In an ideal world, patients would know their benefits like the back of their hands, we’d have a global payer list, and every claim would be accepted on the first try. But the world is not a perfect place, and there’s only so much you can control. Still, you can do your darndest to get close to the perfect billing workflow. Perfect—or near-perfect—billing begins way before you even create the claim. So, let’s start at the very beginning: the initial visit.  

Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans - Regular BannerSuppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans - Small Banner

The initial visit is everything.

Basically, the first visit determines the success or failure of every subsequent claim for an individual patient. Plus, it often brings the highest payment—so treat it with care. Say someone wrote down the wrong address for the payer—maybe just one number was off—and you end up sending the claim to the wrong carrier. You’d almost certainly receive a denial on the basis of eligibility. Of course, if this happens to you, you’ll correct the denied claim and appeal the decision, but by that point, you’ve already wasted valuable resources. Clearly, it’s much better to make sure that all claim information is correct from the get-go.

The Front Office Factor

Generally speaking, your front office should follow the tips below to ensure clean claims from the start:

  • Put your patient data collection forms online. By the time your patient comes in for his or her first visit, you’ll already be ahead of the game.
  • Verify insurance. It would be great if your front office staff could simply swipe an insurance card like a credit card and have all the patient’s insurance information in a snap, but until that happens, you’ll need to pick up the phone. During that critical call to the payer, you must confirm:
    • patient eligibility,
    • coinsurance or copay,
    • deductible,
    • benefits cap,
    • where to send the claim,
    • whether the payer requires specialized forms or additional documentation, and
    • whether the payer requires authorization. Some payers will retroactively authorize services, but for those that don’t, you need authorization before you begin providing services.
  • Make a copy of the insurance card and keep it on file for reference.
  • Confirm that you have the correct patient demographics.
  • Have the benefits conversation immediately. (Be sure your staff is ready and willing to have this kind of conversation.) Ideally, you’ll want to confirm patient understanding in writing, too. It’s as simple as including a financial responsibility section in your patient data collection forms. Make sure your patients read and sign it.
  • Collect any coinsurance or copay. (And continue checking and collecting the patient’s balance at each visit.) If you can’t get an accurate amount from the payer, make an educated guess as to what you think the charges will be; then, collect them before providing services. It’s easier to issue a refund than it is to chase down unpaid balances.
  • Put a payment card on file and get the patient’s permission to charge it at every visit.
  • Know the claim submission requirements for your top five local payers. You probably work with many more payers than that, but if you have a firm handle on the top five, you’ll save yourself a lot of time and headaches.
  • Understand timely filing guidelines. Of course, you always want to file as quickly as possible, but your idea of ASAP may not be the same as your payers’—and a clean claim is worthless if you don’t file it within the required timeframe.
  • Re-verify patient insurance when appropriate. Did your patient just get a new job? Has it been a while since the patient’s last visit? Did you recently have to flip a page on the wall calendar? Then it’s time to re-verify insurance.
  • Install a 72-hour verification period policy. That means your front office must check benefits within 72-hours of the patient’s appointment. Not only does this help ensure patients are up to speed on their financial obligation, but it also allows you to inform a patient if he or she has a high deductible. That way, if the patient decides to cancel, you still have time to fill the open time slot. That’s a win-win.

Check-outs are just as important as check-ins.

If your patients check in, but they don’t check out, then it’s time to change your procedure. A concrete check-out policy can help your staff ensure they collect any cash left on the table at check-in. How? It affords them another opportunity to collect information or payments they failed to obtain at check-in. Plus, they’ll have a chance to schedule patients for their next visits right then and there instead of trying to track them down by phone or email after they’ve left the building.

The back office better have your back.

Your front office has collected all the patient information, the therapist has finalized his or her notes, and the back office sends the claim on its way to the payer. But somewhere, somehow, wires got crossed or numbers were transposed—and the claim gets denied. Bummer, dude. Wouldn’t it be nice if payers offered suggestions on how to correct denied claims? Well, we can all keep dreaming, but for now, it’s on you to determine where the claim failed to cut the mustard. But don’t take too long getting to the bottom of it; the odds of reimbursement decrease greatly after you get a rejection, so you must follow up on denials immediately. The longer you wait, the less likely you are to receive any payment at all.

Beyond quick re-submissions, following trends can do wonders for your back office billing success. You have to figure out:

  • where your claims are getting bogged down,
  • which claims are getting denied the most, and/or
  • what’s causing your claims to be denied.

Then, work to resolve those issues. Also, pay attention to fee schedule updates (and keep an eye out for claims that are getting paid out at 100%) to ensure you aren’t leaving money on the table. An unknown pay schedule increase of only a few dollars can result in huge losses for your clinic over time. And as for those old collections accounts, the biggest mistake you can make is not having an outside billing agency—or someone at your clinic—to call patients who have outstanding bills.

Automation is the ticket to error-free acceptance.

Clean claims are the bread and butter of billing—but they can be especially difficult to produce consistently. There are more than 3,000 payers—and each one has its own set of guidelines or regulations you must follow to get paid. That’s why electronic claims submission and reimbursement is where it’s at. While it might seem scary to put your revenue in the hands of something that, well, doesn’t even have hands, automation is the fastest and least cumbersome way to get paid. Billing services and software will scrub your claims for you, ensuring that your claims have all the information they need. Plus, you can auto-post your reimbursements. There’s no paper copy or receipt, but you always have the option to check the payer’s website for claim status and payment.


Ultimately, creating the perfect billing workflow comes down to taking accountability for your business. There will always be keying errors (we’re human, after all), but everything else is controllable, so do the work upfront to ensure you create a clean claim the first time—every time.

  • Clear Course for Cash: 5 Simple Ways to Optimize Your PT Billing Workflow Image

    webinarJul 6, 2015

    Clear Course for Cash: 5 Simple Ways to Optimize Your PT Billing Workflow

    Is your current billing workflow flooding your clinic with claim delays, rejections, and/or underpayments? Don’t try to bail yourself out with a sieve. Instead, stop taking on water entirely by patching the holes in your billing processes. But how, you ask? Never fear; we have the answers you need to shore up your ship—for good. Tune in to this month’s webinar, where hosts Heidi Jannenga and Charlotte Bohnett will show you how to set your billing workflow …

  • Founder Letter: Why Clean Claims are Everything Image

    articleJul 7, 2015 | 6 min. read

    Founder Letter: Why Clean Claims are Everything

    When you consider the many complex aspects of running a  private practice , your bottom line might be the biggest source of anxiety. And that’s for good reason; it’s your lifeblood. In an effort to improve  your metrics , you’ve likely examined your workflow, documentation practices, and staffing requirements for any possible improvements. That’s a great start, and I encourage you to stay on top of  self-evaluation  in all of these ways. But have you ever stopped …

  • What to Look for in a PT Biller Image

    articleJul 28, 2015 | 4 min. read

    What to Look for in a PT Biller

    In the words of American rock legend Tom Petty, “Good love is hard to find.” While I agree wholeheartedly with Mr. Petty’s wisdom, I think some rehab therapy practice owners might say good employees are even harder to find. And that certainly applies in the billing department. After all, your clinic’s billing operation is crucial to its financial well-being. One bad hire could mean the difference between your clinic achieving private practice rockstardom and hitting rock bottom. …

  • 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, …

  • The Physical Therapist's Guide to Contract Negotiation Image

    downloadSep 15, 2016

    The Physical Therapist's Guide to Contract Negotiation

    As a PT, you put your heart and soul into your work. So, it’s only fair that you get paid what you deserve. Unfortunately, payers don’t often see it that way, which means that in order to get what you want out of your private payer contracts, you’ve got to negotiate. And to do so successfully, you need to know how to play ball. Enter your email address below, and we’ll send your free guide.

  • Why RCM is a Practice-Wide Endeavor Image

    articleJun 20, 2016 | 5 min. read

    Why RCM is a Practice-Wide Endeavor

    If you think revenue cycle management (RCM) only involves billing your patients, then Houston, we have a problem. As indicated in this Greenway Health resource, your RCM strategy should account for the manner in which your practice generates, captures, and collects revenue—and that means getting your whole crew on board with adopting optimal RCM practices. But before you can launch a successful RCM strategy, you should perform a pre-check. Here are a few questions to ask yourself …

  • articleMar 14, 2013 | 4 min. read

    Get Your Life Back: Billing Best Practices for Rehab Therapists, Part 3

    Billing is one of the most important aspects of running a rehab therapy clinic, aside from patient care. But it can also be one of the most challenging, especially if you’re working with a billing process that doesn’t suit your clinic. The right billing method should streamline your workflow, increase your profitability, and free up some much needed bandwidth. Just think, what could you do with some extra time. With that in mind, we’re going to devote the next …

  • articleMar 18, 2013 | 3 min. read

    Get Your Life Back: Billing Best Practices for Rehab Therapists, Part 4

    Billing is one of the most important aspects of running a rehab therapy clinic, aside from patient care. But it can also be one of the most challenging, especially if you’re working with a billing process that doesn’t suit your clinic. The right billing method should streamline your workflow, increase your profitability, and free up some much needed bandwidth. Just think, what could you do with some extra time? With that in mind, we’re going to devote the next …

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