Billing Breakdown

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10 tips to efficiently audit a patient contract.

By Connie Ziccarelli

Busy private practice owners can find it difficult to keep a close eye on billing practices. With limited time and many aspects of a clinic, it is common for billing details to fall by the wayside. It does not take a lot of time dedicated to auditing billing processes, as long as the process is organized. By following this checklist, it is possible to increase efficiencies when auditing managed-care contracts.

Check online directory to ensure all locations are listed
Check insurance websites twice a year to ensure that the addresses and providers listed are correct. Patients often go to their insurance website to see what clinic is closest to them, so make sure all the information is correct. Also, be proactive in keeping your payers updated with any new providers, programming, or clinic locations.

How Do You Determine if Medicare Is the Secondary Payer (MSP)?

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By Mary R. Daulong, PT, CHC, CHP

Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility; that is, when another entity has the responsibility for paying before Medicare. Over the years, Congress has made an effort to shift costs from Medicare to the appropriate private sources of payment, which has resulted in significant savings to the Medicare Trust Fund.

In addition to complying with Medicare statute and regulation, providers and entities contribute to the Medicare Trust Fund’s sustainability by determining, and then billing the responsible payer first. While Medicare does have an MSP Questionnaire, providers are not required to use it. However, they must question the patient about situations in which Medicare could be the secondary payer prior to the initial billing. Sample questions to ask the Medicare patient are:

Knowledge Amplification

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By Tannus Quatre, PT, MBA

We have all thrown a pebble into a calm lake—the transfer of energy creating ripples that move outward from center until all visible reaches of the lake have been touched. It is a beautiful thing. In a similar way, the transfer of education and knowledge throughout the workplace also often starts from a single source, and done correctly can also touch all corners. While it does not have to be difficult, it does have to be intentional. Educating yourself or your staff is an investment. There is virtually no circumstance in which it does not cost time, money, or both. As such, the return on your investment is going to be greatest if there are many ripples, and they extend far throughout your practice.

What’s in a Name?

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By Terry C. Brown, PT, DPT

An idea that is developed and put into action is more important than an idea that exists only as an idea. – Buddha

When you hear “Private Practice Section,” what does that name say to you? What is private practice? Who belongs to that organization?

I thought my orthopedic practice epitomized private practice, a bricks and mortar outpatient clinic owned and operated by physical therapists. This type of clinic is the foundation on which the Private Practice Section (PPS) was built, but does it still describe our members today? Is it private practice that we represent or physical therapist entrepreneurs?

Poised for Change

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By Stacy M. Menz, PT, DPT, PCS

While at the Graham Sessions in Savannah, Georgia, I had the benefit of listening to and interacting with some truly amazing people in our profession. What made it even more amazing was this group of people ranged from those who have been involved in the physical therapy profession for years and several Doctorate of Physical Therapy Students (DPT) who are just beginning their journey. The common thread among the group was their willingness to ask questions and raise issues from their individual perspectives. I left the meeting with ideas of next steps for my practice as well as things that I hope to help drive in our profession.

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