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.