Almost all of our rehabilitation clients name timely reimbursements as the number one headache on the business side of running their practices. Yet cash flow forecasting is one of the top things a buyer looks for when acquiring a practice. Even if you are not planning to sell your company, our tips for effective reimbursement will help speed up your payments.
1. Develop and implement standard coding procedures for all therapists in your organization.
With a little effort, effective coding practices can be documented and incorporated into your total training program for all current and new therapists. Remember, your reimbursement starts with the therapist and his or her interaction with patients. It’s imperative that therapists bill for all services provided and make sure they utilize all the codes available to them.
Many physical therapy CPT codes overlap. This means that more than one code could be appropriate for the procedure performed, depending upon the intent of the outcome. This is especially the case with timed codes including Therapeutic Activity, Therapeutic Exercise, Neuromuscular re-education, and Manual Therapy. (Most therapists are unaware that Manual Therapy is typically the lowest reimbursed code of this group.)
Other quick coding fixes:
• Re-evaluations. Perform and bill for re-evaluations when a patient is discharged or going back to see the physician. Medicare requires a change in status to justify a re-evaluation, so be sure that is clear. Utilize a 59 modifier when a re-evaluation is billed with other treatment codes.
• Range of Motion (ROM), Manual Muscle Testing (MMT). In order to measure objective progress, ROM and MMT can be performed periodically and billed on the day performed. The exception is when these services are performed on the same day as an evaluation or re-evaluation. In that situation, these codes would be considered part of the evaluation and could not be billed separately. In this scenario, ROM and MMT are NOT timed codes and should be accompanied by a clear report to depict measurable progress in motion or strength.
• Therapeutic Activity and Neuromuscular Re-education. These two codes should not be billed on the same day of service as they are viewed as interchangeable.
2. Put in place a disciplined, replicable insurance and patient follow-up process.
Payers will play the game of avoiding payment as long as you will allow. Educate your staff on ways to use more assertive tactics when performing insurance and patient follow up.
With proper training, our clients have had success implementing a strict follow-up cycle to effectively demonstrate to the payer that they are serious about collecting their money. If a payer is not complying with the contractual terms of your agreement and/or are inconsistent with state insurance regulations, you and your staff have every right to request a face to face with the payer.
For insurance companies, we recommend the following follow-up cycle from the day a bill is sent:
• 30 days- Follow up and re-bill if necessary
• 45 days- Follow up and re-bill if necessary
• 60 day – Appeal and send the bill to the patient for collection support
• 90 days- Contact the insurance commission in your state. If there are a number of late claims from a single payer, schedule a face-to-face meeting.
Our suggested patient balance follow up is:
• 30 days – Friendly letter and phone call
• 45 days – More assertive letter and phone call
• 60 days – Final notice for collections and an assertive phone call
• 90 Days – Turn over to credit bureau collection company
3. Develop and encourage a system of regular communications between the billing and clinical staff.
It’s an old wives tale that the business side of physical therapy can run separately from the clinical side of the house. The business functions need the full support of the clinical staff in order to bill and collect effectively. Proper documentation, coding, timeliness of notes are all factors that will impact a billing staff’s ability to be successful. Therefore, regular meetings between these two functions must occur at least on a monthly basis, preferably once a week.
Sample agenda:
• Summary of denials and rejections
• New insurance regulations and the impact
• Timeliness of notes, reports, etc.
• Payer tips (what is paid, not paid, etc.)
• Specific patient issues, i.e. non-payment, compliance
In addition to these tips, there are a number of other factors that contribute to successful accounts receivables management. Clean claims submission, days in accounts receivables, denial rates are a few of the key indicators that you should be utilizing to measure the success of your billing and collections department. For more information about an effective reimbursement program in place, visit Martin Healthcare Advisors.
