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Physical Therapy Insurance Billing Basics

The basics of Physical Therapy Billing

Most people have a good sense of what documentation and scheduling are all about. For some, billing is much more of a challenge. Start-up physical therapy practices are often unsure of exactly what is needed to bill and even seasoned practices can have trouble. This blog post will go into basics as well as in depth details to help make sure that you know exactly what you need to be successful. It’s all about the 1-2-3’s!

Part 1: What you need

In order to successfully bill insurance, you need three things:
 
1) Billing Software
You will need billing software that allows you to do things like create claims, keep track of claims and patient accounts, generate statements and so on. It’s important to note that medical billing software is not the same thing as accounting software. Accounting software like Quickbooks allows you to keep track of your books, produce profit and loss statements, and do your taxes. This is important stuff but it’s not what medical billing software does. Similarly, accounting software can’t do what medical billing software does due to the complexity and challenges of how insurance billing works. Years ago, PT practices may have been able to bill on paper, manually but those days are over. The best billing software is usually part of a full package with EMR and scheduling and so forth. PT practices should look for systems with built-in billing and avoid separate, “integrated” systems that are always out of sync.
 
2) Billing Staff/Human Resources
Now that you’ve got your shiny new billing software, you need someone to drive it. You can choose to your own billing in-house with your own billing staff (or just do it yourself if you’re a PT). Some practices don’t have the expertise or time it takes to be bill successfully and so they look to external billing companies or services to help. Both are perfectly viable options and it really just depends on a practice’s staff, resources, and financials. 
 
3) Clearinghouse
A clearinghouse is required to transmit e-claims. Think of a clearinghouse as an electronic post office helping take the claims you create in your billing software and delivering them to the various insurance companies. Make sure not to confuse a clearinghouse for a billing service. They aren’t the same thing. A clearinghouse is simply transmitting your claims, they aren’t looking at them in-depth to see what you billed and how you billed it. If you need this kind of support then a external billing service is what you need. Different software vendors handle it in different ways. Clearinghouses do have a cost, whether you pay it directly or it is buried in your billing software fees.

Part 2: In-House or Outsource

Deciding whether to bill in-house or outsource can be an easy decision for some practices. Practices that already have a longstanding biller on staff typically know the drill and will bill in-house with great success. For others, the decision can be challenging. For start-up practices and established practices without a biller or that had a biller who recently retired or moved on, there are some important considerations to undertake. Either way, it’s a crucial decision. You’ll have put in the hard work to get the patient to your practice and to provide excellent care – you deserve to be paid everything that you’re owed.
 
1) Financial
 
If you don’t already have the human resources needed to bill then you’ve got to weigh the cost of hiring that resource vs outsourcing it. Hiring someone in-house will offer you instant access to that resource right under your own roof. A biller may also be able to fill dual roles such as running the front-desk or performing other back office operations. Of course, as with any hire, there is compensation, benefits, and space required. In contrast, a competent outsourced biller will charge a fair percentage of collections for its services but will be you partner in bring in the cash. Charging a percentage helps make sure that the biller stays motivated and that means money in your pocket. While the prospect of paying a percentage may not be instantly attractive, it may be the best deal.
 
2) Expertise
 
Insurance billing has gotten a lot easier of the past several year due to the advent of good billing software and related technologies. However, medical billing is still a skill. Knowing how to bill – how to keep up with the latest is all part of that skill. It’s also important to know how to navigate insurance company regulations, how and when to follow-up and so forth.
 
3) Time
 
Like any task, billing takes time. There’s time to send out claims, post payments, chase down accounts receivable and so on. It’s impossible to tell exactly how long this will take in your practice but it is a key consideration. If the insurances you accept are easy to deal with and pay promptly with little error then that’s great. In other cases, you may deal with insurances that require constant supervision and have to be followed up with regularly to ensure appropriate payment. Most practices have some insurances from both columns.

Part 3: Tracking and measuring KPIs for billing

No matter what you do for billing software, clearinghouse, or deciding who will bill for you – tracking key performance indicators is key. This will help you keep an eye on how your practice is performing and where there may be room for improvement. As an owner, it’s also the way that you can assess the performance of your billing staff (whether in house or outsourced). There are many metrics that one can look at but there are three key ones
  • Receivables Insurance and Patient - keeping an eye on who owe you what and for how long it as been owed
  • Collections Data - what's coming in the door and how long it's taking to come in
  • Billing Data - a breakdown of billables and collections by insurance company and other key filters
At a minimum, these should be looked at monthly. In active clinics, you have even look at them biweekly or even weekly. This will allow for detection of issues early and to act quickly so as not to leave money on the table

The Bottom Line

Insurance billing doesn’t have to be a mystery. There are some key tools and resources that you need to bill successfully and with the right setup, you can make the billing part of your practice a smashing success.

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