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
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.
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.
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.
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:
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.
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.
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!
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.
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.