There are a number of factors in the physical therapy industry that influence billing; some might be entirely out of your control (like the Affordable Care Act, ever-changing Medicare regulations, and documentation requirements, to name a few). But there also are factors you can influence that directly impact your clinic’s success: namely, your staff and your processes. If your people and your workflow don’t support your desired outcome (i.e., getting paid), then you’ll want to evaluate how you operate. And although that might sound like a lot of work, there’s no need to panic.
Want your billing to run like a well-oiled machine? Simply tune up your attention to detail, and start optimizing your workflow. Here are four ways you can influence your PT billing workflow for better results:
1. Get Started on the Right Foot
Where should you start? At the very beginning, of course. Before your patient even enters your clinic for treatment, you have the opportunity to set up the entire episode of care for billing success. As soon as you’re in contact with the patient, immediately discuss his or her benefits. You’ll then need to confirm with the patient’s payer:
- the patient’s insurance eligibility,
- coinsurance, copay, or deductible amounts,
- the patient’s progress toward his or her benefits cap,
- where to send the patient’s claims (e.g., payer address),
- whether the payer requires specialized forms or additional documentation, and
- whether the payer requires authorization.
This might seem like a lot of information to collect, but the more efficiently and accurately you can collect data, the better your chances of sending out a clean claim on the first try. But simply collecting information isn’t enough; you’ll also want to confirm the accuracy of that data as well as make copies of the patient’s insurance card to keep on file for future reference.
Once you’ve determined the patient’s financial responsibility, make sure you offer him or her your patient payment policy in writing. You can easily add this document to your patient intake packet, thus giving your staff an easy opportunity to clear up any patient confusion regarding payment responsibility. Make sure the patient understands and signs this document to ensure you’re both on the same page.
To further streamline your processes, put a payment card on file and get the patient’s permission to charge it at every visit. One more time-saving tip: put your patient intake forms online so patients can complete them before they come to your clinic.
2. Figure out Your Front Office Process
Your front office staff—and their processes—are crucial to your billing success. That’s because they’re your clinic’s first point of contact with your patients. With this position comes the power to make—or break—your chance of smooth claims submission. For cleaner claims, your front office staff should:
- Check the patient’s balance for past-due payments, and collect all coinsurances or copays at each visit.
- Re-verify patient insurance when appropriate.
- Stay up to date on the claim submission requirements for your top-five local payers.
- Follow a check-out policy and procedure to ensure you’ve collected any balances for visits/supplies.
These policies and procedures are necessary, but they don’t hold much weight without the right people on staff. With that in mind, here’s what you need to look for in your front office staff:
- A love of—or at least an understanding of—the billing process.
- Confidence in payment collection.
- Attention to detail.
- Tech-savviness that allows for easy navigation of your clinic’s software and computers.
3. Get Timely with Your Filing
Even with the right policies in place, mistakes can happen. Implementing a software in your clinic will help minimize that risk. The right billing software (or service, for that matter) should scrub your claims before they head out to clearinghouses and payers. Once your claim is cleaned up and ready to go, you’ll want to file it in a timely manner. Your software should timestamp documents to track claim submission dates. This allows you to follow up on any claims denied due to timely filing mistakes.
You might be wondering what the definition of timely filing actually means. The answer? It depends on your payer. For example, for Medicare patients, you have one year—that’s right, an entire year—from the treatment date of service to submit your claims. Thank goodness all payers don’t operate like Medicare. Although many private payers are following the big M’s lead when it comes to documentation requirements, fewer offer the same lengthy claim-submission time frame. To avoid denials related to timely filing, it’s crucial that you know your contracts inside and out. So, what happens when you do get a denial? If you need to refile a claim, you’ll want to do so promptly. Because the faster you submit the corrected claim, the sooner you’ll receive payment. Then—bada-bing—cash flow can resume.
4. Track Your Trends
Not all claims processing cycles are identical. That’s why, at this point in the billing process, you need to pinpoint:
- which claims are slow to process,
- which claims are denied, and
- the reasons behind the denials.
With everything going on in your clinic, the process of analyzing these trends can be time-consuming. That’s why—again—staffing is crucial. You’ll want to put together a proficient billing staff who can quickly identify why some claims are quickly paid in full and others aren’t. These are the qualities you want to look for in a biller:
- Educated on the ins and outs of billing and up to date on industry trends.
- Diligent with chasing down lost money.
- Ability to use all of your clinic’s technological programs and systems.
- Honest and ethical.
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Ladies and gentleman—start your engines. With the help of solid policies, great people, and updated procedures, you’ll have your billing process speeding to claim reimbursement victory no time. Want to learn more about optimizing your billing workflow? Check out this webinar.
What billing challenges has your clinic overcome? Let us know by leaving a comment in the section below.
About the Author
Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT
As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.
An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.
Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.