According to our
most recent survey, billing remains one of the top concerns facing readers
of Practice Management News. Entire books have been written
on this topic, yet for many offices, simply implementing and maintaining
a reliable billing process is the first step to success. Here are a
few key procedures to review with your office, along with tips on how
SpectraSoft’s AppointmentsPRO
and DocuPRO can help.
1.
Conduct a thorough patient intake procedure
Efficient
billing starts by remembering the classic “garbage-in, garbage-out”
principle. It’s much less expensive to take the time to get all the
patient information you need upfront, than it is to scramble for that
information after a claim is denied. AppointmentsPRO makes detailed
patient intake a breeze:
- Click the “New
Patient” icon to create the patient record.
- Fill out all
the details in the Add/Edit Patient window, including the Social
Security number and birthday.
- If you are missing
any vital information when you create the record, click the Notes
tab to create a pop-up note that will prompt the front desk to get
this information on the next patient visit.
- When you have
filled out all of the information, click OK and you will see
a new window that you can use to fill in the specific case data.
- Be sure to fill
in the primary/referring physician and the primary and secondary insurance
coverage of the patient. Then include the number of authorized visits.
You may need to call the insurance provider to get this information.
You now have all
of the demographic information you will need to include on your claim.
AppointmentsPRO can pass this information on to most leading documentation
and billing solutions including DocuPRO, ReDoc, PTOS, BMS, TurboPT,
DBC and more.
2.
Track authorized visits
Once you
have entered the number of authorized visits in AppointmentsPRO, the
system will track this information automatically and notify you when
the number of authorized visits are nearing an end. Since this number
may not always be available atthe time of patient intake, it is a good
idea to get in the habit of checking this statistic by clicking the
“Edit Case” icon.
3.
Bill the full amount for your services
This may
seem like an obvious suggestion, yet many practices and businesses fail
to bill for all the services they provide. Even small items like billing
for 10 minutes of therapy instead of 15, or neglecting to include an
icepack on the billing slip can add up to substantial revenue left on
the table.
For physical therapists,
DocuPRO generates billing codes directly from the documented activity
of the therapist, eliminating both the need for billing slips and the
chance that a therapist will underbill for treatment. A 4-year, 40-clinic
study found that DocuPRO increased the average charge per encounter
by 41% -- dramatizing the level of underbilling that often occurs with
more subjective methods.
If you are in another
specialty or business, it is important to have regular reviews with
your practitioners to ensure that everyone is billing the same way for
the same services.
4.
Ensure every case is documented and billed
It is
important that you have a method of verifying that the paperwork is
completed for every client you see and that every completed case is
passed on to the billing department. If you are a physical therapist
using SpectraSoft’s DocuPRO, all of your outstanding cases remain on
your screen until they are charted and signed, so you have a built-in,
fail-safe method for ensuring that no case “falls through the cracks.”
SpectraSoft also
offers a special version of AppointmentsPRO for healthcare providers
who work with a billing service such as BMS or MDeverywhere. This version
transmits billing information on a daily basis to your billing partner
automatically, reducing the possibility of human error or omission.
For other office
situations, you will need to implement a manual system to verify that
each case is completed and billed.
5.
File claims electronically with billing software that handles front-end
edits
Capitalizing on an insurance carrier’s automated system reduces turnaround
time on claims. Most billing software or services will clean your claims
of minor errors that delay claims. And by conforming to the carrier’s
electronic standards, you reduce the chances of a denial at least somewhat.
As mentioned above, AppointmentsPRO integrates with many leading billing
systems and services. If you are using a billing system not currently
supported, email us at newsletter@spectrasoft.com
and we will contact your billing solution provider about the possibility
of an integration.
6.
Appeal promptly
When you do receive a denial that you disagree with, take the time
to appeal. Not only do you have the chance of recovering compensation
for your services, you will also learn more about the process and what
carriers are looking in terms of documentation for future claims. Begin
by requesting the plan language and definitions of medical necessity
in the patient’s coverage, if you didn’t receive it with the denial.
Then review your
documentation to make sure it is easy to read and plainly explains how
your care fits under the patient’s policy. You may also need to call
the reviewer and find out what additional information he/she needs to
understand how the care meets the coverage criteria. Avoid the temptation
to deluge the provider in information.
A recent article
in Advance for Directors in Rehabilitation suggests you highlight
the following information in the documentation you submit with your
appeal (you can read the entire Advance article here):
- functional deficits
and goals
- baseline status
on functional tests and assessments
- measurable progress
or an explanation regarding limited progress
- residual problems
that warrant additional interventions
- your plan for
additional interventions or projected discharge
If you use DocuPRO,
one of the existing report templates will likely provide the information
you need to present in a clear, easy-to-read format. You can also customize
any template to fit your needs with the template editor.
7.
Track referrals of unprofitable cases
You may find that certain cases are
less profitable than others for your practice. If so, you may want to
match up case types with your referal network to see if one referrer
is sending you a disproportionate number of these unprofitbale cases.
You can do this by generating a report I AppointmentsPRO: click on Reports > Statistical Reports > Diagnosis
Summary.
