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 of their secrets for RCM success. Here’s what they had to say.
How do you ensure your claims are clean?
Asia Giuffrida, office manager at Gilford Physical Therapy & Spine Center, prefers getting her payer information straight from the source. She combats claim confusion by contacting “the payer directly and verifying all billing information” before sending out the first claim. In doing so, she sidesteps easily-avoided snafus at billing time by having a clear understanding of payer preferences as well as what should “be included/omitted on the HCFA.”
For Michelle Underhill, speech language pathologist at Northern Colorado Therapy Services, LLC, it’s all about using the right RCM software. She recommends having a billing software with claim checks in place to ensure her forms are pristine before she ships them off to the payer. As Underhill puts it, “this allows me to catch simple mistakes so they don't [result in] denials.”
How do you maximize reimbursements?
It’s tough to overstate the importance of using the right modifiers, especially when your goal is getting the maximum payout for your services. As Samantha Van Arsdale, office and billing supervisor at Pacific Northwest Physical Therapy (PNWPT), says, “I make sure to use modifier 59 when applicable.” And that’s great advice, as appropriate use of the 59 modifier can be the difference between receiving a bundled reimbursement—one that combines payment for one or more codes—and getting paid for every separate service you actually provided.
Giuffrida, who uses Therabill for her RCM software, likes the program’s automated modifier system, which helps her verify proper application of all modifiers. She also emphasizes the value of timely filing: “Filing on time...[often] comes with pay incentives for some payers,” she says.
Annette Knight, billing manager at Schultz Physical Therapy, suggests taking the time to research potential reimbursement roadblocks prior to the initial evaluation. For example, she looks into limitations such as capped dollar amounts and annual allowed visit maximums for therapy services. She also stresses the importance of communication with the patient regarding any other ongoing therapy services. “Ask if the patient is currently receiving any type of home health services, and obtain a discharge summary with the date of discharge from the home health company,” she says. Knight also recommends keeping this kind of documentation on file to assist in the event of recoupment from the insurance provider.
What are your tips for consistent timely filing?
Many therapy practices prefer to file claims as soon as they come in, but Samantha Van Arsdale suggests a different approach: “Billing consistently on the same days really helps our practice,” she explains. Van Arsdale says submitting batch payments on specific days helps her better predict when she will receive reimbursements from insurance companies. “It keeps the payment [flowing] really well!” she says.
Giuffrida checks her billing software’s A/R report on a weekly basis to verify the stage of each claim. “Follow up first on the ones you know have a narrow timely filing window,” she advises. She also emphasizes the value of using the payer’s website to monitor claim status. “Always use the payers’ websites to check on claims before calling. Often, this can reveal what stage the claim is at.” Finally, she recommends keeping copies of everything—just in case she ever needs proof of timely filing.
How do you handle denials, rejections, and past-due balances?
Of course, even the most organized practice will receive the occasional denial. And when that happens, Knight doesn’t waste any time. “Work denials and rejections as soon as [you receive them],” she advises. “Timely filing of corrections and appeals usually have very narrow time frames.” She also sets a consistent schedule for going over past-due balances, making time to review and follow up on those amounts on a biweekly basis. When a patient’s balance is past-due, her clinic follows this process:
- She calls the patient to set up a payment plan for the remaining balance.
- If the patient doesn’t respond, the clinic sends the patient a statement with an attached letter requesting the patient call the billing department to discuss a payment arrangement.
- The clinic repeats steps one and two a every 30 days for three months.
- The clinic sends one last letter in a final attempt to set up a payment arrangement.
- If all attempted patient communications fail, the remaining balance goes to collections (if it exceeds a specific dollar amount).
When it comes to patient collections, Giuffrida recommends consistent follow-up. “Work diligently with the insurance company to correct [denials and rejections] as soon as possible and record every step [you] take as proof of due diligence,” she says. And like Knight, she recommends having a formalized process that starts with calling the patient to set up a payment arrangement and then following up with mailed statements.
Anything else you'd like to share?
“I learned a lot from self-teaching and [researching] on my own time,” Van Arsdale says. “I've also gone to a lot of the meetings the insurance companies put on [regarding] the billing aspect.” Additionally, she found that taking an online college course went a long way toward boosting her billing knowledge.
Knight also touts the benefits of keeping yourself educated on industry and compliance changes: “Stay up-to-date with the ever changing rules and regulations by researching on your own time, and by attending workshops and webinars offered through insurance companies and [industry thought-leaders].”
There’s nothing simple about rehab therapy billing, but with a little patience (and a bit of golden advice from your peers), you’ll be spotting—and correcting—potential denials before the payer ever has a chance to hit you with them. Ready to up your practice’s RCM game even more? Join us for Ascend—the ultimate rehab therapy business summit—on September 29–30 in Washington, DC. There, you’ll have the opportunity to learn from industry leaders and meet with other rehab therapy professionals to discuss successful strategies and share ideas.