Today’s blog comes from WebPT’s Billing Onboarding & Operations Manager Stacey Abelman. Thanks Stacey! 

 I wish I could tell you that today’s blog was going to be about how to make rehab therapy billing a breeze. But it’s not. There’s no magic answer, no simple solution, and certainly no easy-as-pie fix. Not to fear, though. There are things you can do—steps you can take—to make sure your billing processes are at their very best so you’ll increase your revenue and decrease your headaches. Here are ten:

1. Make a Plan

What’s your clinic’s one-year plan? How about your five-year? Oftentimes, the answer is purchase new equipment, open a second location, or bring on an additional provider. Regardless of your particular goal, though, the first step is always the same: start making a plan of how you’re going to achieve it. And I’m guessing that increasing cash revenue will fall somewhere on this plan. If so, it’s time to start looking at your billing department. Maybe, to meet your practice goal, you need to set some billing specific goals—like decreasing accounts receivable (A/R) greater than 90 days down to less than 10% or sending all claims to carriers in less than two business days. Regardless of your goals—billing-specific and overall clinic—put it on paper, communicate it to your team, and break it into manageable steps.

2. Report and Measure

Want to know where you stand in terms of billing? Start looking at the data. Regularly. Weekly. At the very least, monthly. Then, once you start running your reports regularly, start comparing them—month to month, year to year—so you know what’s going on in your practice in terms of volume, growth, and decline. Look for patterns—and red flags. So, which reports should you run? Start with these:

  • Charges / Payments / Adjustments
  • A/R
  • All carriers and individually for top five carriers
  • Practice activities
  • Provider and facility volume

3. Be Efficient

Being efficient means you accomplish a job with minimum time and effort expended. In billing, there are many ways that efficiency pays off—literally—but here are the top three:

  1. Examine your claims process and ensure as many claims are going electronic and not via paper.
  2. Review the time is takes from date of service to billing. I get it: documentation isn’t fun and it takes time to finalize notes. However, the sooner a claim goes out the door, the sooner you receive reimbursement for your hard work. Also, examine your charge entry and billing process; make adjustments if claims are not being sent on a daily basis.
  3. Determine how long it takes to receive payment. Most payers now process and submit payment within two weeks when you establish the appropriate EDI connections. If your reimbursement waiting period is longer than six weeks, your process needs more technology automation. Patient balances are a whole other beast and it is hard to be the big bad collector. But keep in mind, your patients aren’t leaving the grocery store with arms full of grocery bags without paying first. You should apply the same theory to your services—collect the patient’s payment portion upfront.

4. Prepare Yourself (and your staff)

It’s crucial you establish a strong front office staff—and check-in process—before a patient walks through your door. And whoever is manning your front desk should fully understand the importance of insurance verification. For anyone who’s not familiar with the term, insurance verification is how a practice determines that a patient has valid insurance coverage and that said coverage applies to their services (for how many visits and at what rate). Ultimately, before you treat a patient, make sure you know how you’re going to receive payment—even if they’re an established patient. And if you determine that your patient requires additional visits, request approval beforehand—not after the fact. 

It’s also important to remember that most of your patients don’t fully understand insurance jargon and terminology, so be patient, answer questions, and make yourself—or someone—available to teach. This will make billing and copay collection so much smoother down the road.

5. Clean Claims

Sending clean claims so your payers can accept, process, and pay them on their first try isn’t only a billing best practice, it’s simply good business. Incomplete claims with missing or incorrect data wastes resources and slows down the billing and collection process. And all it takes to send clean claims is a little bit of due diligence at the beginning. Establish a process to double check that  ID #s, dates, and names are correct on the claim form and that your codes are accurate. 

Want to see how you’re doing? Run a few reports. See if you can identify any common themes in your returned claims and then start making fixes there.

6. Go Electronic

About 99% of all payers now accept electronic claims, and Medicare requires them. For good reason! It takes an average of two weeks to receive reimbursement for an electronic claim, especially if you establish an ERA (Electronic Remittance Advice), and six to eight weeks for a paper one. Need more reasons than getting paid faster? Check out this blog post.

7. Watch the Payers

At minimum, you should know who your top five payers are in terms of patient volume. But don’t stop at the minimum: shoot for ten. It’s probable that about 90% of your business comes from your top ten payers so understanding their reimbursement rates, processing times, and payer-specific nuances will help you maximize your billing. Start by running the Carrier A/R summary and comparing month to month. This way, you can locate patterns in your payment process as well any potential problems.

8. Monitor Cash Flow

If your top payer is reimbursing you less than your other payers, then it is certainly time to renegotiate your fee schedule—especially if you have historical reports on hand and you’ve done your research. And ask around. Your payers aren’t going to post their fee schedules online so the only way to know if you’re receiving as much as you should be is to ask your colleagues.

It’s also wise to pay attention to your cash payments (i.e., copays). Keep in place a solid system of checks and balances to ensure there’s no double dipping.

9. Get Ready for ICD-10

Everyone’s talking about ICD-10 right now. And if you aren’t, you should be. Recently, I’ve heard a couple clinics say they’re planning on ignoring the deadline because it “will get pushed back anyways, just like it has before.” But that isn’t the case this time. As a result of the last two delays, Medicare is now under strict implementation guidelines from the government.

Here’s what we know about ICD-10:

  • When Canada made the switch, they went from using approximately 6,000 codes to 20,000 codes and experienced a six-month delay in claims processing and payments.
  • In the US, we’re going from 20,000 codes to 60,000 codes.

Do not underestimate the enormity of this project and the learning curve we will all face. You should absolutely prepare for a delay in reimbursement. CMS is advising providers to have six months of revenue saved to offset the ICD-10 burden—but you might want to consider more. In the meantime, take advantage of all the educational resources you can; take classes, watch webinars, read everything. Get ready.

10. And finally, be accountable. It’s your practice, your processes, and ultimately your money. So, do your research, stay on top of industry changes, and adapt your processes so they work for you. And being accountable means more than just holding yourself to high standards, it means holding your staff, payers, and vendors to the same. Not only will your cash flow increase, but your patients’ satisfaction will as well.

10 best practices to maximize billing

Those are my ten best practices to maximize your billing. What best practices or strategies have you implemented that have been successful? I'd love to hear them. Tell me in the comments below. 

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