Record-Breaking Payment Speed During the COVID-19 Crisis

6 Tips to getting paid faster than you ever have in the time you need it most

Janet M. Shelley, PT, DPT*

The health care industry is notoriously inefficient at billing and collecting payments, even in times of prosperity.

With patient volumes dwindling during the COVID-19 crisis, there has never been a better time to streamline billing and eliminate speed bumps in payment collection. It is more crucial than ever to work with your billing staff to modernize your collection strategy with these six easy tips.

1. Verify the Insurance Codes for Service and Place of Service

Coding your claims correctly on the front end will ensure prompt claim payment and prevent delays for correction and refiling. As physical therapy is extending beyond the clinic setting during the crisis, it is essential to verify the correct place of service codes and billing modifiers with the payer. Ask if the regular therapy CPT codes can be charged for telehealth visits, remote evaluations, virtual check-ins, telephone assessments, or e-visits, or if there are alternate codes required for these new intervention types.

Common Place of Service Codes

• 02 Telehealth
• 11 Office
• 12 Home
• 13 Assisted Living Center

Common Modifiers Required by Payers

• GT Via Interactive Audio and Video Telecommunications Systems
• GQ Via Asynchronous Telecommunications Systems
• 95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
• CR Catastrophe/Disaster
• DR Disaster Related

Common CPT Codes (specific to each payer in this temporary environment of telehealth and digital visits):

• Regular 97000 series of codes for physical therapy
• Remote Evaluation of recorded video/images (G2010)
• Virtual Check-in (G2012)
• Telephone assessment and management services (98966-98968)
• E-visits (G2016-G2062)

Note that modifiers, place of service codes, and CPT codes to file ARE payer-specific, so it is crucial that you verify these with the payer before delivering the care.

2. Prioritize Patient Collections at Time of Service

Four ways to accelerate collections at the time of service are to take payments at the front desk at the time of the appointment, enable payment plans, create an option for online bill pay via your company website, and perhaps consider working with a third-party company that issues medical credit cards or provides for health care financing.

With increased patient responsibility for their portion of therapy bills over the last decade, it should be a standard practice to collect payments at the front desk of your clinic at every appointment. As of 2019, 82% of insured patients have deductibles compared to 59% in 2008. Additionally, the deductibles have increased from an average of $735 in 2008 to now $1,655.¹ The COVID-19 crisis has hit right after deductibles have reset at the beginning of the year, so patients should expect to pay at their visit either their copay, deductible or co-insurance. Taking patient payments at the time of service expediates the collection process, so now is not the time to shy away from collecting money upfront. Coach your front desk staff on the importance of collecting payments at the time of service whenever possible.

According to the Kaiser Family Foundation survey, the increase in insurance deductibles has resulted in 467% more patients asking for payment plans from 2015 to 2018.¹ To accommodate this need, you may want to set up an automatic bank draft monthly for payment plans you agree to. Spreading the payments out over time will help your patient mange the expense, but having their permission to process the payment automatically at the beginning of the month will give you some confidence that the payment plan will be a priority long after they have discharged from therapy.

If you haven’t already, eliminate paper statements and switch to emailing or texting bills. This reduces the time to collect payments, as many patients will pay on their mobile device as soon as they receive a bill. Not shockingly, 71% of consumers want eStatement medical bills, yet only 17% of consumers receive electronic bills.² To meet this patient demand and enhance your collection process, ensure you can also accept online payments. Paying your bill online is standard in virtually every industry and gives the added benefit of directing patients to your website. With 81% of consumers owning a smartphone and 75% of American adults owning a desktop or laptop computer,³ paper statements have become nearly obsolete and cause unnecessary hindrance in collection when you need payments quickly.

Another option to increase payment speed is to work with a third-party company for healthcare financing or medical credit cards such as Care Credit. This will allow immediate payment to the practice and Care Credit will carry the debt with the patient, rather than patient debt causing delays in your collection process.

3. Ensure Completed Treatment Notes Daily

As a clinic owner, it can be really easy to neglect treatment notes and leave them open at the end of the day as you pursue other management duties. Busy therapists are known to struggle with this process as well. Incomplete patient notes prevent charges from reaching the billing department or billing company, and it is an easy habit to fix within your practice. Most electronic medical records have an option for you to run an open note reports, which you can inspect daily. Identify therapists who are habitual offenders and keep them accountable for completing their treatment notes every day. This small step will accelerate the billing process, helping you remain financially viable during this crisis.

4. Request Advance Payment from Medicare

Medicare has an advance payment system in place for natural disasters or emergencies and has expanded this program for the duration of the COVID-19 public health emergency. The Advance Payment Program provides 100% of the Medicare payment amount for a three-month period as an immediate loan, which can provide some needed financial relief while patient volumes are down. Payment for approved requests will occur within seven days. For the following 120 days, you will submit claims and be paid for them as you always have. Repayment will begin after 120 days, where new claims will reduce the outstanding advance payment balance. Your loan amount will be paid back to Medicare via recoupment from claims. Most providers will have 210 days to complete the recoupment process. This is effectively equivalent to being pre-paid for future work and is a great option to keep your clinic open during this financial downturn. See this Fact Sheet⁴ for more information.

5. Resolve Credentialing Issues

Use this time of lower volume to work on resolving credentialing issues that may have pended claims. Insurance payers are prioritizing provider enrollment tasks so that health care providers can rapidly move to manage patients during the COVID-19 crisis. Because private practices are considered an essential business, keeping patients out of urgent care, primary care, and emergency departments, this is an ideal time to pursue credentialing delays. Medicare survey requirements for private practice physical therapist have been temporarily suspended resulting in phenomenal completion of Medicare enrollments, less than one week for a client of ours.

6. Aggressively Work Outstanding Accounts Receivable

Another common payment delay is neglecting to respond to requests from payers and billing companies. Provide payers with requested records and answer your billing office’s questions so that they can quickly make corrections and refile claims to facilitate the payment process. Swiftly addressing the needs of the billing department or company will help reduce your time from initial claim filing to payment.

In the time of the COVID-19 crisis, tightening your billing and collection process should be a top priority. Several small adjustments, like verifying claim codes, collecting payment at the time of treatment, completing treatment notes, and addressing outstanding accounts receivable will greatly increase the rate of payment for your clinic. However, it is also a great time to make some bigger changes: switch to online billing, work with a medical credit card company, request advanced payment from Medicare, and resolve credentialing issues to maximize collection efficiency and buffer against the loss of patient volume. Implementing these strategies at this opportune time will lead to the fastest collection of outstanding accounts that your practice has experienced and forming good habits now will lead to sustained improvements in your billing and collection process for years beyond the crisis. 

References:

¹2019 Employer Health Benefits Survey. Kaiser Family Foundation website. https://www.kff.org/report-section/ehbs-2019-summary-of-findings/. Published September 25, 2019.

²Trends in Healthcare Payments Ninth Annual Report: 2018. InstaMed website. https://www.instamed.com/white-papers/trends-healthcare-payments-report-2018/

³Mobile Fact Sheet. Pew Research Center website. https://www.pewresearch.org/internet/fact-sheet/mobile/#who-owns-cellphones-and-smartphones. Published June 12, 2019.

⁴Fact Sheet: Expansion of the Accelerated and Advance Payments Program for Providers and Suppliers During Covid-19 Emergency. Centers for Medicare & Medicaid Services. https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf

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Janet M. Shelley, PT, DPT, is CEO of Medical Billing Center (MBC) and specializes in billing for outpatient therapy. She can be reached at jshelley@4mbc.com.

*The author has a professional affiliation with this subject.