If your billing operations aren’t buttoned up, you’re likely not collecting every dollar you’re billing for. I realize that may sound a bit bleak, but it’s true—and it was also the main point John Wallace, WebPT SVP or Revenue Cycle Management, made in his recent Founder Letter. That’s why we’ve put together some best practices for rehab therapy billing to make sure you’re operating as efficiently as possible to keep your clinic in the black.
1. Respond to requests for information from payers.
The number of audits is on the rise, be they from CMS or commercial payers. And while you might be able to dodge that particular bullet for a while, the truth is that you’ll eventually get that dreaded letter from your MAC or another auditor. Instead of fretting, there are steps you can take to make the process as smooth and efficient as possible.
The best thing providers can do when faced with an audit is to respond to requests for information in a timely manner, and follow the instructions provided by payers. For CMS audits, providers typically have 45 days to respond to requests for additional information—which means you want to get on top of those requests right away. As Business and Clinical Management Services President and CEO Mary R. Daulong suggested at PPS 2022, clinics should consider having an assigned mail sorter and having that sorter prioritize any mail from payers so that it gets opened promptly.
2. Subscribe to emails from payers.
No one’s clamoring for more emails, especially when it’s hard enough to keep up with the ones your staff is already receiving. But emails from payers—or third parties managing claims on the behalf of those payers—can contain important details on billing changes that you need to know about. At least one person on your staff should be subscribed to and reading emails coming from payers in order to keep your clinic apprised of any updates and clear of future billing errors and claims denials.
3. Have a process for claims denials.
Claims denials can be a drain on your billing department’s time and energy—and a hit to your clinic’s cash flow. That’s why creating a process for how your clinic handles claims denials can help to reduce the potential impact on your staff’s efficiency and your finances.
Ideally, you should clearly identify who will review the denial and carefully read the accompanying notification, which should specify why the claim was denied and identify how it can be corrected and resubmitted. You should have a determined process for each of the most common types of denials:
- Eligibility issues;
- Authorization issues;
- Missing data;
- Missing documentation; and
- Non-covered services.
While you can likely fix and resubmit claims denied for missing data and missing documentation, denials for eligibility, authorization, or non-covered services are likely unappealable or unable to be corrected—and yet too many clinics waste time trying to appeal.
Another key part of your process should also be identifying the upstream errors or oversights that ultimately caused the claim to be denied. As this article notes, disparate systems and workflows and front office bottlenecks can be major culprits when it comes to claims errors that lead to denials—which is why having an all-in-one platform can help reduce denials and rework.
4. Follow up on A/R.
Dealing with accounts receivable is a pain—that’s why so many clinics put it off until the end of the month, if not longer. But A/R is another example of vital revenue your clinic needs that’s being held up. Fortunately, there’s something you can do about it.
Designate time each month for staff to work on collections and follow up with patients on outstanding balances. While you can turn to a collections agency, you run the risk of ruining patient relationships with harsh tactics—to say nothing of the diminished financial returns and expense of hiring an agency. To try and minimize potential collections, make sure patients are clear on your payment policies from their first visit, and have your front office staff collect outstanding balances as they’re scheduling patients for their next appointment.
5. Set aside time for staff to work on patient accounts.
It can be hard to find time for a lot of the important work that needs doing at your practice, but setting aside time for your staff to do the necessary work involved with maintaining not just your billing operation but a well-oiled practice. It’s important for your team to be reverifying benefits (ideally with WebPT eBV), checking authorizations for visits and units, auditing records, or any of the other tasks that help set the stage for a smooth billing operation.
6. Make one person responsible for each billing department.
Billing may be a team effort (for some practices), but that ethos may not be helpful when it comes to determining accountability for claims submissions. Even with clearly defined responsibilities, the lack of a single person in charge can make it harder to ultimately correct errors—or ensure errors don’t happen in the first place. By designating a responsible individual for each aspect of your billing department, you’ll have someone you can hold accountable.
7. Post payments against line item charges.
Speaking of time constraints, billing departments pressed for time at the end of the month might find it easier to dump payments into an unsigned account. And while it’s good to have the money, it’s bad if you’re not able to track exactly where it’s coming from. Your practice should be using key performance indicators (KPIs) to measure how your business is performing (specifically its billing department), and those KPIs require accurate data on which payers you’re being paid by and when, how long it’s taking to be paid, and how effective your collection process is.
8. Follow up on returned mail.
Along the same lines as collections, make sure your billing department is taking action on any patient statements that come back as returned mail. Time spent tracking down delinquent patients may not be exactly what your billing staff signed up for, but it’s essential for maximizing your revenue. It may seem like considerable effort and expense to collect on those accounts, but there are affordable solutions for skip tracing like Tracers and Skip Genie that cost $20 to $60 a month and can help you locate patients. Or, if you have a bit of time and ingenuity, there are a few free or low-cost options for skip tracing you can take advantage of as well.
At a time when clinic budgets are tight, your clinic needs to be collecting on every dollar owed in order to meet your revenue targets—which means that your billing team needs to maximize what you’re collecting and how you’re collecting it. As Wallace is fond of saying, it’s picking up the nickels and dimes that makes the difference between breaking even and making a profit.