As the old adage goes, your best offense is a good defense—and no one knows that better than the folks responsible for revenue cycle management (RCM). When it comes to rehab therapy billing, getting dinged with claim denials might seem inevitable. But, taking steps to avoid the following four RCM killers will help you shield your practice from taking a critical hit.

WebPT + Billing Software - Regular BannerWebPT + Billing Software - Small Banner

1. Ineffective (or Non-Existent) Payment Policy

Money talks, and when we’re talking money, there’s no room for murkiness. Making sure your payment policies are crystal clear not only benefits you and your staff, but also sets a straightforward expectation for your patients. In this post, I highlighted the essentials of a successful patient payment policy. Check it out to see whether your practice’s payment guidelines are up to snuff. Once you’ve got your policy on lock, turn your focus to effectively enforcing it.

Define staff roles.

Think about your favorite band. What makes them sound so good together? Well, it all starts with the predetermined role of each individual member. The vocalist sings the melody, the guitarist pulls the rhythm and main tune together, the bassist brings depth to the sound, and the drummer keeps everyone in time. But, what if those distinctions weren’t so clear? What if there was no communication among bandmates? Some music aficionados might call the end result “jazz,” but more likely than not, it would be total chaos.

The bottom line: In any group—whether it be a band or a rehab therapy staff—having clear role definitions is a surefire way to ensure each individual uses his or her time and skills to the fullest. That includes outlining each person’s responsibilities with respect to payment processes.

Trust—but still verify.

Generally speaking, billers shouldn’t be responsible for front office work, just as front office staff shouldn’t be responsible for handling claims. A good way to prevent your biller from doing extra work is to record and verify all the correct intake information before a patient ever sees the therapist. That means implementing policies that ensure you cover all your bases by verifying information like:

  • insurance benefits,
  • demographics,
  • the name on the policy, and
  • whether or not there’s a secondary insurance.

It’s also vital that you collect patient copayments at the time of service. Doing so eases the pressure on your front office staff, as they won’t have to chase down patients with past-due balances.

2. No Follow-Up

Your practice—just like any other business—relies on a steady cash flow to keep things running smoothly, but you can’t always rely on payers to reimburse claims in a timely fashion. However, you can control how long it takes your clinic to follow up on unpaid amounts—whether those are payer reimbursements or patient-owed balances.

According to WebPT’s Courtney Lefferts, you should “send your patients regular invoices, and when a patient whose payment is overdue comes into your clinic, give him or her a friendly, in-person reminder about the outstanding balance. A personal interaction is more likely to result in a payment.” Also, be sure you’re sending patients their invoices in a timely fashion, as they’ll be less likely to dispute charges.

Additionally, your biller should follow up with insurance companies “every 30, 60, 90, and 120 days” regarding any unpaid or underpaid claims. Doing so will help your biller identify simple billing mistakes sooner rather than later, which means you get paid faster.

3. Failure to Identify Error Trends

Some folks say the definition of insanity is doing the same thing over and over, yet expecting different results. While I can’t say that making the same claim errors over and over is “insanity” per se, it is—if nothing else—exhausting. In a busy practice, it’s normal to for a biller to ship claims off as soon as they’re generated. In fact, it’s expected. However, if your biller is sending out claims one at a time, he or she could be overlooking high-level processing trends that are clogging up your RCM cycle.

The solution: Implement processes that identify workflow and coding errors that repeatedly lead to claim denials. For example, you could create an Excel spreadsheet and start tracking remark codes and downcoded claims as your practice receives them. This data will help you pinpoint recurring hiccups on both the billing and documentation sides—which you can then take steps to correct. After all, a denial here or there may not seem like a big deal, but collectively, they can really add up—and seriously stop up your cash flow.

4. The Wrong RCM System

If you use an electronic medical record (EMR) system, then you already know the benefits of housing your patient records in a secure, cloud-based platform. But, what about your RCM software? With so many options available today, choosing the right one for your practice may seem like a daunting task.

You might be thinking, “Does it really matter which RCM software I use? They’ll all get the job done, right?” The truth is, no two RCM systems are created equal. On that note, you should take the following into consideration when vetting potential RCM solutions:

  • Does it integrate with your EMR?
  • Is it up-to-date on compliance changes?
  • Does it have coding checks in place to avoid common errors?
  • Does it offer robust reporting?

If your current RCM system doesn’t measure up on those fronts, then it might be time to consider a new billing software. After all, if your RCM system doesn’t streamline your revenue process, you could end up losing out on a serious chunk of change down the line.


Defending your clinic’s RCM process doesn’t require any superpowers—or an actual shield—but it can mean the difference between having a practice that thrives and one that struggles to stay above water. Defining—and refining—your RCM process puts your practice on the road to success, with you in the driver seat. And, by identifying billing challenges and implementing policies that defend your financial procedures, you can be the RCM hero your practice deserves.

  • 9 Questions to Ask a Potential Billing Software Vendor Image

    articleMay 30, 2017 | 7 min. read

    9 Questions to Ask a Potential Billing Software Vendor

    The consumer landscape has changed drastically over the last two decades, and the healthcare space is no exception. Technology has driven much of that change. The rapid pace of innovation has created a technological smorgasbord, meaning consumers can sift through dozens of products until they find the perfect match. This proliferation of options has yielded a fresh set of challenges—including the overwhelming nature of so much choice. Salespeople might be counting on you to make a quick—and …

  • PT Billing Tips from the Trenches Image

    articleMay 22, 2017 | 6 min. read

    PT Billing Tips from the Trenches

    It’s hard out here for a biller—between dodging denials, hunting past-due balances, and navigating the ever-changing compliance climate, keeping a rehab therapy practice’s billing processes in tip-top shape is no simple feat. The heat is definitely on when a good portion of your company’s cash flow falls squarely on your shoulders—but you don’t have to go it alone. In fact, we’ve rounded up several therapy billing gurus who were happy to lend their expertise and spill some …

  • 4 Keys to Keeping a Steady Cash Flow Image

    articleMay 18, 2016 | 5 min. read

    4 Keys to Keeping a Steady Cash Flow

    As a private practice clinic owner, you’re probably familiar with the cold sweat-inducing struggle to keep a steady cash flow. Claims management muck-ups, inefficient processes, staff issues, and lack of insight into your clinic’s financial health can leave you feeling like you’re riding a revenue rollercoaster. So, whether you’re trying to maximize reimbursements , combat employee theft , or optimize patient payments , these four keys to maintaining a steady cash flow will help you even out …

  • Founder Letter: 3 Ways Your Practice is Losing Money Image

    articleMay 5, 2016 | 7 min. read

    Founder Letter: 3 Ways Your Practice is Losing Money

    Much like the patients you treat, your practice can appear healthy on the outside despite significant internal issues. And when those issues are money-related, the consequences can be deadly. If your practice already is in the red, you know you’ve got some pretty serious cash flow problems. But even if you’re in the black every month, you may still be washing dollars down the drain. While there are myriad ways your practice might inadvertently be losing revenue, …

  • Coding Faux Pas: 5 Common Rehab Therapy Billing Mistakes Image

    articleMay 9, 2017 | 7 min. read

    Coding Faux Pas: 5 Common Rehab Therapy Billing Mistakes

    As the old saying goes, “To err is human.” But when human error stands between you and timely reimbursements, it’s difficult to remain philosophical. From missing GP modifiers to miscalculated coding units, here are five common billing mistakes that keep rehab therapists from getting paid. 1. Omitted Modifiers Modifiers: Easily applied; even more easily overlooked. Therapy modifiers—including GP, GO, and GN—specify to the payer what kind of therapy service was provided (e.g., physical, occupational, or speech therapy). …

  • The Dos and Don’ts of Working With Insurance Companies Image

    articleJul 7, 2017 | 6 min. read

    The Dos and Don’ts of Working With Insurance Companies

    In 2016, Forbes reported that doctors spend more than 66% of their time on paperwork. And a good deal of that paper-pushing is insurance-related. There’s no denying that working with insurance companies is a challenging—yet required—part of running a rehab therapy clinic. One of the biggest hurdles in this professional relationship is negotiating contracts. Most medical professionals have at least heard a story of a nightmare negotiation that led to nothing but frustration. Ultimately, insurance companies usually …

  • 7 PT Billing Software Deal Breakers Image

    articleMay 24, 2017 | 6 min. read

    7 PT Billing Software Deal Breakers

    I don’t know about you, but for me, it’s hard to put a price on a good cup of coffee. For some, it’s not merely a beverage to be sipped with eggs and toast—it’s an integral part of a morning ritual. For these folks, the difference between a stellar cup of joe and a subpar one can mean the difference between a productive day and one they struggle to push through. Much like a hot cup of …

  • Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans Image

    webinarFeb 23, 2017

    Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans

    Copayments, coinsurances, unresolved balances—oh my! Any one of these can cause headaches for healthcare providers, but as healthcare reform efforts shift more and more financial burden to insurance beneficiaries, today’s practitioners are increasingly facing all three. And these challenges are not only hurting their patient acquisition and retention rates, but also their bottom lines. Tired of spending time verifying benefits only to lose those patients to copay sticker shock? Stuck in a constant cycle of pursuing past-due …

  • Common Questions from Our Patient Sticker Shock Webinar Image

    articleMar 31, 2017 | 33 min. read

    Common Questions from Our Patient Sticker Shock Webinar

    From copays and deductibles to payer contracts and benefits verification, understanding all the nuances of third-party insurances is tough enough for healthcare providers—let alone their patients. In WebPT’s most recent webinar— Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans —co-hosts Heidi Jannenga, PT, DPT, ATC/L, the cofounder and president of WebPT, and WebPT CEO Nancy Ham provided a lot of great advice on how to have productive conversations about healthcare costs with your patients—without …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.