Smoothing the Billing Process to Achieve Faster Payment
12 tips to help get paid correctly and faster
By Jessica Matherne
The priority for a billing company is to help their clients get paid quickly and correctly. Unfortunately, many payers don’t share that priority. In fact, they are strongly motivated to find ways to NOT pay valid claims, creating friction in the A/R cycle.
One example to illustrate this point: We found with a new client that a major insurer was consistently denying one common CPT code whenever it was billed. After extensive efforts on our end, we were able to speak with a manager at the insurance company about this issue. She shared that they kept denying that CPT code simply because the client (or their previous biller) had never appealed the denial. There may have been nothing wrong with the claims. The payer had found that when they denied that CPT code it wasn’t contested. That was sufficient reason in their eyes for them to continue this practice. This amounted to thousands of lost dollars over time.
While likely legal, this action toes the line when it comes to being ethical. But it highlights that when trying to get paid correctly and quickly, it isn’t enough for physical therapists to be correct on our end. We must fight, and we have to do it proactively.
Whether you manage your own billing or outsource it, here are some key things that PTs should do to optimize the speed and correctness of payments:
Use the best billing and clearinghouse software you can afford.
Without advanced software, your billing tasks will take much longer, and it is more likely that mistakes will be made. Unfortunately, some of the most commonly used billing platforms are fraught with design issues that contribute to payment errors and slowdowns.
The downside of using the best software is that it requires a solid understanding of the billing process and insurance industry. However, if you are not inclined to keep up with this knowledge, you probably shouldn’t be doing your own billing anyway. It will be cheaper and faster for you to outsource it.
Utilize a real-time online eligibility verification platform.
Although you will still need to call the payers on approximately 20% of your patients, online eligibility verification is less prone to error and will save you significant time.
Take the time to ensure you have authorization for ALL visits and ALL CPT codes you will use.
Unfortunately, it is very common for physical therapy offices to have visits and CPT codes that have not been correctly authorized. It is so frustrating for physical therapy owners when they have to approve write-offs for thousands of dollars because the front desk didn’t follow the steps to ensure the procedures were approved. With margins in physical therapy being so narrow now, you simply can’t afford to not be paid due to lack of authorization and other front desk errors.
Submit clean claims.
This is another benefit to using great billing platform and clearinghouse software. They catch errors on claims BEFORE they are submitted to the payer. You don’t want to wait 30 days to find out from the payer that you have someone’s ID number wrong. If you can have every claim go out to the payer correctly, you will be well on your way to faster payments.
Submit as many claims as possible electronically.
A top-of-the-line clearinghouse can connect you electronically with a much higher number of payers. When you have to mail claims and wait for mailed payments, your payment cycle will obviously be much longer. This is even more significant when denials or errors must be corrected and mailed back to the payer. You also want to be able to attach documents to the electronic claims, rather than having to send attachments by mail.
Fix payer rejections immediately.
Regardless of how well you aim to submit clean claims, you may still find you receive rejection notices from some payers. Fix these rejections immediately and resubmit.
Respond to denials immediately and fix the system or procedural problem.
Some of these denials will be appropriate and some will be mistakes by the payer. Regardless, address them right away. Also, investigate what processes and systems you can change in your organization to avoid these denials in the future. Appeal denials that you feel are inaccurate.
Post payments quickly.
From a workflow perspective, posting timely payments is especially important for patient statements. If there is a delay in posting an insurance or patient payment, it will increase the likelihood of their next statement being incorrect. This will cause more work on your end and slow your payment cycle.
Ensure adjustments are correct.
Another sneaky game payers play is that they sometimes use an adjustment code to write off a line item (or entire claim) that should have been paid. You can’t afford to just accept adjustments. Someone on your team needs to be looking at these to ensure that the adjustments are correct.
Fight every unpaid line item every 30 days.
To do this, you should run your A/R report by patient (balances due insurance and balances due patient) and take action on every unpaid line item. Sometimes this entails a lengthy phone call. Sometimes it will simply require resubmission with documentation.
Someone on your team should be reviewing random accounts every month to ensure that your billing processes are being followed. There is no point in having the same person doing both the billing and the auditing. Everyone needs to be held accountable, and only by looking deeply into accounts will you be able to feel confident that everything is being done correctly.
Ensure your visits seen = visits billed each month.
This may seem obvious, but there are a number of reasons why visits seen may not be billed out. Each month, take the time to run reports that show that everything was billed out.
Unfortunately, physical therapy billing is still far too manual a process. One would think in this day and age that the steps would be all carried out seamlessly by software. However, partly because insurance companies make mistakes, partly because some of them intentionally make life difficult, and partly because physical therapy offices also make errors, a live person still has to be involved in every step of the billing process.
The average outpatient clinic generates over 2,000 separate charges (CPT codes) each month. Someone has to be responsible for making sure that each line item is paid correctly. Even with the best software, mistakes will be made, and you must have systems in place to catch them when they do.