Are You Getting Paid Fast Enough?
By Daniel Jensen, PT, DPT
Revenue Cycle Management (RCM) is one of the most difficult aspects of the health care industry and is likely one of your biggest headaches as a private practice owner.
There are so many factors complicating this process, including our third-party payor system, federal vs. commercial billing guidelines, slow credentialing, retroactive review processes, and authorization requirements. Unfortunately, many of these factors are completely out of our control, so it is important that we understand where we can make an impact.
The ultimate goal for the RCM team is to not just get paid, but get paid fast by cutting down the amount of time between when claims go out the door and when the check arrives back in the mail. The longer this process takes, the less likely you are to receive full reimbursement, if any at all! Getting paid fast isn’t just the RCM’s job; getting paid fast starts with the practice owner.
ACCURACY AND EFFICIENCY
The two keys to success are accuracy and efficiency. Again, look at what you can impact and control. One such thing is cutting back on denials. If a claim is denied, you have lost all of the time it initially took to process and are now starting over again. Some questions to ask yourself are:
- Are our therapists documenting well, showing medical necessity, using acceptable objective measures, and justifying continued care? Are we giving the insurance companies the information they want to see?
- Do our therapists understand how to accurately bill for what they do based on federal or commercial guidelines? DO YOU?! Do we know what our contracts say we can and cannot bill?
- How quickly are we completing documentation?
- How accurate and timely is our front office staff with data entry, authorizations, etc.?
- How well is our team communicating when required evaluations/re-evaluations are due?
- Are we collecting copayments at the time of service? This should be a lay-up!
- Do we know what our current outstanding Accounts Receivable (AR) balance is?
- Do we know how long it is taking for our claims to be reimbursed?
Some of these things may seem elementary, but some honest evaluation of these bullet points could likely reveal some major pain points for your business.
VALUE YOUR SERVICES
Addressing these deficiencies may create some difficult conversations with your team members, particularly clinicians. One such conversation might be addressing the subject of billing with your therapists. As physical therapists, we are generally empathetic people, however, when it comes to reimbursement, this general mindset can lead to “feeling bad” about charging for our services. It is imperative that we educate our staff members on valuing the services they are providing, and how this ultimately has a massive impact on the profession itself. In preparing for these discussions, understand that you can avoid looking like the “corporate overlord” or the “money hungry owner” who just wants to bill more to get more money. One way to avoid this is to educate the therapists on underbilling, as well as overbilling, and how oftentimes you are just asking them to bill for things they are already doing! Additionally, when having conversations about operations and workplace efficiencies, it is important to take the approach that while we are empathetic caregivers, we are also a business; in order to succeed we need to do both things well!
RCM is certainly a multifaceted, complicated process and the trend seems to be that this will only continue—or get worse! We must adapt to these changes, and continually review the processes we have in place to ensure we maintain our accuracy and efficiency. Refining your approach to this essential business function is crucial for sustaining profitability and building a culture of success.
Daniel Jensen, PT, DPT, is the Area Manager of Southeast Pennsylvania for Pivot Physical Therapy. He can be reached at firstname.lastname@example.org.