21 Days of Billing with TheraNest
With the holiday season upon us, we here at TheraNest wanted to give you a gift that we know will keep on giving: the billing knowledge you need to build a successful private practice. Every (business) day for the month of December we will be releasing a new billing tip on this page and via our social media. Our billing tips are designed to help you build a healthy revenue cycle in your private practice so you can focus on your patients and not on your bills.
To get paid on time, you have to submit your claims in a timely manner. Making a habit to submit your claims every day helps ensure no claim falls by the wayside and allows you to get paid faster!
Create a claim follow up process to ensure that you’re getting paid for your hard work. Creating an office-wide process to follow up about every outstanding claim until it is fully paid helps you build a more successful private practice!
Non-covered medical service is one of the leading causes of claim denial—don’t let this happen to you. Make sure you check a patient’s eligibility before rendering a service. By doing so you’ll ensure that you’re going to get paid and you will avoid having an angry client on your hands because they won’t be receiving a bill for an expense they thought their insurance would take care of. It’s a win-win!
Insurance companies are a finicky lot. Having even a small mistake on the patient demographics or insurance information is a guaranteed way to not get paid. Make sure you (double) check patient information before submitting a claim—this is an easy way to avoid getting a denial and surefire to getting paid faster.
A tip from Samara Stone of Perfected Practice.
The feedback on those EOBs is golden when it comes to improving your systems. It could be something as simple as not knowing exactly where to send the claim or accidentally submitting a duplicate claim or even entering a code in incorrectly. Sometimes a more complex issue like coordination of benefits might come up and you will have to navigate billing to secondary insurance. Maybe you will need to track your authorizations more accurately. The point is, all billing issues are solvable problems that can be fixed once you understand what has to happen. Each error actually points to a new area where you can strengthen the systems you are creating to keep your practice strong and healthy. The strategies essential to maximize the income in your practice can be developed as a direct result of handling denied claims. There are a few subtle nuances that are particular to different insurance companies, but the patterns will become clear if you approach each one with a healthy dose of curiosity and solutions focused thinking.
Inaccurate insurance and patient information is the leading cause for claim rejections—don’t let it happen to you. Your clients may not always remember to inform you when their insurance or personal information has changed, that’s why you have to be proactive. Insurance information in particular changes all the time, whether it’s because of a new job or a new policy. That’s why once a year, ask all patients to either confirm or update their insurance and personal information in your system so you can make sure you avoid that dreaded denial.
Patients often know they will have to pay a portion of their bill by themselves (often known as a co-pay). Simplify some of your billing processes and increase your cash flow by collecting co-pays at the beginning of each appointment. This ensures that you get the money you’re due and lets your clients worry about one less bill coming in the mail.
Engaging in an internal audit of your billing process every couple of months ensures that you are being as efficient as possible. A great way to do this is by setting quality assurance measures and then selecting a random batch of claims and invoices to make sure that your billing process meets the guidelines you have set up and follows all rules and procedures outlined (both by you and the insurance companies they are being submitted to).
Platforms like TheraNest make your life easier, don’t be afraid to use them! Such platforms allow you to streamline your billing process. They make it easy to submit claims and to later check if they were accepted or denied by insurance companies–taking the brunt of the work off of your shoulders.
There is nothing worse than not getting paid for your hard work simply because you forgot to send out an insurance claim in a “timely manner.” Timely filing standards vary by the insurance company, as well as the in-network and out-of-network status of the provider, so make sure you’re on top of your claim submission. Submit your claims daily to avoid getting a timely filing denial—not getting paid because of an oversight is not only frustrating but also damaging to the health of your private practice.
The medical and insurance industries change every day—don’t be caught off guard by new information. Make sure you stay up to date on industry trends along with changes in insurance policies and state and federal regulations. Many times insurance companies and state/federal regulatory bodies will have newsletters or bulletins that you can sign up for to make sure you know what’s going on. Take the time to find them!
Understanding the payer contract you have with an insurance company helps you process and submit more accurate claims and lets you get paid faster. Payer contracts not only stipulate things like covered services and the need for authorizations or referrals, but they also outline billing requirements such as what is considered “timely filing” and other payer-specific items. Knowing your payer contract also makes it easier to follow up and appeal a claim if you do not get paid as much as you expected.
A tip from Davia Ward of Healthcare Partners Consulting & Billing
Set up EFT payments with the payors even if you are out of network. This will cut down on wait time for paper checks and you are normally paid a week to 10 days faster.
Set up ERA (electronic explanation of benefits) as well. This way you will see any declined claims or requests for information quicker, instead of waiting for a paper remittance and explanation.
Before seeing a patient, make sure to check their insurance information and see if they need a referral from another physician or authorization from their insurance company to see you. This information can be found in the payer contract you have with the insurance company or you can directly call the insurance company to confirm. If you’re seeing a new client, you can also have them call their insurance company before their initial appointment to see if they are required to have a referral or authorization.
Make sure you take a moment to analyze your reimbursements from insurance companies—there is a lot of valuable information there. Analyzing your reimbursements can give you insight into the health of your practice and can help you determine if you are routinely being underpaid by some insurance companies. This will give you the data you need to figure out if you should try to renegotiate your contract or maybe just end your contract with certain insurance companies. Remember knowledge is power!
Provide patients with a contract on their first visit that outlines all billing procedures—including charges for late payment and no-show fees. This ensures that you are on the same page with your client and allows both you and your client to feel comfortable. Communication is key to running a thriving private practice.
Seeing a client’s insurance card is not enough. Insurance coverage can end abruptly and you don’t want to end up with a denied claim. Whenever a client comes in for an appointment, take a few moments to verify their insurance to ensure they are still active and eligible for the service being provided. This should become a regular part of your client sign-in process because it helps ensure the billing process runs smoothly.
Keep a detailed account of all the services you provide to a client so you and your practice do not miss out on any payments you are due. Make sure your claims are properly coded and that you are billing for every service you provide. Having a designated coder makes this process easier since they have in-depth knowledge of ICD-10 codes and can make sure you are not only coding correctly, but also that you are not under-coding your services. This can help boost your revenue stream (and may even help the biller pay for themselves).
We all live very busy lives and often times a bill can go unpaid in the hustle and bustle of the everyday. In order to encourage your clients to make timely payments and stay up to date on their accounts, make it as easy as possible for them to pay their bill. Always include clear instructions on how to make a payment and make sure the due date is apparent. (p.s. TheraNest makes this step very easy by allowing patients to pay right online using the client portal, saving them time and letting you get paid faster!)
To figure out if your services are adequately priced and if you are being fairly paid by insurance companies, you have to know what the cost for each patient visit to your office is. To calculate the cost per visit, you have to combine direct costs (your salary, employee salaries) with indirect costs (rent, utilities, insurance) and then determine the unit cost. Check out this resource to gain a more in-depth understanding of how to do this. Having this information handy will help you determine if you need to raise your rates or re-negotiate insurance contracts.
This is where the age-old advice that you can catch more bees with honey than with vinegar comes in handy. It is easy to get frustrated when you’re dealing with claim denials or clearinghouse hang-ups, but remember the person you’re talking to on the other end of the phone is also human and is just trying to do their job as well. Being nice can take you a lot farther than being mean. Try to explain your situation and avoid directing your anger at the representative you’re talking to, instead seek out their help in a calm way and we guarantee your problem will be handled much quicker.