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The 5 Most Important Questions to Ask When Checking Benefits

Posted by Daniel Ramsey on Nov 26, 2018 8:40:42 AM

Checking your patient's insurance benefits BEFORE the patient is seen should be a fundamental part of your practice's administrative process. Otherwise, you run the risk of claims being denied and left unpaid. You don't always have the right to appeal or bill your patient which is why it is so important to know the patient's insurance benefits before treatment begins.

When checking benefits, be sure to ask the right questions. Here at Account Matters, we had our administrative experts come up with the top 5 questions you should be asking every time. We highly recommend sharing this information with your front desk staff to ensure they are receiving the most accurate information possible.

Let's jump right in to the 5 most important questions:  

1. "What is the patient's financial responsibility?"

Informing the patient of any co-pays, deductibles or co-insurance upfront will guarantee a better patient experience. Not only will the patient know what is expected from them financially, your front desk staff will also feel more confident when asking for payment at time of service.  This decreases the chance of a nagging patient balance and can reduce the number of patient statements that you need to send each month.

Routinely checking benefits can also reduce the amount of refunds to the patient or insurance company due to over-payments. 

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Topics: Front Desk

10 Steps to Assess Your Physical Therapy Practice

Posted by Diane McCutcheon on Aug 22, 2018 9:42:29 AM

I have assessed hundreds of Physical Therapy private practices in my career and I could tell you hundreds of different stories but instead, I am going to tell you about some of the most common stories I hear in just about every practice I have been in. 

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Topics: Billing, Front Desk, Management

3 Questions for your Biller

Posted by Stacey Fitzsimmons on Aug 9, 2018 3:21:14 PM

Whether you outsource your billing or have a biller in your office you should be able to ask questions that keep you in control of your company at all times.  I have been in this business for years have heard many excuses about not being able to get what you are looking for out of your system and most of them are just simply not true. 

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Topics: Billing

Handwritten Notes vs. Electronic Documentation

Posted by Daniel Ramsey on Jul 18, 2018 10:09:54 AM

Welcome everyone to the first installment of Account Matter’s Tournament of Champions! During the month of March, we will be comparing old school and new school methods of PT, OT, and SLP billing.

To start us off, this week’s competitors will be Handwritten Notes vs. Electronic Medical Records (EMR) followed by Printed Claims vs. Clearinghouses.  Will the old tried and true methods stand the test of time, or will technology reign supreme? Let’s find out:

Handwritten Notes vs. Electronic Medical Records (EMR)

Handwritten Notes- For therapists who have been practicing for over ten or fifteen years, handwritten documentation was your only option, it’s just the way it was.  Once someone gets into a routine, it can be hard to make a change, especially with the learning curve of technology.  Handwriting documentation is time consuming, the documentation is sometimes illegible, and more often than not, the documentation is not compliant.  By staying old school, you also must have enough space to store the paper charts.

Electronic Medical Records- EMR’s make tracking data over time easier and much more organized.  EMR’s make documentation faster; saving your therapists time and saving you money.  EMR’s also come with daily note templates and customizable templates that, when filled out correctly, are 100% compliant.  EMR’s can be e-faxed or emailed which makes them more convenient and cost-effective compared to paper notes which require faxing or mailing.  By switching to an EMR you will save on office supplies and free up some of that storage space.

Results: When comparing old school handwritten paper notes vs using new school technology like an EMR, the clear choice is new school. Technology, like the EMR, has been designed to make processes easier, faster, and more compliant. Although some workers compensation and auto claims must be submitted on paper, many can now be sent electronic with electronic documentation and be accepted.  Eventually all notes will be submitted electronically with those claims.  We believe electronic notes will be mandatory by all insurances within the next few years.

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Topics: Billing

Data Entry and Clean Claims

Posted by Stacey Fitzsimmons on Jul 18, 2018 9:51:43 AM

As a billing company we estimate that at least 80% of the denials we see can be traced back to data entry/accuracy errors.  These errors occur on all types of insurance claims. 

Here are some examples:

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Topics: Front Desk, Billing

5 Rules for Getting Paid

Posted by Diane McCutcheon on Jul 18, 2018 9:43:29 AM

The process of taking a new patient, providing services and getting paid sounds so simple.  I mean, why shouldn’t it be?  Why is such a simple concept so complex? It all comes down to understanding the rules and regulations of each insurance carrier, knowing how to comply and implementing operational systems that will support your ultimate goal - getting paid from insurance and patients.   

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Topics: Billing, Front Desk

What is a Clearinghouse?

Posted by Stacey Fitzsimmons on Jul 18, 2018 9:30:43 AM

Many providers do not know what a clearinghouse is or how it works.   Here is a breakdown of what a clearinghouse is and how it plays a major part in the billing process.

In medical billing, companies that function as intermediaries who forward claim information from healthcare providers to insurance payers are known as clearinghouses. In what is called claims scrubbing, clearinghouses check the claim for errors and verify that it is compatible with the payer software.  So, in other words a clearinghouse serves as a middleman; for your claims to get sent from the billing software to the insurance companies electronically.

Once the insurance company has received the claim from the clearinghouse they can process the claim.  The claim will either process for payment or process denied for any number of reasons.    

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Topics: Billing

Are You Submitting the Patient Summary Form?

Posted by Stacey Fitzsimmons on Jul 18, 2018 9:19:03 AM
There is growing proof that medical providers are not up to date on why and when they should submit the mandatory Optum/United Healthcare  Patient Summary Form .  Here at Account Matters we are hearing first hand from clinics who are being denied payment because they are failing to submit this mandatory paperwork with UHC when required. 

Here is what you need to know:

The  Patient Summary Form  was created for certain UHC plans to provide the insurance company with an explanation for the patient’s visit and confirm the need for treatment.  The Patient Summary Form must be submitted via fax or on-line and the timely filing deadline for providing this documentation is  10  days from the date of service.

Failure to timely submit the  Patient Summary Form  will result in loss of payment.  If the claim is denied, an appeal may be filed but payment will only be received from UHC if you provide an “acceptable” explanation; leaving the chances of payment solely up to UHC’s discretion. 

There are two options you can use to determine if the patient has a plan with benefits that require a Patient Summary Form.  You can either call Optum Health Care Solutions at 1-888-329-5182 or log onto  www.myoptumhealthphysicalhealth.com  and use the “quick group check” utility located in the "Tools and Resources" section.

It doesn’t take long to check and submitting the form in a timely manner will ensure payment and eliminate the hassle of having to file an appeal.  We hope this helps you “ Get Paid Right the First Time ”.

If you have a billing problem you need solved, let us know at 508-422-0233.  We can help!
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Topics: Billing

3 Reasons Why Billing Staff Relies On Accurate Information from the Front Desk

Posted by Diane McCutcheon on Jul 18, 2018 9:08:44 AM
The front desk is a biller’s biggest asset when it comes to getting paid for all the hard work you put in with your patients. Understanding this relationship and how these two roles work with one another is crucial for a successful practice.  

There are many things a front desk must do before the patient’s information gets to the biller. This includes providing benefit checks, entering patient demographics and managing referrals and authorizations. If any of these essential functions are not done accurately and timely, major problems will arise when it comes time for the biller to submit claims and get paid right the first time.

Benefit Checks

The front desk must check each patient’s insurance benefits before their first visit.  We also HIGHLY recommend that your front desk encourage the patient to check their benefits as well.  This helps to avoid getting conflicting information. If there is an issue, it can be addressed immediately.

There are many easy ways to get this job done fast and correctly.  In most cases you can go through the insurance portal or clearing house but there will be times when you just have to pick up the phone and call.

We have seen many denials that could have been avoided if a benefit check had been done.  For example, some of these denials might include patient’s insurance was terminated, the therapist is not in network with patients carrier and the patient has no out of network benefits.   If treatment begins before these issues are addressed, there is a good chance that the biller will not be able to send a successful claim and get payment for that visit. 

Entering Patient Demographics

Over 92% of denials come from data-entry errors made by front desk staff. Accuracy should be the #1 goal when it comes to entering patient demographics. This includes the patient’s name, their date of birth, and their member ID. The front desk may not notice their errors but when it comes time to bill the insurance, it’s the biller who will get a denial and have to correct the mistake and rebill. This process can be time consuming, and as we all know time= money.

A good way to let the front desk know of errors they may be making is to have the biller bring all data entry errors to the person entering data so they can be more aware of where they need to pay attention.

Referrals and Authorization

Referral and authorization management is something many front desk staff handles. The front desk must pay close attention to the insurance guidelines if a referral or authorization is required before treatment. You must have the authorization/referral in-hand when the patient comes in for the first visit or the claim will deny. 

Some carriers require authorization after the evaluation has been completed.  They need the evaluation and the appropriate form completed in order to approve more visits.  And just as important as getting what you need before the patient is seen is to make sure that if the referral or authorization is expiring and the therapist wants to continue seeing the patient, they must get that paperwork in-hand before the patient continues or again, the biller will bill the visit and get a denial for no referral or authorization on file. 

Keeping track of patient’s referral and authorization expirations can be made very easy if you use the tools provided in the billing software to manage them.  There are reports that will give you the patients name, number of visits approved, used and the expiration date. Run these reports frequently and make sure you always have the appropriate approvals to avoid denials.

If you want run a seamless operation, strong communication between the front desk and the biller is key. The biller must feel comfortable bringing up these issues to the front desk and the front desk staff must have a clear understanding of what they must do before the patient is seen for treatment. If you are unsure if your front desk staff, biller, therapists, or office managers are aware of these crucial processes, you should invest in training from experts.

At DMBMCSI, our patented Administrative Power Center (APC) teaches your staff “The Proven Process for Getting Paid Right the First Time” by illustrating how these roles work together starting with the patient’s first phone call to the clinic. To learn more about our APC training and how it has improved the productivity of PT, OT, and SLP clinics all around the US, visit our website.
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Topics: Front Desk, Billing

7 Must Do's When Changing or Adding an Address

Posted by Diane McCutcheon on Jul 18, 2018 8:51:47 AM

Over the years, many of my clients have been practically shut down all because they did not change the business address when they moved or added a location.  There is a lot of stress when moving but not changing the business address can directly affect your revenue stream. 

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Topics: Credentialing, Billing

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