Feb 29, 2012| Mike Mannheimer
Today's post is contributed by Ryan Balmes DPT. Ryan Balmes graduated in May 2011, currently working as an orthopedic resident at LSU-Shreveport. You can follow him on Twitter @RyanBalmesPT and read his blog at www.ryanbalmes.com.
The first Combined Sections Meeting I attended was during my last year in PT school at New Orleans in 2011. Now as a recent graduate and new professional at CSM 2012, I felt a sense of accomplishment to be considered a colleague among others who are also enthusiastic about our profession and eager to learn how to better help our patients.
Combined Sections Meeting this year was one that I will never forget. Here are my top four insights from CSM2012:
1. The educational courses were helpful in shaping my clinical reasoning, and they also served as starting points for deeper research in the literature.
Taking a break from patient care to attend CSM this year allowed me focused time to learn new concepts and reinforce my current knowledge base. Since all the courses were rooted in the literature, the provided references has led me to read the cited articles directly. Reading the articles after CSM has given me a deeper understanding of the content provided from the courses, which has helped me apply the new concepts in my practice..
2. Networking with fellow colleagues was as beneficial as the courses.
The educational courses were definitely the highlight of my weekend, and the additional benefit was networking with others at CSM. I really enjoyed meeting new colleagues and reuniting with old ones at CSM. Meeting new colleagues broadened my network further, which was very helpful for a new grad like me. Catching up with former classmates allowed us to share our experiences of our new careers. I particularly enjoyed meeting the people whose blogs I read on a regular basis online, like the authors of this WebPT blog. There’s nothing like talking to someone face to face.
3. The opportunities are seemingly endless for a new grad.
As evident from the number of recruiters and post-professional programs available, such as residencies and fellowships, a new grad’s career can lead to many possible directions. What I’ve found most difficult is choosing the “right” path. All my mentors have advised me however that there is no such thing as a “right” path but instead a “best” path. CSM helped me realized that I can find the best path through the help of mentors, networking contacts, and by staying true to my personal goals.
4. There’s no place like home.
My time in Chicago was a nice mini-vacation away from my established routine of life in the clinic. In the end though, I was very happy to return home. Part of me was excited to implement the new concepts I learned at clinic, but I was also looking forward to a home cooked meal!
For my fellow new professionals, if you didn’t get to attend CSM this year, I highly recommend you to attend CSM2013. Attending a national conference like CSM is definitely beneficial to your early career.
Feb 24, 2012| Geoff Elledge
This post was authored by WebPT Billing Specialist, Geoff Elledge. The photo of Geoff we used for this post was just too good to pass up. Enjoy!
The number one key to mastering your A/R is a good tickler system. Long term success is all about timely and consistent follow up of your outstanding claims. In order to get a good handle on this mastering a few key elements will go a long way.
The first step is a good registration process. The correct entry of patient demographics and correct insurance information is vital. If the claims go out error-free to begin with, you’ve won half the battle. This includes both patient and insurance information, as well as proper coding of CPT and ICD code combinations that support your service and the insurance accepts through their standard coding edits.
The second step involves getting to know your insurance plans. Learn the normal payment cycles for all of your major companies. For example, how long does it take each one to process and pay a clean claim? BCBS can process and pay in as little as 2 weeks. Other carriers, such as Medicare take an average of 21 days. Other carriers like Cigna are usually 30 days or less. Health Net will tell you while you hold over the incessant hold messages to allow a minimum of 30 days to receive and enter a claim…payment may take significantly longer. Knowing the normal processing and payment cycles for the major insurance companies allows you to most effectively plan your strategy for follow up.
Most Practice Management (PM) software allows you to view your aging through a variety of reports. They are typically organized by Current (under 30 days from submission), 30, 60, 90, and 120 days or higher. Most practices will aim for an A/R with a low percentage by total dollar value that is over 90 days, 5% is about as good as most practices will ever achieve. It’s more common to see a 10-15% figure for all of your A/R 90 days and above. Keep in mind this can be the result of just a small number of claims with a common issue. It doesn’t mean not to worry, but be aware of the underlying members/insurances beneath the numbers. If you handle a lot of liability cases or pending attorney settlements, they can artificially inflate your older aging out of proportion to goals. The vast majority of your aging should always be in the current to 30 days categories. There are very few companies that do not pay out claims within 60 days.
As you view your reports, save a copy of each month’s final totals. From one month to the next look for patterns in any individual insurance company. If you know that Cigna generally pays in 30 days and you start seeing the 30-60 day categories rise it’s a sign of trouble. Have your biller follow up on all of your outstanding claims 30+ days and see if there is a particular issue in common. Maybe it’s a clearinghouse issue or possibly changes in electronic format or even your provider file. Whatever it may be, you won’t know what or how to fix it if you never realize there is a problem.
Organize your standard monthly follow up by normal clean claim processing times. Focus on the insurance companies with the shortest timely filing requirements to start. From there, work on your oldest to newest claims in the aging. If you have a single patient with multiple claims as the culprit for a higher aging, commit some time to finding out what the insurance needs to complete processing the claims. It might be as simple as the patient completing their annual Coordination of Benefits form. A conference call with the patient and the insurance might handily solve your problem. If it’s medical records or a physician’s order, get a fax number you can send them to and call to follow up to verify it’s been received and routed to the proper department.
In the end, the true key to achieving your A/R goals is all about organization. You must have a good tickler system set up for disciplined timely follow up and resolution of your outstanding claims. Different offices have different tools available. I personally use my email calendar to add reminders on set days after each call I make. When you call BCBS and they tell you allow 10 business days for resolution or response, set a reminder to call back on that patient on the 11th day. Set out time every day to do all of the follow up in your calendar. If you don’t get through everything, move it to the following day until it is completed. If you wait until the next time you run a report 30 days from now, it’s delaying your eventual payment that much longer. If it was a simple fix you could resolve on the 11th day, it would be done and the claim paid before you would normally run the report again.
With solid registration skills, knowing your insurance plans and becoming disciplined at claims follow up, I guarantee you can easily maintain a solid Accounts Receivable aging cycle. During my time at a national company, I was personally responsible for bringing in 1 million dollars or more a month. When I started, the aging over 120 days was at 21%. By utilizing my knowledge of insurance and a disciplined follow up system, I made a huge difference. In six months I was able to reduce it to 10% and by 12 months I had it consistently at 5%. It is not difficult, but it requires firm commitment and discipline. Every month, it takes less time, and your overall aging will start to dramatically improve, allowing you to allocate time and resources toward other aspects of your practice.
Feb 23, 2012| Geoff Elledge
The A/R cycle starts and ends with a solid patient registration process. It is probably the most under-appreciated aspect of the billing process, yet one of the most important! Most new practices think it’s good enough to get a copy of the card and then submit a claim. After all, it’s the insurance company’s job to pay for your services, right? Not so fast, just a few standard practices can dramatically increase your chances of payment and lower the amount of time it takes. Wouldn’t you rather be paid in 2-3 weeks with no phone calls or follow up? Knowing your insurance plans and getting the registration right from the beginning is the first step to achieving your financial goals.
How many times have you billed a claim and then weeks later the claim is returned unprocessed due to an incorrect ID number or group number? If you had checked your information and data entry at the start, that claim might already be paid. At a minimum, now the information has to be corrected/re-verified, the claim rebilled and typically another 30 days will pass before you can possibly expect payment. Now think of repeating that experience 10, 20, or 30 times a month. How much time and money did that cost you? Not a very pretty picture and certainly not great for business.
The first step in the process is insurance verification as part of your standard patient registration. It doesn’t take long, and if you’re lucky, a few mouse clicks can accomplish most of what you need at the insurance website. I would recommend going one additional step and calling with a specific list of questions for each patient that might not be part of the standard eligibility and benefits available online. Yes, I know it’s boring and tedious, but in the long run it will be worth it. PT/OT has specific challenges versus a standard physician office visit. Every insurance company has unique requirements and they may be different even within the same company depending on the type of plan, HMO, PPO, etc.
Here’s a quick list of standard questions you should ask every time.
- Does the plan cover PT/OT services?
- What is the co-payment, co-insurance and deductible that would apply and what amount has been met year to date?
- What network is used to price claims for this plan? (Multiplan, BCBS, etc.)
- What is the address for paper claims submission and the payer ID for electronic claims.
- Do you show any other insurance coverage for the member? If so, does the coordination of benefits show this plan as primary or secondary?
- Is there a yearly visit limit for PT/OT? If so, how many visits have been used and then obtain specific instructions on where/how to obtain additional authorization over the max.
- Is there a specific form that is required for advance notification or a separate review company that must be notified of the plan of treatment? If so get details and call them as well to make sure you know everything required in advance of treatment.
- Are medical records required with submission? Most Worker’s Compensation and liability coverage will require records with every claim submission. Some other plans may require periodic records review even if the yearly maximum visits has not been met. Obtain a fax number, if you can, and note it in the record.
- What is your timely filing requirement for claims?
- Who do I call for claims follow up? Make a record of the correct phone number. This will save your biller endless frustration where there are employer or plan specific phone numbers.
You can expand or adapt this list to your individual needs based upon your contracted status for specific plans. It shouldn’t take more than about 10 minutes during non-peak phone times and can save hours of time on appeals and claims follow up and speed up payment by weeks or months! I guarantee that a little time on the front end will save hours of time on the back end, decrease denials and speed up your average payment time considerably.
This post was authored by WebPT Billing Specialist, Geoff Elledge.
Feb 22, 2012| 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.
Feb 20, 2012| Mike Mannheimer
Many clinic owners don’t pay quite enough attention to how billing tactics can effect their business overall. It’s one of those scenarios where the phrase “You don’t know what you don’t know” seems appropriate. Let’s take a close look at one billing method that can improve the health of your practice and give you the most visibility and control over billing practices.
In house billing is all about control. Deciding to go with an in house billing solution has a lot do with you as a business owner. If you currently have a hands on approach and want to see each and every detail that goes in or out of your clinic, then in house billing is probably your best option.
In house billing means that you have at least one billing employee on your staff that is in charge of submitting all of your claims and seeing them through he collections process. One benefit to this method is that you can select the employee yourself. This gives you the ability to choose someone who is not only a fit at your office, but also is an expert in physical therapy billing. Being able to choose with whom you work and to verify their knowledge level offers a great sense of security for your practice. If you choose an outsourced billing service, you may not in all cases know exactly who is filing the claims for your clinic.
The next consideration you need to think about for in house billing is what software to use. Before you start looking at every software out there you should contact your EMR company (if you don’t have one, go here) and see what systems they integrate with. This will not only help you to narrow down your search, but also make sure that you don’t have to do double entry of your information. Some clinics that ignore this important step have to enter in each patient and each charge twice, because they have two systems that do not communicate with each other. Everyone has their reasons, but buying a system that doesn’t communicate with your EMR seems counter-intuitive.
Feb 17, 2012| Lindsay Bayuk
As a physical therapist, what does it mean to outsource your billing? Is it worth it to have another company handle your claims? It’s a big change, so what does the on-boarding process look like?
These are all excellent questions for you to consider. Even if you think you’re satisfied with your current billing circumstance, it may be worth re-evaluating. It’s always smart to periodically invest some time in auditing your processes and business vendors/partners. You never know if better solutions are out there!
Let’s talk outsourced billing. Of course, your first question is probably about cost. What does outsourced billing cost? We’ve found that it’s usually between 6% to 12% of claims collected each month. You’ll need to consider whether or not the monthly fees are worth it for you and your clinic.
Outsourced billing my be right for your clinic if you’re seeing a high turnover in front office/billing staff. You may need to calculate your total costs for the additional employee(s) plus the cost of the billing software and clearinghouse fees. One of our partners, Software Advice, created an extensive list of considerations and cost break downs that you may want to check out.
A big factor can be the total amount of claims collected. Is your staff (would your staff) really collect the maximum amount? It’s quite possible that more seasoned, dedicated billers could collect more for you and your clinic. You work hard for every dollar you earn. You want a billing company that does the same. Ask for specific examples of how they have caught small claim errors and tracked down every possible dime for their clients. As a business owner, you know that that sort of persistence and attention to details is priceless!
When deciding on an outsourced billing service, it’s also key to consider your visibility to your claims and the collections process. It is after all, YOUR money! With any outsourced partner, make sure to ask about transparency and whether or not they touch your revenue.
Speaking of transparency, are the billing professionals in the United States or offshore? Some outsourced billing companies literally outsource your business to offshore teams. If it’s important to you, make sure to ask the actual geographic location of the team managing your patients data and claims.
Feb 15, 2012| Lindsay Bayuk
WebPT has asked me to share my personal top 5 physical therapy resources in social media. This is by no means an extensive list; it is simply a list of the folks I check in with on a daily basis to share research, hash out practice issues, address topics of interest, and generally stay on top of what’s new in our profession. Enjoy checking these folks out, and feel free to add suggestions!
On Twitter, Founder of EIM, Larry Benz provides a “knowledge exchange studio” that provides CE, Post Professional Certifications, Executive Program/DPT, Musculoskeletal Transitional DPT, Residencies and Fellowships, and a blog which covers topics relevant to PTs. EIM is comprised of leaders in education, research and business practice.
Erson is a P.T. in private practice in N.Y. State, as well as part time faculty at Daemen College and adjunct faculty at D’Youville College. He is also a mentor for Daemen College, McKenzie Institute, and the Evidence in Motion Fellowships in OMPT. He maintains a blog and is the creator of The Edge, an affordable tool for instrument assisted manual therapy.
Mike is a clinician, researcher and educator; additionally, he is the Head PT for The Boston Red Sox. His website contains journal articles, clinical pearls, book and product reviews, and links to his own products, which include videos and continuing education resources.
Feb 13, 2012| Lindsay Bayuk
Today's blog post was contributed by Alex Zarazua, a stellar member of the WebPT Support team. Thanks Alex!
Earlier this morning thousands of WebPT members were greeted with a number enhanced features and a new color scheme as we improved our system this weekend. Approximately 25 members suggested improvements to our application which we developed and implemented in our latest release!
We are so thankful for our contributing members that help improve the system via our Ideas Portal. Today we’re excited to introduce a new and improved Ideas Portal to increase the searchability of current ideas and encourage engagement across the entire WebPT community. Members now have the ability to participate by reviewing, commenting and voting on ideas as well as see where their ideas are in the development process.
Our Insurance Authorization manager was improved with new visit count features that will let your staff keep track of visits and authorizations more easily. Members now have the ability to see the number of patient visits per policy across all cases and reset those visit counts as necessary.
Other updates include billing and documentation enhancements, added functionality to the Home Exercise Program, an addition to the Neuro Vascular section and overall system enhancements. Members have access to a detailed list of improvements under the News & Updates section of the Dashboard.
If you have more ideas on how we can make WebPT better we want to hear them. Email them to email@example.com or visit our Ideas Portal!
Feb 6, 2012| Mike Mannheimer
Last month we gave you some marketing tips to get your clinic in good health for the New Year. The next topic we want to consider is a little bit more serious. Many clinics have their billing practices in place and haven’t really considered what options are available. The truth is, your clinic has many options when it comes to billing and switching to a method that makes more sense for you could have a dramatic effect on your bottom line.
Billing is one of the most important considerations you have when running a physical therapy clinic. Billing can also be one of the more confusing aspects of running a practice, especially if you choose a method that doesn’t fit your management style. This month, we are going to be looking at best practices in billing on our blog. In addition to best practices, we’ll cover how to choose the most appropriate method for your practice, implementation tips, and more.
Experience is key. It’s important to remember that you want to have someone (employee or company) who has experience billing for physical therapy. You want to verify that whoever has control of your claims is well versed in the nuances of physical therapy. Having specialized domain knowledge can increase cash flow and decrease the amount of time it take for your claims to be processed. We would recommend finding a professional or a professional company that is trained in physical therapy billing.
The next question to ask yourself is whether you should outsource your billing or do your billing in house. It is likely that you already have one of these methods in place, but it’s always a good idea to audit your process and see what you can do to improve it. Constant improvement! Sometimes this may mean a few minor tweaks and other times, it may mean switching to another method entirely. Let’s first define each method of billing.
Feb 6, 2012| Lindsay Bayuk
When it comes to marketing your physical therapy clinic, most of the commentary out there has to do with referrals from physicians. This is no doubt a key to creating a successful practice, but there is another base of referrals that is equally as crucial to nurture. I am talking about referrals that come directly from your existing patient base. Word of mouth referrals are the most powerful.Having your services recommended is the best way to establish trust in your community. Becoming an important part of the overall health of the community is a sure fire way to create a sustainable business.
- Ask one patient a week for a testimonial
- Email your discharged patients quarterly with new exercises
- Write a weekly blog & share topics with current patients
- Ask for referrals on your clinic Facebook page
- Volunteer for a 5K Race
- Contribute an article to your local newspaper
- Host an educational stretching class at your clinic for all patients
- Include your professional business card with patientdocuments
- Schedule one hour per week to make follow up calls to recently discharged patients
- Create a referral contest for current patients (the top prize could be an iPad)
The bottom line in all marketing, regardless of marketing to physicians or to patients, is to develop relationships. Meaningful relationships with the customer base you already have will lead to peer referrals that can be hugely valuable to your business.
What tactics have you employed to nurture referral patients in your practice? We’d love if you could share one idea that has worked for your practice.