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.
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.
Once you begin the credentialing process for your new business, you’ll discover that the insurance companies have a long list of required documents that you will need to submit in order to verify the legitimacy of your business. One of the biggest issues that we run into when credentialing a client is that the information on these documents does not match. That’s where the trouble begins…
Physical therapy is one of the fastest growing healthcare industries in the country, with new private practices opening daily. This is great for patients because the number of clinics they have to choose from is larger, but not great for new owners, because many insurance panels are being closed to new groups.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, they will close that panel and no longer issue contracts for new providers/groups. This can be extremely frustrating for a new business owner.
CP 575 Form - The CP 575 form is an IRS document that you receive in the mail after you’ve registered for a Tax Identification Number. This form serves as a confirmation of your Tax-ID number and many insurances request a copy. The most important part of this document is how your business name is printed by the IRS. Any application you fill out for your business needs to have the exact same spelling and punctuation as this CP 575 form because if it does not, your application may be sent back because they could not confirm the business name with the IRS. For example, if your CP 575 form says your business name is “Good Health Physical Therapy LLC” you wouldn’t want to fill out a credentialing application with “Good Health Physical Therapy, LLC.” Even though the comma seems inconsequential, insurance companies are extremely thorough and may reject the application.
CAQH Proview Profile - The CAQH Proview Profile is an essential part of the credentialing process. Insurance companies use this to verify the information you have on your insurance specific application. Providers need to update and attest to their CAQH Proview Profile information every quarter, so make sure your primary practice is accurate as well as your license information. If your CAQH is incomplete or inaccurate, your application may be delayed or rejected.
Business License - Some states do not require PT, OT, SLP clinics to have a business license so that should be the first thing you consider when drawing up your business plan. If your state does require a business license, your desired insurances will want to have a copy for their records.
General Liability Insurance - Every provider needs to have their professional liability insurance in place, unless stated otherwise by your employer. But new businesses need to have General Liability Insurance that covers their company. Every insurance that you would ever want to be in-network with will require a copy of your liability insurance. One important thing to remember when signing up for liability insurance is to use the clinics address. Often owners will buy liability insurance before they have an established practice location and use their home address. It doesn’t always cause delays or rejections of credentialing applications, but it is always good to go back and update the address or use the practice location when applying for the liability insurance.
Credentialing requires a lot of documentation, and I mean a lot. But these are a few of the major ones that you will need established before tackling the stack of applications. If you have any credentialing horror stories, please feel free to share them with us. If you would like some advice or assistance with your credentialing, please feel free to reach out, we are more than happy to help. Just call 508-422-0231 or email email@example.com.