corporeal Therapy Billing
Physical therapy billing is often misunderstood and taken for granted by most inexpressive practices which follow in thousands of dollars lost each month, if not more. Allowable Pt billing and Cpt coding can make or break a practice. Those who know rehab billing secrets and techniques and do it well are more thriving overall. Those who do not fully understand billing for physical therapy don't do as well.
corporeal Therapy Billing
What You Don't Know Will Hurt You!
Your billing theory is the life blood of your inexpressive practice. The billing theory keeps the wage flowing that in turn keeps the enterprise going. Most physical therapists want to treat patients and not deal with the billing. They think it's a "headache" and would rather dump it off on someone like a billing service or enterprise or an employee. As a follow of this mentality most practices over the country are losing out on a lot of money! The typical custom collects only 40% of what they should be and could be collecting. Billing is more than generating a claim with pathology codes and Cpt codes. It is much more than that.
What the Most thriving Practices are Doing
1. They get all the right tools. They don't use borrowed (stolen) forms from past employers and copy someone production a lot of mistakes. They don't use MediSoft, Lytec, TurboPt, Ptos, or Clinicient. Instead they have...
Good Software with few bells and whistles.
Good patient Intake/Registration Form .
Good Assignment of benefits (Aob) form containing prominent legal language. It should gain legal proprietary from the patient allowing you to deposit checks made out in their name, file a complaint with the assurance commissioner on their behalf, receive checks directly from the assurance enterprise on their profit (even when their procedure states otherwise. A good Aob will give you solid legal recourse should the assurance enterprise or the patient ever try to evade payment.
Good New patient interview form.
Good Fee slip that's easy to read and understand.
2. They present a bill and gain patient portions at the time of service. They don't waive and discount co-pays and deductibles. Which is illegal without documented financial hardship.
A good staff member handles the new patient interview with professionalism and tact and the patient is made aware of their financial responsibilities, not a minimum wage receptionist.
All pertinent personal and assurance information is gathered at first interview and/or first appointment.
Services and codes are strategically chosen based on the type of assurance the patient has and the payer rules.
Modifiers are applied to maximize billing. All staff are trained well on how to use them.
Patients are presented with a bill with their portions clearly stated and they pay that day.
The billing someone receives the charges and codes daily.
3. They gain assurance portions within 60 days! They don't accept assurance enterprise stall tactics such as, "we don't have description of your claim", "it's being processed", "we need more information", "it wasn't medically necessary", etc. They apply the state and federal provider proprietary laws and get paid fast.
Billing data is input into the computer timely
The Aob is manually sent to the assurance enterprise payer
Bills are generated and submitted electronically. Electronic claims are paid within 14 days whereas paper claims can take as long as 60-90 days.
If cost is not made within 30-45 days, a tracer is sent with a observation warning of a inherent complaint with the assurance commissioner.
4. They gain 90-100% of Billed Charges! They don't accept denials of any kind such as, "Untimely submission", "Not Ucr", "Not Medically Necessary", "No Benefits", and "We sent the check to the patient so go after the patient", etc.
request for retrial letters are sent to the assurance enterprise in response to all denials. (View sample)
The assurance commissioner and patient are sent a "Cc" (copy) of that letter.
If a repayment check is sent to the patient, a ask is made to issue someone else check referencing the instructions made on the Aob form.
When a invite for "more information" is requested, they fee the assurance enterprise a healing invite fee () so they stop using that stall tactic with them. And much, much more...
If a patient has an outstanding equilibrium owed they don't use weak collection letters, bargain, or write-off the debt. They use collection letters that work and encourage the patient to do the right thing which is to pay the debt!
They have cost plans available for their patients that are indeed setup and administered.
They make sure to fee patient coinsurance/co-pay's at the time of service each and every visit!
5. They maximize reimbursement! They don't bill every patient exactly the same way. They don't just bill ther-ex, by hand therapy, ice and ems (97110, 97140, 97010, 97014) with every patient for a mere reimbursement.
They use modifiers like -59 and -22 to get paid more for those patients who want more time and power to treat, such as the patient who c/o neck, shoulder, back, buttock and knee pain.
They also use the modifier -52 for when services are reduced.
6. They keep patient loyalty They don't allow assurance fellowships to maliciously splice the relationship between provider and patient by using derogatory language such as "Fee's are excessive for that geographic region", "Fees are Not usual, customary, or reasonable", "Services rendered were unnecessary or not professional".
Template letters are sent to assurance fellowships every time they use derogatory language in the Explanation of Benefits statements to patients/providers.
The assurance commissioner and patient are sent a "Cc" (copy) of that letter.
They gain patient coinsurance/co-pays at the time of each visit so the patient won't have to later pay a lump-sum-bill three weeks after extraction which most people can't pay and fast come to resent.
Studies show that patients who owe you money are more likely to file a malpractice suit against you. Studies also show that patients who pay something out-of-pocket for their healthcare services each visit get great faster.
Billing Options available
1. Contracting out to an independent healing billing service
Most of the so called "medical billing services" are stay-at-home moms who took a weekend procedure on "How to Make ,000/yr Working From Home". They learn how to purchase software, gain and input data and submit claims. They're also taught how to print enterprise cards and present themselves as a professional organization. The question is most of these individuals have limited to no experience.
Pros economy and more personable. Allows you time to market and advertise your services.
Cons Lacks experience. Most likely won't know how to request for retrial denials or respond to stalling tactics. Most likely paying for straightforward data entry.
Characteristics
o No setup fee.
o 4-10% of gross reimbursements.
o They gain patient info and billing by fax, Fed-Ex, or Pc Anywhere
o Not very good about updating you on status of claims and collections
o Reports are not very good
Results typically are 40-50% of money lost by falling straight through the cracks and never getting appealed and collected. Most do not know how to request for retrial denials, file complaints with the assurance commissioner, respond to derogatory language in Eob's, train your staff on modifiers and good coding for dissimilar type of payers, or respond well to assurance enterprise tactics on stalling and refusing payment--all the things that make a billing theory great.
If you want to find a decent billing person, one who is organized and knows the basics, ask them these questions:
o Do you have any physical or occupational therapy billing accounts now?
o Can I contact them for reference?
o Can you send me a sample of 3 reports?...monthly claims submitted, monthly paid items posted, aging description on every outstanding claim.
o What type of billing software do you use? Is it Hipaa compliant?
o How will you gain the charge/patient data from me?
o Will you teach me code strategies for each payer type (ie. Workers comp, blue cross, medicare, medpay, etc)?
2. Large healing Billing Companies
The larger healing billing fellowships usually work with many providers and have many accounts. They typically have more contact but that is no warrant they know how to go beyond data entry, claims submissions and cost postings either. There is not much money in it for them to request for retrial denied claims because it takes human resource and time to write letters, make phone calls, and submit complaints. They would much rather do the straightforward data entry and get their percentages from that.
Pros Reports are better. They have more experience. Allows you time to market and advertise your services.
Cons More expensive. Probably won't do all appeals, letters to assurance commissioner and patients especially if you are a small inventory (less than ,000 per month).
Characteristics
o Setup fee
o 8-15% of gross reimbursements.
o They gain patient info and billing by website log-in, fax, Fed-Ex, or Pc Anywhere
o Not very personable
Results typically are 30% of money lost by falling straight through the cracks and never getting appealed and collected. Most will not file complaints with the assurance commissioner or respond to derogatory language in Eob's.
If you want to find a good billing company, one that appeals denials, files complaints with the assurance commissioner, provides detailed reports of claims submitted monthly, claims paid monthly, and aging reports with 30-60-90-120 day statuses then make sure to screen them well. Ask the following questions:
o Do you have any physical or occupational therapy billing accounts now?
o Can I contact them for reference?
o Can you send me a sample of 3 reports?...monthly claims submitted, monthly paid items posted, aging description on every outstanding claim.
o How will you gain the billing/patient data?
o Will you teach me code strategies for each payer type (ie. Workers comp, blue cross, medicare, medpay, etc)?
o Do you request for retrial denials?
o Can I see sample request for retrial letters that you use?
o Do you ever send patients letters? If so, what and can I see a sample?
o How do I ask you questions? What are your keep hours?
Prices are all the time negotiable with exterior billing fellowships and independents but be ready to pay if you want them to do everything listed above.
3. In-house billing where an employee does the billing
I advise doing billing in-house with an employee after a year of solid marketing, advertising, and promoting your practice. Most owners do not have the time necessary to do both adequately (as well as treat patients). If you are considering hiring an employee to do the billing be ready to learn the in's and out's first. Even if the employee boasts about knowing billing. It's a good idea to learn it yourself, setup the system, and work closely with the employee until they demonstrate competency.
No one will go after the money owed to you and look out for the welfare of your enterprise like you.
Pros More operate over the system. great collection rates. If monthly billing is more than ,000/month you will save money by using an employee versus an exterior service. They can also assume other admin tasks.
Cons Takes time to learn the theory and set it up.
Characteristics
o employee wages
o employer taxes
o More operate over billing procedures Results typically are less than 10% of money lost. Less money will fall straight through the cracks and get lost. Complaints with the assurance commissioner will get filed and derogatory language in Eob's will get responded to.
If you want to find a good employee, one that will do the job well, you may want to hire someone who tried to start an independent billing service at one time. It's not necessary but they may already know the basics. Ask them these questions?
o Do you have any contact with healing billing?
o How much do you think this job should pay? Look for someone in the /hr or more range.
o What type of work do you enjoy more, office work or person-to-person work?
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