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.
Many healthcare providers are unfamiliar with the credentialing process because they worked in a setting in which it wasn’t required, or their employer handled their enrollment. So, it only makes sense that providers can be intimidated by the amount of work that goes into credentialing when they attempt it for their own practice. We have outlined four ways to streamline credentialing so you can start treating patients as soon as possible.
Rehab billing is difficult to say the least. There are several pitfalls that you need to watch out for in order to “get paid right the first time”. Here are the top 7 most common mistakes you may be making:
There are many important decisions to make when starting a PT, OT, or SLP private practice. One crucial decision is whether to be in or out-of-network with insurance plans offered to members in the practicing area.
According to a survey conducted by GoBankingRates, 27% of respondents plan to use their 2019 tax returns toward their debt. Our experience as a billing company has proven that tax season is a great opportunity to collect overdue patient balances. While it is recommended to collect all money at the time services are rendered, we realize that isn’t always possible. Use the following 5 tips to increase your patient collections.
These tips will help you, your front desk, and billing department by ensuring the most accurate information is in your system
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.
Topics: Front Desk
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.
Getting your providers or group credentialed and contracted may sound straight-forward but often times it can be anything but. Problems can arise at any point during the credentialing process and if you aren't quick to find the solution, you could find yourself starting from square one.
Let's take a look at some examples of credentialing issues from the beginning to the end of the process so you can learn from other's mistakes.
Jack has experienced a lot of success as a sole proprietor of his business. Jack has had so much success that he is thinking of opening a new location and hiring new therapists. He stops by Diane’s office to discuss the credentialing for his new practice. Jack sits down across from Diane and says, “So I am really excited about this new location, we are signing the lease this week. Hoping to start in about a month.”
Right out of the gate, Diane has some questions for Jack to make sure he is prepared for all the credentialing speed bumps that could come up. “That’s great Jack. Have you gotten your type 2 NPI yet?” Diane asks, the second the question is asked Diane can tell that Jack has become unsure of himself. “A type 2 NPI? No, I don’t think I have one of those” Jack said.
“No problem, you can apply for one online, and they’ll email you one within ten days. But you will need a type 2 NPI in order to credentialing your business as a group provider,” Diane explains to Jack. They then visit the NPPES website and apply for Jack’s type 2 NPI.
Later that week, Diane receives a call from Jack, “I received my type 2 NPI for the business, thanks for letting me know I needed that. Anything else I’ll need before I can begin the credentialing process?” She then goes on to inform him of all of the different things that will need to be in place so his credentialing can go smoothly. Jack couldn’t believe that so many other things had to be in order before he could enroll with different insurances, but he was glad he had a resource to make the process easier.
Penny is the owner of her own physical therapy private practice, and has worked there for over 10 years. Penny wants to start seeing less patients so she can spend more time managing her staff. Her current administrative employee is on vacation for the week so Penny takes it upon herself to make some follow up calls on the credentialing for her newest therapist.
Penny starts by calling Blue Cross Blue Shield, “Good morning, I am looking to get the status of an application that was submitted for a new provider.” She then goes on to give them all of her identifying information, but is surprised when the representative says, “I’m sorry ma’am, that application has been rejected because we requested a copy of the provider’s liability insurance and it was not sent within 30 days.” Penny hangs up and becomes frustrated, now her new employee must wait even longer to start treating Blue Cross Blue Shield patients. When Penny checks the admin email account, she sees there are multiple unread emails from insurance agencies requesting provider information.
When Penny’s admin employee returns from her vacation Penny asks her why these emails were not addressed. The admin employee explains, “With the scheduling of patients, calling on authorization/referrals, and all of the other daily tasks I have, it’s difficult to make time to follow up with the credentialing.” Penny then explains to the employee how important provider credentialing is to getting paid for services provided. While the employee promises to make credentialing more of a priority in her day, Penny’s new therapist still has to wait an extra 60-90 days for the new application to get submitted and approved.
Brittany was extremely prepared when she opened her business, she was organized and thorough. She did all her credentialing herself which was a point of pride for her. Brittany began seeing patients and her billing company began submitting claims. Her billing company explains that the claims are getting rejected at the clearinghouse because she isn’t a provider. “That’s impossible, I have the approval letter right here in front of me,” Brittany explains to the billing rep over the phone. The rep then asks, “Did you put that provider number in the clearinghouse, and get approved to submit electronic claims?” Brittany then pauses for a minute and thinks about the question. “Well no, I didn’t know that was something I had to do. I thought I just got credentialed and I could start submitting claims.”
The rep then goes on to explain that getting set up through the clearinghouse is an important step to the credentialing process, while it doesn’t involve the insurance company directly, it is necessary to send claims and receive payments. Brittany makes a note of this information, so when she hires a new therapist and does their credentialing, she’ll be sure to remember this step.*
The credentialing process is a complex one, that requires accurate applications and rigorous follow up. Outsourcing your practice's credentialing to experts will ensure that your applications are submitted correctly the first time, and follow up is made routinely so you know your application is going to the appropriate channels. To learn more about Account Matters credentialing services, give us a call at 508-422-0231.