How Clinics Can Support Their Billing Teams in the Era of Payer Complexity

Running a rehab therapy clinic should really be easier.   

I’m not saying that it is in fact easy, and that current clinic owners are just making a mess of things; I’m saying that in a fairer universe, vital healthcare providers would have every resource at their disposal to manage patients and admin, and payers would bend over backward to make sure they’re paying for any and all care clinicians deem necessary—and at a more than generous rate.  

Sadly, we have to venture back from this glorious alternate dimension, where I’m certain your skin was glowing and your hair looked fantastic, to our harsh reality. Rehab therapists are still vital providers in the healthcare landscape, but money being what it is, payers are throwing up more hoops to jump through than a circus, and paying you like the people who clean up after the circus.   

Your billing team shoulders much of the burden to get your practice paid, but it’s a burden that increases every year, along with the pressure of collecting every dollar to help meet those financial goals. They need support that can be hard for smaller practices to provide in order to match wits with the insurance companies, who are themselves turning to new tools to streamline the process of saying “no”.   

Billing teams manage a lot of variables on a daily basis.  

If all insurance companies were a uniform evil, that would still be enough of a headache for your staff to have to manage. For the sake of keeping things lively, however, every payer has added their own fun twists and nuances to their rules that keep things lively. That means your billing team (or your single, beleaguered biller) has to consider any number of different variables during a day, based on each patient’s insurance carrier.

Throw on top of that the fact that they have to deal with internal inconsistencies: each provider documents slightly differently, and each claim comes with the possibility of its own set of errors or missed information. Unfortunately, physical therapy revenue cycle management is inherently complex and a little painful. While your biller is undoubtedly skilled enough to handle anything thrown at them, it all adds up to a lot of stress and a lot of work over time.  

AI should serve as a billing workhorse.

Let’s venture back to that fantastical universe we visited earlier, the one where the bananas you buy at the store don’t turn brown two days after you buy them. In this world, your biller is heralded for their knowledge, wisdom, and judgment, and isn’t forced to toil all day at the tedious tasks that waste their mental energy. That’s the world that AI is starting to make possible. 

Now, to be clear, AI doesn’t share that wisdom or judgment that your biller possesses. Despite what some of AI’s biggest proponents might prophesy about the future, the human brain possesses a unique kind of brilliance that can’t be matched in that regard, if we ignore a few spring break decisions here and there.      

What AI is good at is taking the knowledge put forth by humans and connecting the dots, so to speak. Look at AI in rehab therapy revenue cycle management, for example; if it knows payer rules about authorizations, for example, it can check against requirements for claims at a rate faster than any biller could and surface any expiring authorizations for your biller to act upon. 

That’s where the workhorse comp comes from: AI can’t (or at least shouldn’t) be making judgment calls on a claim where murky payer rules require some thought, but it can take on the areas of the billing workflow that require so much tedious work.   

Supporting Claim Accuracy Before Submission

You’d love to catch every mistake on a claim before it gets submitted, right? Avoid the pain of having to resubmit and wait for payment? One of AI’s best applications is in doing that hard, tedious work we talked about to check claims against the most common risks that ultimately cause denials: missing modifiers, absent demographic information, or those documentation elements that are required but didn’t make it into the note. 

We talk a lot about being proactive in RCM, getting ahead of issues so you’re not stuck in an endless loop where you’re forever making fixes and chasing down information, unable to get caught up on your A/R. AI is going to be the thing that helps you get to the place where you’re on top of your revenue cycle. 

Prioritizing Work More Intentionally

We’ve all had that moment where you open up your computer and stare for a minute or two, unable to wrap your head around everything you have to do or figure out where to start. That’s especially true if you’re in a high-pressure environment where all you have are urgent priorities. 

You can’t outsource your thinking, but you can have smarter workflows where AI highlights the claims and accounts most in need of your attention at the beginning of the day, so you can tackle the areas most in need of your expertise first before moving on to the easier stuff.  

Reducing Administrative Drag in Payment Posting and Correspondence

Speaking of time-consuming and tedious, payment posting and payer correspondence have to be at or near the top of the list of things that eat up too much time, given their relative simplicity. Yes, it does require some thought to sort remittance advice, match EOBs, or review payer letters, but the demands don’t line up with the amount of time billers are forced to spend on these tasks. 

If you’re using AI in your billing workflows, it’ll handle the work of extracting key information, categorizing correspondence, and routing items to the appropriate queue to save you the work of manual sorting. That way, you can focus that time and energy on any of the necessary follow-up.   

Stabilizing the Revenue Cycle Supports the Entire Clinic

Your practice is a living, breathing organism, and like any such being, pain is referred to other parts of the body. Just like intake errors cause headaches for the billing team, billing challenges lead to higher denial rates and more delayed payments, which adds to the pressure on the rest of the operation. If you’re collecting less from your treatment due to admin mistakes, there is more often than not a corresponding push to increase productivity, whether that’s more patients on the schedule or more codes billed per patient. 

The solution should be to clean up your operational inefficiencies and collect on what you’re billing and actually owe, rather than taking for granted that you’re going to miss out on some percentage of every dollar.  Using AI to support rehab therapy revenue cycle management helps establish baseline efficiency and predictability by allowing billers to catch errors sooner and freeing clinicians and other staff from the pressure of outsized productivity expectations.