As a physical, occupational, or speech therapist, your primary focus is to provide high-quality care to your clients. But let’s face it, with reimbursement rates continuing to drop, running a sustainable practice requires optimizing your billing process to maximize reimbursement. By implementing some best practices, you can streamline your billing procedures and minimize claim denials, ultimately improving your practice’s financial health. In this blog post, we’ll explore key strategies to help therapists optimize their billing process and boost reimbursement.
Set Goals and Monitor Performance:
To begin, it’s important to establish goals and track key performance indicators (KPIs) that can guide your billing process optimization. While the metrics you should monitor are unique to each practice and their goals, there are some metrics you can start with:
- Clean Claims Rate: This metric reflects your billing accuracy. If you submit clean (error-free) claims, you’ll be paid more quickly. On the other hand, consistently denied claims can lead to wasted time and effort in resubmitting them, resulting in lower productivity and an unstable cash flow. Your clean claims rate needs to be 98% or higher. If you fall short of this target, you need to identify the reasons behind the denials and take corrective action.
- Days in Accounts Receivable: With this metric, you want to focus on how much of your Accounts Receivable are over 90 days old. It indicates the length of your billing cycle. Your Accounts Receivable over 90 days old should make less than 20% of your total Accounts Receivable (less than 15% optimally). If a lot of your Accounts Receivable are over 90 days old, it’ll take longer for you to get paid, and you won’t be able to accelerate your cash flow.
- Cash As a Percentage of Net Revenue: Don’t worry, this doesn’t mean you should only be paid in cash. Simply put, your practice’s revenue-to-payment ratio measures how effectively you generate operating cash from your services within a specific timeframe. It reflects the efficiency of your practice in converting revenue into cash flow. It should be around 95%.
By keeping a close eye on these indicators, you can identify any weaknesses in your billing process and make necessary adjustments.
Understand Medicare and Payer Policies:
Having a clear understanding of Medicare policies and payer guidelines is crucial for accurate and compliant billing. Familiarize yourself with the CPT codes relevant to your services and ensure they align with the requirements of Medicare policies. Additionally, various Medicaid plans may use different rules for determining billable codes, such as CMS 8-minute rules or CPT guidelines. Stay updated on these policies to avoid coding errors and potential reimbursement delays.
Stay updated on changes in payer policies. We strongly recommend maintaining a comprehensive document that includes all payer policies and their latest updates, especially if you work with multiple payers.
When it comes to CPT codes, it is crucial to have a readily accessible license for you or your staff during documentation. Some EMRs, like Fusion, offer AMA licensing for a nominal fee. By using these types of EMRs, you can minimize the chances of errors and stay up-to-date with the latest codes.
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Proactive Communication with Insurance Companies:
Maintaining open lines of communication with your clients’ insurance companies can significantly reduce the risk of claim denials and payment delays. Before providing treatment, proactively inform the insurance company about your care plan and ensure they have all the required information. Review your contract, and don’t hesitate to negotiate if you find areas for improvement. Advocating for your clients and effectively communicating the necessity of your services can help support successful reimbursement.
You should establish an estimate of cost-before-care guidelines so you can notify clients of the billing situation before treatment begins to avoid unexpected costs. A review of insurance policies should be done annually to revise necessary forms and update billing procedures.
Streamline Documentation and Billing Processes:
Efficient documentation and billing processes are key to maximizing reimbursement. Ensure that your therapy documentation is detailed and accurate, and supports the medical necessity of the services provided. Consistent and clear documentation not only helps in successful claim submission but also strengthens your case during potential audits or reviews. Take advantage of your EMR to streamline your documentation and billing workflows, minimizing errors and improving efficiency. If you can, use your EMR to automate some billing processes. For example, Fusion can create claims automatically when charges are submitted from daily notes. You’ll also want to have a clear claims status when looking at claims. Fusion indicates claims status prior to submissions via color. If your EMR alerts you about missing information beforehand, your chances of submitting clean claims significantly increase
Regularly Review and Update Insurance Policies:
Insurance policies and requirements can change regularly. To avoid any surprises or billing errors, review your insurance policies annually to ensure you have the most up-to-date information. Revise necessary forms and update your billing procedures accordingly. Staying proactive in understanding the latest insurance policies will help you maintain compliance and maximize reimbursement.
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Educate Your Staff and Create Clear Processes:
Optimizing the billing process requires a team effort. Educate your staff on the importance of accurate documentation, coding, and billing procedures. Establish clear processes and provide ongoing training to ensure everyone is aligned with best practices. Regularly communicate updates and changes in billing regulations to keep your team informed and prepared.
If you’re tired of battling billing issues that drain your revenue and eat up your time, it’s time to bring in the experts. Outsourcing your billing may not be the right fit for everyone; take a look at your billing workflow and ask yourself if your time and money could be better spent elsewhere or if some adjustments are needed.
When you choose to outsource your billing, you’re entrusting your revenue cycle management to a team of seasoned professionals. They’ll take care of everything, giving you the freedom to focus on your clients. At Therapy Brands, we offer top-notch revenue cycle management services. And here’s the best part – our team only gets paid when you do, so we’re fully invested in getting you the best results.
By implementing these strategies, physical, occupational, and speech therapists can optimize their billing processes to maximize reimbursement. It’s an ongoing process, but by proactively managing it, you can make necessary adjustments that will greatly benefit your practice. Optimizing your billing process not only benefits your practice but also ensures that you can continue to provide high-quality care to your clients without financial strain.
We know the struggles physical, occupational, and speech therapists go through when it comes to managing their practice. That’s why Fusion is packed with smart billing features and user-friendly documentation workflows. You can effortlessly streamline your billing processes and boost your efficiency. Learn more about Fusion and see how we can simplify your practice management needs and help you maximize reimbursement: Schedule a demo today.