more clients to use EMRs, software developers are learning to provide just what clinics and clinicians need from a complete electronic system.

Not Just CPT Codes – All Medical Coding

And of course, CPT codes are just one aspect of the job of a medical coder. CPT codes for Medicare are the same as certain HCPCS codes. Not every clinic will use all CPT codes, but only a certain sub-set. CPT codes list are only good if they are combined with the appropriate ICD codes when submitted with claims.

These kinds of important requirements keep medical coding staff very busy, which is one reason why many practices prefer to hire certified medical coders.

Communication with Patients

Another important way that CPT codes are used is in communication with patients. After a claim is filed and the insurance company responds with the amount they are covering, if there is any leftover amount it is up to the medical biller to bill the patient.

Patients usually find the medical billing paperwork to be confusing and overwhelming, especially patients who have recently undergone a medical procedure or have been diagnosed with a serious disease or condition.

CPT codesMedical billing staff have to be able to communicate why certain CPT codes are used, why the insurance company did not cover the entire cost, and what the patient is responsible for paying.

Determining Future Costs

It can also be helpful if patients get an explanation about what future costs to expect due to discrepancies between the amount the insurance company will cover and the amount the patient has to pay.

CPT codes dictate how much a patient will be charged as well as how much the insurance company will pay.

The hope is that with a reasonable agreement between the health care provider and the insurance company, the patient will not be responsible for partial payments all the time. CPT codes can be used to ensure that pricing is consistent with the expected reimbursements from insurance companies as well as programs like Medicare and Medicaid.