5 Biggest Billing Mistakes in Rehabilitation

5 Biggest Billing Mistakes

By Mary Wirkus, Director of Implementation, Hands on Technology

Your billing determines the success and failure of your practice. Are you billing efficiently enough to grow your practice? Are you doing enough investigating to understand how your payers are reimbursing you? Even the smallest mistakes in billing can have an enormous impact on the performance of your practice. Let’s discuss the five biggest billing mistakes that you can fix today!

Mistake One. And this is a big one. Do you have an EMR? Is it fully integrated? If you answered no to even one of those questions – you could be throwing money and productivity out the window. Imagine the ability complete your documentation on your patient within minutes, be alerted on missing units, modifiers, and diagnosis codes. The time it takes to hand write your documentation and the general issue of illegible notes or mistakes on dates, treatments, etc. can be avoided by a simple download of a software that allows you to build your own templates and complete your documentation within minutes of treating the patient. Switching to an EMR will decrease your rejections dramatically and increase your overall productivity by allowing more time for your PT’s to treat patients. When choosing EMR’s – make sure you are choosing an EMR that is fully integrated – Nothing is more efficient than an EMR that communicates directly to the billing module. Your billers will have all of the information they need to submit a clean claim. Your billing mirrors your treatments for these patients – no missing data, precise & detailed documentation of medical necessity, and flawless claims to maximize reimbursement. If you are not using a fully integrated EMR today – You could be stunting your growth. I highly recommend starting some research today (www.theraoffice.com).

Mistake Two. Ignoring Change. And nothing changes more than Medicare. If you did not know this already, Medicare is the trendsetter for all your payers. Nothing is more important than to PAY ATTENTION. No one likes to sit in a room and listen to changes that may or may not happen 2 years down the road but I will tell you the people who pay attention to these webinars and discussions are the Practice Owners that are getting it done right. When I say getting it done right, I mean they would score 99%-100% in an audit, and they are still growing their company by maximizing their reimbursements. Medicare and all payers are not adjusting their rules to make your life more difficult, I swear! They are making changes to support your industry and to prove necessity. Ultimately, these rules will lead to facts on the complexity and success of physical therapy that will bring you more patients. Besides the Medicare changes, understand ICD-10, be sure to follow-up on your remits – generate reports that will show your reimbursements (or lack thereof) and maybe it’s time to re-negotiate contracts, pay attention to modifiers (remember mistake 1 – get an EMR that will remind you when to add these modifiers), collect more money upfront, offer cash pay options, the opportunities are endless once you do the research to find out where your practice may be falling short. Grow with the trends and stay informed!

Mistake 3. Incomplete Intake & Verification of Benefits. It all starts at Intake. The first step to clean claims is getting all of the accurate and complete information upfront. Nothing delays billing more than trying to get information from the patient AFTER a visit. Implement an intake process that gathers all of the information you need in order to have the benefits verified and communicated to the patient at their initial evaluation. Clinics with a clear and concise intake process typically have a smooth billing process because they have everything they need right at their fingertips and therapists are alerted of the payer specific rules they are required to complete. Allow your EMR to alert of incomplete data at intake and reduce the number of denials due to small details that were missed.

Mistake 4. Giving patients a free ride. Therapists are typically in healthcare because they love helping people and making them feel better. It would be impossible to turn away someone in pain but don’t forget that your time and expertise is valuable, and you deserve to get paid for your services. Pay attention to the time spent with each patient and charge the appropriate amount of units for that time. Many clinics will set a minimum number of units a therapist can charge per visit, typically this number is four units per visit. This goal will allow you to set annual goals for your therapists and calculate your annual revenue. Stay on track and charge for what you accomplish.

Mistake 5. Inconsistent and Incorrect Billing. EMR will allow you to complete all your notes THAT day so why not bill EVERY DAY? Follow up with your billing team to find out how often you are sending claims, correcting claims and re-submitting, etc. You might have to do some auditing to make sure we are getting clean claims out daily. Also, I do recommend a clearinghouse to scrub each claim for mistakes to avoid rejected claims from the payer. If you find that you are constantly submitting claims with the same issues – this could be causing a delay in getting paid or a decrease in reimbursements. Through the use of a fully integrated EMR and a clearinghouse, you should be able to submit clean claims daily which results in an even cash flow for your practice and reduce the amount of manual checks of each claim.

Ultimately, the best practice to medical billing is to stay informed and implement changes to set your practice up for success. Run the reports, investigate areas you can improve and make changes that allow your practice to grow!