WebPT Blog - insurance regulations
Aug 6, 2012| by Heidi Jannenga PT
Today’s blog post comes from WebPT cofounder and COO Heidi Jannenga, PT, MPT, ATC/L
To all of our Super Therapists working diligently to improve their patients’ functional level and quality of life, the Center for Medicare and Medicaid Services (CMS) has tossed a chunk of Kryptonite into our clinics.
As you know, CMS has implemented many changes this year and continues to have the Proposed Rule for prospective payment and data collection pending. Keeping up to date with these changes is crucial if you are treating patients with Medicare insurance. As our fellow superhero Spiderman says, “Whatever comes our way…we always have a choice...It's the choices that make us who we are, and we can always choose to do what's right.” As therapists, we want to do what’s right for our patients, and that means producing excellent documentation that aligns with Medicare’s compliance requirements. Our skillset as therapists includes validating the need for our services, and we can only achieve this through thorough documentation and use of tests and measures to help show progress during the episode of care. EMRs can help to enforce Medicare compliance, while improving workflow efficiency, but ultimately you’re the last line of defense.CMS, compliance, electronic billing, emr, insurance, insurance regulations, Mac, manual medical review, medicare, proposed rule, reimbursement, therapy cap
Feb 22, 2012| by Lindsay Bayuk
Today's post is contributed by Greg Babiec, Physical Therapist, and Owner Evolve Physical Therapy & Sports Rehabilitation in New York. Greg is also a member of WebPT. You can follow him on Twitter at @DrBadBack. Thanks, Greg, for contributing your insights and expertise today!
As a PT, understanding how health insurance works can sometimes be an unpleasant yet important part of the profession. Of course, treating patients is our primary role but since we spend so much time with our patients, taking an opportunity to educate them about their insurance can set us apart from other health care professionals. I recommend a bit of research about the insurances you deal with most and a good place to start is on the APTA website.
In my experience there are a few key things that we as PTs should know about insurance:
1) Understanding the insurance verification
2) What is the patients responsibility
3) What is your responsibility as the PT
Once a patient attempts to schedule an appointment for PT, most PT clinics have an administrative staff member perform an insurance verification. I think all PT’s should do a few just for the experience. If you have never done an insurance verification before, its very simple and usually is best done with a phone call to the insurance company. Once the patient provides you with their information, call the insurance company to speak to a representative.
The rep will tell you about the co-payment, co-insurance, deductible and maximum out of pocket costs. Do a web search for these terms or read something like this so that you know the difference. The rep will also tell you if the patient needs authorization, how many visits they get and if there are special forms that need to be filled out. Try to get a good understanding of what needs to be done so that you know what the patient needs to do and what things you need to do.
Aug 12, 2011| by Mike Mannheimer
One of WebPT’s strategic partners and web-based billing software provider, Kareo, recently posted a blog regarding the 2011 National Health Insurance Report Card. The findings were that insurance payments were actually declining from last year. Some of the worst offenders paid as low at 62% of what they were contractually obligated to.
What can be done to keep insurance companies honest while maintaining the thousands of private practice clinics that are struggling to make it in this economy? In any other industry, it would be unacceptable to pay anything under 100% of what we were contractually obligated to pay. Please respond to this post if anyone has ideas on how to change this trend.