Many rehab therapists believe that once they are in-network with an insurance panel, they are an in-network with the insurance indefinitely. This is just one of the common misconceptions of credentialing. The truth is, group and individual providers need to complete recredentialing applications periodically to remain in-network. Let’s take a closer look at recredentialing to avoid unexpected contract termination.
When a healthcare provider gets married and takes their spouses last name, they will update their driver's license, bank accounts, car insurance, etc. With so many crucial areas that need updating, providers might forget to notify the insurance carriers in which their employer participates. Providers must update their professional license and national provider identifier (NPI) with this change, as well as the individual insurance companies.
The Centers for Medicare and Medicaid Services (CMS) implemented new modifiers that could impact your practice, these are the CQ and CO modifiers. If your practice utilizes physical therapy assistants and/or occupational therapy assistants, you will need to know when and how to apply the CQ and/or CO modifier.
Right off the bat, I have to say this is a subject that I get very passionate about. When I do assessments, I always address the cancellation/no show issue. I tracked my last 50 client’s responses as to whether they charge for cancels and/or no shows and went from there. Here is what I found:
To protect Medicare patients from identify theft and illegal use of Medicare benefits, Medicare has replaced the Health Insurance Claim Number (HICN) with Medicare Beneficiary Identifiers (MBI). HICNs were based on member’s SSNs while MBIs are unique and randomly generated.
The new year is a great opportunity to set standards in your practice to ensure profitability and efficiency. Now is the time to meet with your administrative team to assess how they are performing and set expectations for 2020. Don’t know the right questions to ask? Don’t sweat it! We’ve outlined the 5 questions to ask yourself and your team:
Therapists put in years to fulfill the educational courses to become a therapist. It is an awesome field to be in. Just one thing about the education, the curriculum does not typically include classes on important administrative issues that are vital to a therapists starting their professional career. Once they take and pass the exam to become a licensed therapist the search for employment begins.
What is a closed panel?To see a patient who wants to use their "in-network" benefits, you will need to be an “in-network provider”. This means that you have been credentialed and contracted with the patient's insurance company. When an insurance company feels that they have reached the adequate number of providers for a specialty in the area, they will close that panel and no longer issue contracts for new providers/groups. This can be extremely frustrating for a new business owner.
During our Administrative Power Center (APC) training sessions with rehab private practice owners and their front desk staff I always ask, “How do you answer the phone?”
Surprisingly, I have never had an entire staff, in one or multiple sites, all say the same thing. ‘Hello, thank you for calling APC Physical Therapy how can I help you?’ ; or ‘APC can I help you?’ ; how about – ‘APC Physical Therapy hold please.’; or ‘Hi, APC Physical Therapy, we are happy you called, this is Diane, how can I help you today?’; or how about, ‘APC Physical Therapy, if you want to schedule an appointment press 1, if you want to speak to a therapist press 2, if you want to discuss your bill press 3…’
Short, long, name, no name or a recording – what do you want every caller to hear every time they call your office?
Topics: Front Desk