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.
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.
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.
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.
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.
As a consultant I am called in to practices to evaluate the billing function and to answer questions like why are we getting so many denials, why aren’t our payments consistent, how do we know we are charging correctly, are we in compliance and most of all where is my money? And this is on the heels of investing in and implementing a new billing system.
We have all read articles on choosing the right system and they all promise that you will get better payments, stay in compliance, and your ability to charge and document will be enhanced, but the truth is, in order to get paid and get paid right the first time you need a competent, well trained staff and processes in place to support your goal – payment for services rendered.
There are great benefits to buying a new billing system, especially if it is an “all in one”, billing, scheduling and documentation system. Those that are not can be more difficult to guarantee an accurate flow of information back and forth. Investing in a new system for your practice can make a huge difference in staff productivity, improved documentation and charging for services.
Beware not all systems will work in your favor. Sales people will tell you things like: your profits will soar, you will always be in compliance and the system will do everything for you and the demo will be equally enticing – “it’s like magic”.
And there’s more - if you purchase this system you will begin to make more money almost immediately and the system is so easy to use. It’s great for a start-up, a small or large company, good for 1 or 100 sites and the list goes on. But before you choose, answer some questions.Why are you getting a new system? Who will help you choose a new system? Did you really drill down on the problems with the old system so you would not face the same issues again?
The truth is, there is not one system out there that will do “everything” the way you want but there are some that are much better than others. The best systems will hold their promises if there are skilled people maximizing all functions. Everyone will need extensive training. You have to put great info in, to get great info out.
Beware of the older or free systems out there that cannot bring your business to a new level. Those systems tend to keep you down and buried in the manual systems of entering charges, payments and have reports that are difficult to read and useless as a tool for managing the practice. Usually, you pay nothing and get as much to show for it.
Many sales people know how to use the system they are selling but they have little experience with using it in a real life situation such as your practice or in various states that have some specific requirements.
Here are some specific things to consider when investing in a new billing system.