physical Therapy Billing

Health Insurance Claim Form 1500 Instructions - physical Therapy Billing

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Physical therapy billing is often misunderstood and taken for granted by most incommunicable practices which follow in thousands of dollars lost each month, if not more. Permissible Pt billing and Cpt coding can make or break a practice. Those who know rehab billing secrets and techniques and do it well are more thriving overall. Those who do not fully understand billing for physical therapy don't do as well.

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Health Insurance Claim Form 1500 Instructions

What You Don't Know Will Hurt You!

Your billing ideas is the life blood of your incommunicable practice. The billing ideas keeps the wage flowing that in turn keeps the enterprise going. Most physical therapists want to treat patients and not deal with the billing. They think it's a "headache" and would rather dump it off on man like a billing service or enterprise or an employee. As a follow of this mentality most practices over the country are losing out on a lot of money! The typical institution collects only 40% of what they should be and could be collecting. Billing is more than generating a claim with prognosis codes and Cpt codes. It is much more than that.

What the Most thriving Practices are Doing

1. They get all the right tools. They don't use borrowed (stolen) forms from past employers and copy man manufacture a lot of mistakes. They don't use MediSoft, Lytec, TurboPt, Ptos, or Clinicient. Instead they have...

 Good Software with few bells and whistles.

 Good sick person Intake/Registration Form .

 Good Assignment of benefits (Aob) form containing foremost legal language. It should obtain legal proprietary from the sick person allowing you to deposit checks made out in their name, file a complaint with the guarnatee commissioner on their behalf, receive checks directly from the guarnatee enterprise on their profit (even when their procedure states otherwise. A good Aob will give you solid legal recourse should the guarnatee enterprise or the sick person ever try to evade payment.

 Good New sick person interview form.

 Good Fee slip that's easy to read and understand.

2. They present a bill and obtain sick person portions at the time of service. They don't waive and reduction co-pays and deductibles. Which is illegal without documented financial hardship.

 A good staff member handles the new sick person interview with professionalism and tact and the sick person is made aware of their financial responsibilities, not a minimum wage receptionist.

 All pertinent personal and guarnatee information is gathered at initial interview and/or first appointment.

 Services and codes are strategically chosen based on the type of guarnatee the sick person has and the payer rules.

 Modifiers are applied to maximize billing. All staff are trained well on how to use them.

 Patients are presented with a bill with their portions clearly stated and they pay that day.

 The billing man receives the charges and codes daily.

3. They obtain guarnatee portions within 60 days! They don't accept guarnatee enterprise stall tactics such as, "we don't have narrative of your claim", "it's being processed", "we need more information", "it wasn't medically necessary", etc. They apply the state and federal victualer proprietary laws and get paid fast.

 Billing data is input into the computer timely

 The Aob is manually sent to the guarnatee enterprise payer

 Bills are generated and submitted electronically. Electronic claims are paid within 14 days whereas paper claims can take as long as 60-90 days.

 If cost is not made within 30-45 days, a tracer is sent with a observation warning of a potential complaint with the guarnatee commissioner.

4. They obtain 90-100% of Billed Charges! They don't accept denials of any kind such as, "Untimely submission", "Not Ucr", "Not Medically Necessary", "No Benefits", and "We sent the check to the sick person so go after the patient", etc.

 appeal letters are sent to the guarnatee enterprise in response to all denials. (View sample)

 The guarnatee commissioner and sick person are sent a "Cc" (copy) of that letter.

 If a repayment check is sent to the patient, a examine is made to issue someone else check referencing the instructions made on the Aob form.

 When a ask for "more information" is requested, they payment the guarnatee enterprise a curative ask fee () so they stop using that stall tactic with them. And much, much more...

 If a sick person has an excellent balance owed they don't use weak variety letters, bargain, or write-off the debt. They use variety letters that work and encourage the sick person to do the right thing which is to pay the debt!

 They have cost plans available for their patients that are in effect setup and administered.

 They make sure to payment sick person coinsurance/co-pay's at the time of service each and every visit!

5. They maximize reimbursement! They don't bill every sick person exactly the same way. They don't just bill ther-ex, by hand therapy, ice and ems (97110, 97140, 97010, 97014) with every sick person for a mere reimbursement.

 They use modifiers like -59 and -22 to get paid more for those patients who require more time and energy to treat, such as the sick person who c/o neck, shoulder, back, buttock and knee pain.

 They also use the modifier -52 for when services are reduced.
6. They hold sick person loyalty They don't allow guarnatee companies to maliciously splice the relationship in the middle of victualer and sick person by using derogatory language such as "Fee's are excessive for that geographic region", "Fees are Not usual, customary, or reasonable", "Services rendered were unnecessary or not professional".

 Template letters are sent to guarnatee companies every time they use derogatory language in the Explanation of Benefits statements to patients/providers.

 The guarnatee commissioner and sick person are sent a "Cc" (copy) of that letter.

 They obtain sick person coinsurance/co-pays at the time of each visit so the sick person won't have to later pay a lump-sum-bill three weeks after removal which most population can't pay and swiftly come to resent.

Studies show that patients who owe you money are more likely to file a malpractice suit against you. Studies also show that patients who pay something out-of-pocket for their healthcare services each visit get great faster.

Billing Options available

1. Contracting out to an independent curative billing service

Most of the so called "medical billing services" are stay-at-home moms who took a weekend procedure on "How to Make ,000/yr Working From Home". They learn how to buy software, obtain and input data and submit claims. They're also taught how to print enterprise cards and present themselves as a professional organization. The problem is most of these individuals have tiny to no experience.

Pros cheaper and more personable. Allows you time to market and advertise your services.

Cons Lacks experience. Most likely won't know how to appeal denials or answer to stalling tactics. Most likely paying for easy data entry.

Characteristics

o No setup fee.

o 4-10% of gross reimbursements.

o They obtain sick person info and billing by fax, Fed-Ex, or Pc Anywhere

o Not very good about updating you on status of claims and collections

o Reports are not very good

Results typically are 40-50% of money lost by falling through the cracks and never getting appealed and collected. Most do not know how to appeal denials, file complaints with the guarnatee commissioner, answer to derogatory language in Eob's, train your staff on modifiers and good coding for separate type of payers, or answer well to guarnatee enterprise tactics on stalling and refusing payment--all the things that make a billing ideas great.

If you want to find a decent billing person, one who is organized and knows the basics, ask them these questions:

o Do you have any physical or occupational therapy billing accounts now?

o Can I taste them for reference?

o Can you send me a sample of 3 reports?...monthly claims submitted, monthly paid items posted, aging narrative on every excellent claim.

o What type of billing software do you use? Is it Hipaa compliant?

o How will you obtain the charge/patient data from me?

o Will you teach me code strategies for each payer type (ie. Workers comp, blue cross, medicare, medpay, etc)?

2. Large curative Billing Companies

The larger curative billing companies regularly work with many providers and have many accounts. They typically have more taste but that is no warrant they know how to go beyond data entry, claims submissions and cost postings either. There is not much money in it for them to appeal denied claims because it takes human reserved supply and time to write letters, make phone calls, and submit complaints. They would much rather do the easy data entry and get their percentages from that.

Pros Reports are better. They have more experience. Allows you time to market and advertise your services.

Cons More expensive. Probably won't do all appeals, letters to guarnatee commissioner and patients especially if you are a small inventory (less than ,000 per month).

Characteristics

o Setup fee

o 8-15% of gross reimbursements.

o They obtain sick person info and billing by website log-in, fax, Fed-Ex, or Pc Anywhere

o Not very personable

Results typically are 30% of money lost by falling through the cracks and never getting appealed and collected. Most will not file complaints with the guarnatee commissioner or answer to derogatory language in Eob's.

If you want to find a good billing company, one that appeals denials, files complaints with the guarnatee commissioner, provides detailed reports of claims submitted monthly, claims paid monthly, and aging reports with 30-60-90-120 day statuses then make sure to screen them well. Ask the following questions:

o Do you have any physical or occupational therapy billing accounts now?

o Can I taste them for reference?

o Can you send me a sample of 3 reports?...monthly claims submitted, monthly paid items posted, aging narrative on every excellent claim.

o How will you obtain the billing/patient data?

o Will you teach me code strategies for each payer type (ie. Workers comp, blue cross, medicare, medpay, etc)?

o Do you appeal denials?

o Can I see sample appeal letters that you use?

o Do you ever send patients letters? If so, what and can I see a sample?

o How do I ask you questions? What are your hold hours?

Prices are always negotiable with outside billing companies and independents but be ready to pay if you want them to do all listed above.

3. In-house billing where an laborer does the billing

I advise doing billing in-house with an laborer after a year of solid marketing, advertising, and promoting your practice. Most owners do not have the time critical to do both adequately (as well as treat patients). If you are inspecting hiring an laborer to do the billing be ready to learn the in's and out's first. Even if the laborer boasts about knowing billing. It's a good idea to learn it yourself, setup the system, and work closely with the laborer until they demonstrate competency.

No one will go after the money owed to you and look out for the welfare of your enterprise like you.

Pros More operate over the system. great variety rates. If monthly billing is more than ,000/month you will save money by using an laborer versus an outside service. They can also assume other admin tasks.

Cons Takes time to learn the ideas and set it up.

Characteristics

o laborer wages

o manager taxes

o More operate over billing procedures Results typically are less than 10% of money lost. Less money will fall through the cracks and get lost. Complaints with the guarnatee commissioner will get filed and derogatory language in Eob's will get responded to.

If you want to find a good employee, one that will do the job well, you may want to hire man who tried to start an independent billing service at one time. It's not critical but they may already know the basics. Ask them these questions?

o Do you have any taste with curative billing?

o How much do you think this job should pay? Look for man in the /hr or more range.

o What type of work do you enjoy more, office work or person-to-person work?

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