In a perfect world, physical therapists wouldn’t have to deal with billing. They’d simply treat, heal, and magically receive payment for their services. But we don’t live in that fantasy world, and unfortunately, the billing process is anything but magical. If you’re a PT, submitting claims comes with the territory. Luckily, there are a few things you can do to optimize your billing process to give yourself more revenue—and fewer headaches. Here are our top ten:
1. Set goals.
As a therapist, you’ve got a lot of experience in the goal-setting department. Now, it’s time to carry that positive, can-do mindset over to your clinic’s billing processes. Chances are, there’s plenty of room for improvement in that area. Start by establishing specific goals: decreasing the percentage of accounts receivable (A/R) greater than 90 days to under 10%, for example. Or perhaps you’d like to shoot for sending new claims through to the appropriate carrier within two business days. Whatever goals you choose, just make sure you clearly communicate them to the rest of your staff and that each team member knows his or her responsibilities.
2. Track your progress.
Once you implement your changes, it’s important to objectively—and consistently—measure your progress toward your goals. Numbers don’t lie, so make sure you’re checking your data regularly—weekly or, at the very least, monthly. Then, compare your metrics month-to-month and year-to-year to determine whether what you are doing is actually working. What data should you be checking? Here are some starting points:
- Charges, payments, and adjustments
- Total reimbursement for all carriers
- Total reimbursement for your top five carriers
- Provider and facility patient volume
3. Increase efficiency.
You don’t want to spend anymore time on billing than you have to, but you do want to make sure your reimbursements are quick and correct. To get the best of both worlds, make sure you:
- Send claims electronically rather than via paper when the option exists.
- Submit claims promptly (i.e., as close to the actual date of service as possible).
- Track how long it takes for you to receive payment for your services. If you’re waiting more than six weeks, something’s gotta change. Perhaps there’s room for more automation, or maybe you need to be more aggressive when it comes to collecting copays.
4. Educate yourself and your staff.
Insurance verification is an extremely important part of the patient check-in process, and whoever is responsible for performing this task needs to fully appreciate just how crucial it is, because insurance verification is how you determine that (a) a patient has valid insurance coverage and (b) said coverage applies to the services you provide. You also should nail down the number of visits for which the patient has coverage and the rate of coverage. Essentially, you should always know how you will receive payment for treating a patient before you actually treat the patient—even if it’s a patient you’ve seen before. Also, keep in mind that most patients aren’t hip to insurance jargon, so make sure you and the rest of your team are equipped to answer whatever questions might come your way. By clarifying what’s expected of your patients upfront, you’ll avoid billing and collection problems down the road.
5. Clean up your claims.
Nobody likes to do things twice—and that includes claim submission. So, make it a point to get things right the first time around. That means establishing a process around completing and sending claims and ensuring that all of your information—including ID numbers, dates, names, and codes—is correct before you submit. If you’ve got problems with denials, do a little detective work to identify any common characteristics of returned claims. Then adjust your processes accordingly.
Medicare won’t even accept paper claims anymore, and about 99% of payers now accept electronic claims. So in this day and age, there’s really no reason why you should be submitting paper claims. It just doesn’t make sense. If you need a little more nudging to step into the 21st century, consider this: it usually takes about two weeks to receive reimbursement for an electronic claim—especially if you establish an Electronic Remittance Advice (ERA)—whereas payment for paper claims takes six to eight weeks. Still not sold on e-claims? Check out this blog post for more reasons to go digital.
7. Know your payer mix.
At the very least, you should be able to name your top five payers in terms of patient volume. Really, you should know your top ten. After all, the majority—probably about 90%—of your business comes from your top ten payers, so it behooves you to thoroughly understand their reimbursement rates, claim processing times, and special policies. If you can, run a monthly carrier A/R summary report and compare different months to identify patterns and potential problems.
8. Keep an eye on cash flow.
If you notice that your top payer is reimbursing at a lower rate than the rest, then it’s probably time to renegotiate your fee schedule. But as with any business negotiation, you definitely shouldn’t go into this one blind. Arm yourself with historical reports and do a little digging around to figure out whether you’re receiving less than you should be. The best way to do that? Have casual conversations with friends and colleagues. Never ask for specifics; instead, consider questions like, "Are you seeing a decrease in reimbursements?"
You also should keep a close watch on your cash payments—copays, that is—and maintain a system of checks and balances to prevent any double-dipping.
9. Mark your calendar for ICD-10.
Yes, the mandatory transition to ICD-10 got pushed back from October 2014 to at least October 2015, but that doesn’t mean you should take it off your radar. Rather, you should consider this an opportunity to further prepare yourself and your team for the switch. That way, nothing—not even 68,000 diagnosis codes—can trip you up. Plus, it gives you some extra time to build up your cash reserves. And with experts recommending that you have at least six months’ worth of revenue in the bank come transition time, you’re probably going to need some time to save. Want some more specific advice on how to begin your ICD-10 preparations? Check out this resource page.
10. Hold yourself accountable.
At the end of the day, it’s up to you to make sure your billing processes are working as well as they should be. It’s your practice, your business, and your money. If you want to maximize your revenue, you have to hold yourself—as well as your staff, vendors, and payers—to the highest of standards. And that expectation likely will carry over to other aspects of your clinic as well—including patient satisfaction.
Billing has long been the bane of therapists’ existence, and there will probably never be a true billing “easy button.” But with these ten tips, you can streamline your processes and maximize your reimbursements. Which billing strategies have worked in your clinic? What advice do you have for your fellow therapists? Share your thoughts in the comment section below.