Optimize Patient Collections

Tips From the Front Desk Through the Billing Office

By Phil Cadman, PT, DPT

While many of us in the profession of physical therapy began our careers with the intention of making a difference in the lives of those we treat on a daily basis with little regard to the billing, reimbursement, and collection side, we can’t continue to do what we love if we don’t understand and take care of this aspect of our businesses.

While at times a challenging topic to broach, especially directly with the client, the financial strength and success of your physical therapy practice is directly related to effective and timely billing and reimbursement. In fact, it is pivotal in order for your clinic to not only survive, but thrive, so that we can continue to serve our communities.

Declining reimbursements, increasing treatment limits, and complicated approval mechanisms are making it more and more difficult to generate the revenue needed to keep your practice profitable. Allowing balances to accumulate, increasing your write offs from errors, and getting disorganized with your payer contracts are all slippery slopes! So, with all these challenges how can you stay ahead of the curve and improve your collections process?

These are four simple, but not always easy, ways that our private practice clinic has improved our process.

1. Be proactive and prepared

• Look at your payer contracts regularly.
• Track account receivables monthly and at least quarterly
• Review payer mixes to help make efficient strategies and make sure that you not only facilitated the right blend that makes you solvent but that you can utilize the information to make decisions on whether or not you would like to continue to accept specific insurances based on the reimbursement rate

2. Set Goals

For example, for the front desk to collect >95% of all daily collections up front either at the start or completion of each session (make sure you have a check-out process if opting for the end of the session). To help achieve this we incentivize our front desk staff with a cash bonus specifically for this goal.

Additional tips for setting goals:

• Accounts receivable greater than 90 days is less than 10% of total AR
• Send claims out by the next business day by 12 pm
• Track the KPIs that relate to your goals:
• Daily report card for collections for patient responsibilities
• Total AR and % greater than 90 days
• # claims sent out compared to number of visits per day
• # resubmitted claims/total claims
• # of denials/total claims

3. Educate Your Staff and Patients

Make sure that whoever you have at the front desk is good with approaching the subject of insurance/payment with the patients. Provide a policy that the patient has to review and sign based on payment and then be consistent!

We also stress insurance verification. In order to collect, your front desk staff needs to know what the patient’s financial responsibility is, and they must know how to gather all the information necessary to determine this.

Some examples of the information that you will want to verify to reduce delays in payment or reduce confusion include:

• Ensure that you are, in fact, a covered provider (in network) and the services that you provide are ones they will cover
• Copay
• Coinsurance
• Number of sessions covered

Also consider whether the patient has used any visits this year at your location or any other locations other than yours. This may include OT, speech pathology, or chiropractic care if they all come out of the same bucket of coverage for the patient’s plan. Then find out:

• How much have they paid toward their deductible so far?
• Where are they in the progress toward any cap that they may have for their benefits?

Ensuring your staff is clear when explaining insurance benefits is extremely beneficial, as it is foreign to many of your patients and making them comfortable and instilling trust in the staff with the process makes the whole situation more streamlined. Additionally, having the client sign your clinic’s payment policy prevents collections problems down the road.

4. Streamline Your Claims

Here are a few best practices we’ve discovered in our clinic:

• Don’t leave balances uncollected too long. Usually past 90 days, they are unlikely to be collected and this can be avoided by following the above steps!
• Make sure your claims are done correctly the first time! Many of our EMR systems have built-in checks to scrub a claim ensure that the claims will go through clean the first time.
• There are some billing rules that may be specific to payers in your state and you may need to manually set these rules within your EMR system. One such example would be a specific CPT code that is not covered by a payer. This should be blocked or set to 0 so that you do not receive a denial and any delay in payment.
• It is important to review, at the very least, your top five payers for any changes in their coverage or allowed codes regularly to stay current and not miss collecting what is due based on services provided.
• Review charts frequently. I recommend that it is done daily or at the frequency that you send out your claims. The chart review needs to be done before the claims are sent out to allow you to make any corrections necessary. This process will help to ensure that you do not have to resubmit the claims, causing more work and likely a delay in receiving payment for the services that were provided.
• If available, enable your EMR system’s program to notify you of corrections for your patients. This function automatically flags a specific patient’s chart and alert your staff to go back through and rectify the problem.
• Send claims digitally because it speeds up the process. For paper claims, stay on the same schedule as what you are using for your electronic claims. Print them on the current HCFA form (make sure that it aligns when you print) and send any additional paperwork that you need including notes or EOBs. Once you receive checks in the mail, you again should have a process that allows you to quickly post payments to patient accounts and deposit them in your bank.
• Have a check reader in your office so you do not have to go to the back to make a deposit. This will save time and allow the deposit to clear more quickly.

While billing and collections may not be the area of physical therapy that we enjoy the most throughout our work day, it can make the difference in the success of your practice. Using these guidelines and suggestions may help with give your practice the financial stability to bring long-term success.

Dr. Phil Cadman, PT, DPT, is owner of Premier Physical Therapy Services in Cincinnati, Ohio. He can be reached at pcadman@premierphysicaltherapy.org or on Twitter at @pcadman11.