Some quick tips for Maximizing Reimbursement
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The Impact of Medicare Payment Cuts:
Medicare serves as a critical payer for many healthcare providers, including physicians, therapists, and other healthcare professionals. As CMS proposes to cut the conversion factor, it is essential to recognize that these reductions can lead to significant financial strain for practices. With operational costs continuing to rise and demands for quality patient care increasing, a decrease in Medicare reimbursements can make it challenging for providers to maintain their financial stability.
Strong Billers: Your First Line of Defense
To counter the impact of payment cuts, healthcare providers must prioritize their revenue cycle management. The revenue cycle involves various stages, from patient registration and billing to claims processing and reimbursement. Having a team of skilled and dedicated billers is vital to maximize revenue, especially during challenging times. Effective billers can help your practice:
Accurate Coding and Billing: Experienced billers ensure that services are coded correctly and billed appropriately, reducing the likelihood of claim denials and delayed payments.
Timely Claims Submission: Timeliness is crucial in the billing process. Expert billers submit claims promptly, reducing the time it takes to receive reimbursements.
Denial Management: Handling claim denials efficiently and timely is critical to prevent potential revenue loss. Competent billers work diligently to resolve denials and resubmit claims.
Appeals Process: If a claim is wrongly denied, a strong biller will navigate the appeals process with precision and tenacity to secure rightful payments.
Stay Informed: As healthcare regulations and billing guidelines evolve, expert billers stay up-to-date with changes and ensure compliance, avoiding potential revenue disruptions.
Empower Your Revenue Cycle with a Comprehensive Analysis:
To gain a deeper understanding of your practice's financial health, a revenue cycle analysis is a valuable tool. This comprehensive assessment evaluates your revenue cycle process from end to end, identifying strengths, weaknesses, and opportunities for improvement. A revenue cycle analysis can:
Identify Bottlenecks: Discover any inefficiencies or bottlenecks in the revenue cycle, allowing you to take corrective actions and streamline operations.
Pinpoint Revenue Leakages: Uncover areas where potential revenue leakages occur, helping you recover lost income and prevent future losses.
Optimize Coding and Billing Practices: Improve coding and billing practices to enhance claims accuracy and decrease the likelihood of denials.
Strengthen Cash Flow: Implement strategies to expedite claims processing and improve cash flow management.
Conclusion:
The looming Medicare payment cuts in 2024 present a formidable challenge for healthcare providers. To protect your practice's financial viability, it is crucial to have a team of strong, focused billers dedicated to maximizing revenue. By leveraging their expertise in accurate coding, prompt billing, denial management, and appeals processes, you can weather the storm of payment cuts.
Furthermore, a revenue cycle analysis can provide valuable insights into your practice's financial health and identify areas for enhancement. At this critical juncture, let us empower your revenue cycle and explore opportunities for improvement together. Reach out to us to discuss a revenue cycle analysis and secure the financial stability of your practice. Remember, your revenue is worth every penny, and our expertise is dedicated to protecting it.
As a practice owner, maximizing your reimbursement rates for services rendered is crucial to the financial success of your practice. While it can be challenging to navigate the complex and ever-changing world of insurance reimbursement, there are steps you can take to increase your reimbursement rates. In this blog post, we'll provide tips for maximizing reimbursement rates for physical therapy services.
Verifications: Before providing therapy services, verify your patients' insurance coverage to ensure you're providing services that are covered by their insurance plan. This can help reduce the risk of denied claims and increase your reimbursement rates.
Documentation: Accurate documentation is critical to receiving proper reimbursement rates for services. Ensure that all services provided are documented accurately, with clear descriptions of the services provided, the duration of treatment, and the patient's progress. Additionally, ensure that all documentation meets the requirements set by insurance companies to avoid denied claims.
Coding: Insurance billing codes are continuously updated, and staying up-to-date on these changes can help you maximize your reimbursement rates. Consider investing in billing software that updates codes automatically, or regularly review the current codes to ensure you're using the most up-to-date codes for your billing.
Timely Filing: Submitting claims promptly can help increase your reimbursement rates. Insurance companies have strict deadlines (timely filing) for submitting claims, and submitting claims after the deadline can result in denied claims and lost revenue. Ensure that your billing staff submits claims promptly to avoid delays in reimbursement.
Denial Follow Up: Denied claims can significantly impact your reimbursement rates, so it's essential to follow up on denied claims promptly. Review the reasons for the denial and work with your billing staff to correct any errors. It's also essential to have a system in place for tracking and following up on denied claims to ensure timely resolution. Most insurance companies only give you a 30-90 days to make a correction on a denied claim.
EDI: Electronic claims submission is faster and more efficient than paper claims, and can help you maximize your reimbursement rates. Consider investing in electronic claims submission software to streamline the billing process and reduce the risk of errors. Also, ensure that almost all of your claims are enrolled to submit electronically. There are very few payors that will only accept paper claims.
Contract Negotiation: Negotiating contracts with insurance companies can help you increase your reimbursement rates. Consider negotiating for higher reimbursement rates, reduced administrative burdens, and more timely payments. It's also essential to review your contracts regularly to ensure they continue to meet your needs and goals.
In conclusion, maximizing reimbursement rates for physical therapy services requires attention to detail, accurate documentation, and staying up-to-date on changes to insurance billing codes. By following these tips, you can increase your reimbursement rates and improve the financial success of your physical therapy practice.
Accurate documentation is essential for reimbursement for several reasons:
Insurance companies require documentation to support claims: Insurance companies require accurate documentation of the services provided to justify reimbursement. Without documentation, claims may be denied or delayed, which can impact your clinic's cash flow.
Compliance with regulations: Accurate documentation is necessary for compliance with state and federal regulations, including the Health Insurance Portability and Accountability Act (HIPAA) and Medicare requirements.
Legal liability: Inaccurate or incomplete documentation can lead to legal liabilities, such as malpractice claims.
Tips for Improving Documentation Practices:
Improving documentation practices can help ensure that your clinic is accurately capturing the services provided and supporting claims. Here are some tips for improving documentation practices in physical therapy billing:
Use standardized forms or templates: Use standardized templates to capture all the necessary information required for billing and documentation. This can help ensure consistency and completeness of documentation.
Be specific: Provide detailed descriptions of the services provided, including the type, frequency, duration, and intensity of therapy.
Document the patient's progress: Document the patient's progress regularly and clearly, including improvements or declines in function, pain levels, and other relevant information.
Timely documentation: Document therapy sessions as soon as possible after they occur to ensure accuracy and completeness.
Use electronic documentation: Electronic documentation can improve accuracy, speed, and consistency of documentation. It can also provide tools to help ensure that documentation is complete and compliant.
Regular training: Provide regular training to therapists and staff on proper documentation practices, including compliance with regulations and payer requirements.
Accurate documentation is essential for physical therapy billing. It supports reimbursement, compliance, and legal liabilities. By using standardized templates, being specific, documenting progress, timely documentation, electronic documentation, and regular training, your clinic can improve documentation practices and help ensure accurate and complete documentation. This, in turn, can improve cash flow, reduce audit risks, and improve patient care.
At our billing company, we take pride in our ability to navigate the complexities of medical billing and insurance claims. We are a team of experienced professionals who are committed to helping you get paid for the valuable services you provide to your patients. We understand that billing can be a headache, which is why we take care of the details so you can focus on what you do best - providing exceptional care to your patients.
We know that insurance companies can be tough to deal with, but we are ready to take them on. Our team has the expertise and knowledge to navigate the maze of insurance policies, regulations, and requirements. We will work tirelessly to ensure that your claims are processed correctly and that you are reimbursed for your services.
At our billing company, we take a proactive approach to billing. We don't wait for problems to arise - we anticipate them and address them before they become issues. We will work with you to develop a billing strategy that meets your needs and ensures that you get paid for your services in a timely and efficient manner.
We understand that every physical therapy practice is unique, which is why we take a personalized approach to billing. We will work with you to understand your practice, your patients, and your billing needs. Our goal is to provide you with the support you need to run a successful practice, so you can focus on what you do best - helping your patients recover.
In conclusion, if you're looking for a billing company that will fight for you, look no further than our team of billing ninjas. We are ready to take on your insurance and payment battles so you can focus on what you do best - providing exceptional care to your patients. Let us take care of the billing details so you can take care of your patients. Contact us today to learn more about how we can help your practice succeed!
Spreading The Love
Roses are red,
Violets are blue,
We're here to help you,
With all your billing and credentialing too!
We know insurance claims,
Can be quite a chore,
But with us by your side,
You'll stress no more.
We promise to love,
Your practice like our own,
And make sure you're paid,
For all services shown.
We know that paperwork,
Can be quite a pain,
But we're here to ease the stress,
And make sure you don't go insane.
From billing to credentialing,
And authorizations too,
We'll handle it all,
So you can do what you do.
We'll be your Valentine,
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Happy Valentine's Day,
From your friends at Lincoln Reimbursement Solutions
As a physical therapy practice, it's important to keep a close eye on your billing and collections processes. This can help ensure that you are getting paid for the services you provide, while also identifying areas for improvement that can lead to increased efficiency and profitability.
Here are the top 5 metrics you should be tracking for optimal billing and collections in your physical therapy practice:
Accounts Receivable: This metric tracks the amount of money that is owed to you from patients or insurance companies. Keeping a close eye on this number will help you identify any potential issues with insurance coverage, patient payments, or other factors that could impact your collections.
Denial Rates: Denial rates refer to the percentage of claims that are rejected by insurance companies. Tracking this metric can help you identify any patterns or issues with the way you are submitting claims, which can then be addressed to reduce denial rates and improve collections.
Collections Rate: This metric measures the percentage of money collected from patients or insurance companies, compared to the total amount billed. This can give you a sense of how effective your billing and collections processes are, and help you identify trends and therefore any areas for improvement.
Days in Accounts Receivable: This metric tracks the number of days it takes for you to collect payment from patients or insurance companies. By monitoring this metric, you can identify any bottlenecks in your collections process, such as long wait times for insurance approval, and take steps to reduce the time it takes to collect payment.
Average Payment Time: This metric measures the average time it takes for you to receive payment from patients or insurance companies. By tracking this number, you can identify any trends or patterns in payment times, and take steps to reduce the time it takes to get paid.
By monitoring these metrics on a regular basis, you can gain a deeper understanding of your billing and collections processes, and make data-driven decisions to improve efficiency and profitability. Whether you are looking to increase revenue, reduce costs, or simply streamline your operations, tracking these metrics can help you achieve your goals and keep your physical therapy practice thriving.
When it comes to the success of a physical therapy clinic, one important aspect that often goes overlooked is the credentialing process for new hires. Credentialing is the process by which healthcare providers are vetted by insurance companies to ensure that they are qualified to provide services to patients. In order to ensure that your clinic is running smoothly and that your patients are receiving the best care possible, it's essential that you have a thorough and well-organized process for credentialing new hires.
Here are a few key steps to follow when credentialing new hires:
Create and utilize comprehensive new hire credentialing documents. This should include specific payor materials, CAQH information, and education and training records.
Submit credentialing payor applications to payors. This should include all of the necessary documentation and information to ensure that your new hire is approved as quickly as possible.
Have a clear process for keeping track of payor applications, submission IDs, reference numbers, etc. This will help ensure that you don't miss any important deadlines or lose track of important information.
Set follow-up guidelines for each payor. Ask the payor for their expectations and make sure that you are meeting them.
Have clear guidelines for your cosignature process or claim hold process. All team members need to be aligned on this, including scheduling, intake, verifications, therapists, and billers.
Have a process for communication with the billing team as approvals come in. This will help ensure that your billing process is running smoothly and that you are getting paid for the services that you are providing.
Have a process to recredential and reattest CAQH profiles. This will ensure that your clinic is always in compliance with the latest regulations and that your patients are receiving the best care possible.
By following these steps, you can ensure that your new hires are credentialed quickly and efficiently, and that your clinic is running smoothly. With the right processes in place, you can focus on providing the best care possible to your patients, without worrying about the administrative side of things.
As a healthcare provider, it's important to ensure that you're being fairly compensated for the services you provide. One way to do this is by renegotiating your contracts with insurance companies to ensure that you're receiving the reimbursement you deserve. Here are some key points to keep in mind when setting the stage for renegotiating your contracts.
Review the contract, know your current rates, and compare your reimbursement to your frequently billed codes. It's important to have a clear understanding of the terms of your current contract and what you're being reimbursed for.
Know your metrics! When was your contract was executed or last negotiated? What is your current fee schedule? What is your cost to deliver care? What are your outcome scores? What special certifications or equipment do you have? Knowing these details will help you to build a strong case for why you deserve higher reimbursement rates. For example, if you a specialized service that is not widely available, this can be used to support your argument.
Write your letter of intent. Your letter of intent should clearly state your request for higher reimbursement rates and the reasons why you believe you deserve them. Be sure to include any and all relevant information outlined in number 2.
Follow up and continue to file reconsiderations if your request is denied. Don't give up!
Repeat the process and review the rate every 2 years. Negotiating your contracts is not a one-time event. It's important to review your rates every 2 years and to be prepared to renegotiate if necessary.
Remember, as a healthcare provider, you deserve fair compensation for the services you provide. Don't be afraid to fight for the reimbursement you deserve! By following these key points, you'll be well on your way to successfully renegotiating your contracts and ensuring that you're being compensated for the services you provide.
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Below are some items you should be asking your billing team on a quarterly basis. These are your key performance indicators that directly affect your bottom line. If answers to these questions are drastically different quarter to quarter you will likely notice a difference in your cash flow.
Truly understand the intricacies of insurance contracts and navigate the negotiation process
BY BRYANNE JOHNSON AND MATTHEW JOHNSON, JD
Everyone is feeling the impact of rising costs in today’s business environment. Goods, materials, and labor have become more expensive, negatively effecting the bottom line. Unfortunately, there is no corresponding increase in the reimbursement rates for therapy services. These rates are based on the percentages included in the payer contracts with our patients’ insurance companies. Now more than ever, insurance contract negotiation is a critical aspect of driving revenue into our practices.
The process of critically reading and negotiating insurance contracts may seem daunting, especially to owners of large, multi-centered practices who contract with countless insurance companies. There are questions to ask about each contract: What are the reimbursement rates for various treatments? How do those rates compare to your other contracts or practices in your area? Are there any red flags to investigate? It is critical that we are proactive in advocating for our practices, the profession, and payment — and, in turn, for our patients. Follow this step-by-step guide to truly understand the intricacies of insurance contracts and navigate the negotiation process to ensure that you are receiving the highest reimbursement possible from the insurers with whom you contract.
1. REVIEW YOUR CONTRACTS
First, you need to review your current payer contracts and identify your existing rates. While this may seem straightforward, most practice owners stall in this initial stage. If you cannot find your original contracts, you will need to call the applicable insurance company and ask for a copy of the agreement or fee schedule.
When analyzing your rates, be sure to determine how much you are being reimbursed for your most frequently billed codes. Then, compare those rates to the Medicare fee schedule and rates for other payers to see how each payer compares. Perform the same analysis for those insurance companies that pay a “One Rate/Per Diem” and “Case Rate.” Be prepared to present your actual reimbursement rates in an accurate and organized manner when speaking with the insurance company.
Read the fine print to be certain that you are aware of the nitty-gritty of the payment policies detailed in your contracts. For example, some contracts require a modality to be billed as part of a three-unit minimum encounter in order to receive full contractual payment. If a modality is not billed, the payment can be decreased by up to 20%, which could result in a payment that is less than the cost of treatment. Create a strategy to change this arbitrary payment policy, and in the meantime, educate your clinical staff regarding its existence.
2. SET THE STAGE
Next, you should determine where to start. Which payers have the lowest reimbursement rates? Which payers account for the largest portions of your payer mix? Which contracts contain arbitrary payment policies? Answering these questions will help you prioritize the contracts that have the most effect on your revenue and, therefore, your bottom line.
3. MAKE YOUR CASE
Now it is time to collect the information you need to make a compelling case to the insurance company that your rates should be increased. What is it about your practice that makes you stand out or brings unique benefits to their patients? It is important to understand your role in each payer’s provider network so you can prove your value to that network.
Consider your clinicians’ advanced competencies and certifications; cutting-edge technology, modalities, and equipment utilized in the delivery of care; and innovative practice models and specialty programs and services offered in your practice.
Strong outcome data positions you to negotiate from a position of strength. Patient satisfaction scores are another metric that demonstrates your value. In sharing this data, you realize a return on all the time you invested in collecting patient outcome data! You may also use your location to your advantage; if you operate in a rural area, perhaps you are the only provider to provide a particular service in a certain mile radius.
Another key metric you will want to bring to the table is your cost to deliver care. What does it cost your clinic to deliver services to one of their beneficiaries? Unfortunately, with most commercial or managed care payers, there is little difference between the cost to deliver care and the reimbursement for that care. Sharing that information with the payer can further prove the need for a raise in rates.
A letter to the insurance company from a patient with a relevant plan of care is powerful evidence and will bolster your case. It proves to the payers that beneficiaries see true value in your practice — so much so that they are willing to write letters on your behalf.
4. WRITE A LETTER (OF INTENT)
Once you have gathered all the information you need, you will present it in the form of a letter of intent. An effective letter of intent should include the following:
The date your original contract was executed
Your current fee schedule
Your proposed reimbursement rate
Your cost to deliver care
The volume of patients you serve that are beneficiaries of the particular insurance
Outcomes that demonstrate exceptional delivery of care and patient satisfaction
Any patient letters
Now that you have finalized your letter of intent and have gathered all the appropriate and applicable information, call the provider customer service line and ask to speak to the contracting department to determine the best way to get them the information (whether mail, certified mail, fax, or email). Be sure to always keep a copy of everything that you send, as you likely are going to have to send the information more than once.
5. FOLLOW UP
Congratulations on submitting your letter! Hopefully, your payers recognize the incredible work you and your providers do with increased reimbursement rates. If your request is declined, do not be afraid to go back to the insurance company in 30 days to repeat the process with any additional or updated information.
Using basic negotiation tactics will help get you over the finish line. While you should not make unreasonable or arbitrary demands, starting with a higher number will “bracket” a range where you and the insurance company can find middle ground. Be sure to play to your strengths; if you have a two-week waiting list of patients, let the insurer know that your practice is in high demand. Be kind and courteous in your interactions. Asking to speak to a supervisor can be an effective strategy, but copying a boss on a thank-you email is a nice touch, too! Remember that an effective negotiation is one where both parties come away feeling like they won.
6. REPEAT!
Add a review date to your ticker system for each insurance contract, ensuring that you systematically examine every contract in a timely manner. It is critical to communicate with insurance companies on a regular basis to advocate for our profession and practices, promote the positive impact your care has on the lives of their beneficiaries, demonstrate how you save the payer money, and justify your request to be paid fairly for the skilled care you deliver.
As a practice owner, there is no need to be an expert at everything it takes to run a successful practice. The money you spend engaging a consultant or lawyer to review current contracts, as well as new ones you are considering, will come back to you in dividends when your reimbursement rates are increased. Don’t fly solo when a copilot can boost the probability of arrival in the land of higher reimbursement.
Finally, make sure you are working smarter, not harder. Disengage from contracts and insurers that simply don’t make sense for your business. You will never win by increasing volume to offset a reimbursement rate that is less than your costs. This can be a hard decision, because those beneficiaries do deserve access to therapy services. But remember, your ability to provide services to patients in your community is dependent upon a positive bottom line.
Operating a health care company means constantly dealing with changes in regulations, staffing, and delivery of care, just to name a few, and reimbursement rates will not magically increase on their own to help us meet these challenges. If we do not ask, we will not receive — so always ask for what you need to ensure your practice is healthy and thriving.
Landmark #1: Contracting and Credentialing
The first step along the Pathway to Payment is to ensure that your providers are credentialed and participating with multiple payors. Becoming a participating provider (“PAR”) with an insurance has its perks and patients generally are fearful of the terms “out of network” when they are selecting which providers they want to use.
The credentialing process may seem daunting at first - especially with the different forms, applications, provider numbers, and licensure documentation you have to provide, not to mention the processing time for your application. But, this is arguably the most important step on a long process to getting paid.
If you have multiple locations within your practice, each one needs to be credentialed with each insurance you want to be a participating provider with. Each individual provider within your practice should also be credentialed with those insurances to avoid delays in completing documentation due to needing a co-signature.
Landmark #2: Insurance Verifications and Benefits
Once your practice becomes a participating provider with these insurances you can start accepting patients with those insurances. One of the perks of being PAR with these payors is that you can have access to online portals that are available. These portals are extremely convenient and give you access to a multitude of resources - benefit information being one of them.
Many of these insurances can be found on hub portals such as Availity, but other insurances have their own portals such as state Medicaid programs and Medicare. Setting up these portals is generally a simple process where you have to register your NPIs and TINs for each location, create a user login and password, then verify your information.
One of the resources on these portals lets you check benefit information for policyholders. This will help your practice as well as the patient have a better understanding of patient responsibility and cost-share amounts for the services you are providing. The most important items to confirm while checking benefits are:
Authorization requirements (be sure to confirm if this is handled by a third party vendor rather than the insurance)
Copays
Coinsurance
Deductible
Out of pocket expenses
Visit limits (this is not the same as authorized visits)
After you have verified the benefits and confirmed accumulations for each cost-share item, provide this information to the patient prior to him/her starting treatment. This is best done by completing a financial responsibility sheet or insurance benefits information sheet to include in the patient’s intake paperwork. The patient should attest to the benefits information and acknowledge that he/she is aware of the potential patient responsibility throughout the course of treatment.
This ensures there are no surprises to the patient or to your practice once the claims process. If the patient has a copay, you will be aware of that and can collect the copayment at each visit, rather than waiting to collect it once the claims process and your chances of collecting are significantly reduced once the patient leaves your clinic.
Landmark #3: Authorizations
Some insurance plans require authorization - and depending on the insurance this may be referred to as clinical submissions, precert, medical necessity review, etc. - so it’s important to understand each payor and the terminology they use when requiring an authorization. If this information is not on the portals then someone must call the insurance to confirm the authorization requirements. During a time where technology has consumed almost every aspect of society, a good old fashioned phone call to speak to a representative about the authorization is always worth making.
Online Portals / Requesting Authorizations
This information should be collected during the benefits check back at Step #2. The process for obtaining authorization should also be obtained during the benefits check. This is also a feature on some online portals where the benefits information is located, however, if the authorization is handled by a third party vendor, then you need to contact that vendor to have your processes in place for submitting these authorizations. These third party vendors often also have online portals to submit and check the status of authorizations.
Tracking System
There needs to be a diligent system in place to track and monitor your patients who require authorization. If the authorization is required before the eval, then your team needs to ensure the necessary steps are being taken to get the auth requested prior to eval date. There are several nuisances about authorizations that are imperative that you are aware of and you should always confirm which CPT codes require authorization.
Tracking and submitting authorizations will avoid losing reimbursement for services rendered due to missing authorizations. Your entire team should be involved in this process so they understand the “why” behind the importance of diligent tracking and requesting authorizations when they are needed. Once the authorization is approved and can be tracked in your billing software your team should be able to run reports and view patient charts to see when the authorization expires/the patient needs more visits.
Retroactive Authorizations
If an authorization is missed the next option is to attempt a retroactive request for authorization. Many insurances do not allow retroactive authorizations, but again, this information should be obtained during the initial benefits verification. If the retroactive authorization is denied, the final resort is appealing for medical necessity.
Landmark #4: Submitting Claims
This step is one of the most satisfying steps along the Pathway to Payment. It combines all of your efforts from the previous steps and sends them off to the insurance for processing. This step is also the intermission step where we wait for the next step.
Many payors have transitioned to electronic submissions of claims. Every billing software should have the option to physically print these claim forms and mail to the insurances as well as an option to set up EDI for electronic submissions for quicker turnaround times for claims processing.
The two key focuses at this step are 1) ensure each payor is set up correctly and 2) be aware of timely filing deadlines.
When the payor settings are incorrect or do not coincide with the information the payor has on file for your location is when you run into denial issues which ultimately put you at a race against the clock to have claims resubmitted. Getting claims out the door is at its core the purpose of the revenue cycle, but getting claims out the door correctly the first time is what the focus should be on.
Common issues with claim submissions include submitting claims to the wrong physical address, having the wrong EDI set up for electronic claims, missing information on the claim forms, and missing timely filing deadlines. All of this information is easily attainable and should receive a high level of attention from the beginning. Once these payors are set up in the billing software you will likely not have to edit them again.
Take time to refine your process and ensure everything in your billing software is set up correctly before mass submitting claims. Once the claims are out the door - we wait.
Landmark #5: Accounts Receivable
At this point, we are about 30-45 days out from the first time a patient entered your practice for services. This step is also very satisfying because you see the hard work from steps #1-5 pay off - literally.
Overall, you should have a processed mapped out and strategy in place on how you will handle these sets of aged claims. The AR Team needs to be aware of nuisances across insurances as well as timely filing deadlines.
These items should be tracked and handled in an efficient and timely manner.
0-30 Days Aged
Aging reports for claims should be run in a timely manner starting with claims that are 0-30 days aged. Many of these claims will still be processing but it is important to keep track of them because 30 days quickly turns into 90 days if you are not conscientious of the aging process and running the aging reports.
30-60 Days Aged
Claims that have aged 30-60 days should be a primary focus since this is where you will catch any denials or rejections from either the clearinghouse (if claims were submitted electronically) or the insurance company for invalid/incorrect/missing information on the claim forms. This is a crucial hurdle in the process that can be remedied and the potential to collect on these claims is highly likely since this is usually still within most insurances’ timely filing limits.
60-90 Days Aged
This aging bucket is where you should be concerned with the reason for these claims aging out this far. Did the insurance pay and now you are waiting for the patient to pay? Did you miss a denial? What next steps need to be taken to resolve these claims?
90-120 Days Aged
This group of aged claims should sound the alarm for your AR Team. These claims either fell through the cracks of the previous aging buckets or you are waiting for payments from patients. At this point, all hands should be on deck to get claims reprocessed at the insurances - if timely filing limits allow this - or patients need to be called about their outstanding balances.
120+ Days Aged
Any claims outstanding at insurances at this stage should be addressed immediately to resolve the issues. If there is no other remedy for the claim, it will likely result in a write off.
Any patient balances that have aged this far should also be addressed immediately by making final calls to collect on the outstanding balances before they are sent to collections.
Landmark #6: Denials and Appeals
The final step on the Pathway to Payment is addressing any denials that are discovered in the AR process at step #5. Common denials include missing authorizations, invalid member ID, missing provider information, and missing clinical documentation. Each of these can be easily avoided at their respective steps along the Pathway, which is why it is important to take your time at each step to ensure everything is handled correctly before going to the next step.
If the claims are returned for denials, some of the issues can be resolved by resubmitting the claims with corrected information and/or documentation.
Other claims may require additional work such as filing an appeal if they are denied for medical necessity or missing authorization. The appeals process for each insurance is different in that some require forms to be completed while others allow for a more informal request for appeal.
Either way, all insurances have timely filing deadlines for these appeals and they should be strictly abided by. This is your last chance to get paid on claims.
Bryanne Johnson, CEO of Lincoln Reimbursement Solutions, talks with Paul about the recent cut to reimbursements that everyone in the industry is facing, and what it will mean for the future. She also discusses some of the ways that Outpatient Rehab Owners could be missing reimbursement opportunities.
Here at Lincoln Reimbursement Solutions, we strive to become a dependable source of information when it comes to all contracting and credentialing needs. We recognize the importance of this process in jump-starting billing for your business.
At LRS, we know the burden of this administrative process and the time it takes to be able to complete this process from start to finish.
And when the time comes that you may feel the want to negotiate your current contracted rates, LRS has ample experience and expertise to take care of this need for you. Our employees will collaborate with you to gather all of the necessary information before sending these payors a detailed proposal letter to advocate for your practice and demonstrate why your business deserves a rate increase.
We know communication is key. At the end of every week, your company will receive a comprehensive update via email with a document exhibiting what LRS completed for the week and outlining next steps. In these updates, we will also ask you any questions we have regarding your current enrollments or any missing information needed to complete applications. These questions and concerns will also be communicated to you before the weekly updates so we may complete all applications in a timely manner.
