Thanks to a diversity of TV programs, some medical terms have found their way into common usage.

Most people know the meaning of IV and stat, but medical terms are notoriously difficult to spell and decode, making it essential that a medical billing and coding specialist has a working knowledge of the terminology used within the practice.

They can accomplish that by learning the three-part combinations that comprise medical terms.

Medical Terms Are a Combination of Prefixes, Suffixes and Root Words
Medical terminology is comprised of prefixes, root words and suffixes stemming from Greek and Latin. Prefixes appear at the beginning of words. The pre means before, as in preschool, but the prefix can also be used to designate a location, number or time.

The root portion of a medical term forms the central part of the word. An example would be the word premature, as in premature aging. Mature is the root word and the “pre” suffix is used to indicate an individual is demonstrating symptoms of aging that’s at odds with the subject’s chronological age.

Suffixes are used at the end of a word to change the meaning, as in hopeless. It means the absence of hope and reverses the entire meaning. It’s often used to describe a condition, disease, disorder or procedure.

Root words, prefixes and suffixes are combined to create medical terms. Broken down into its component parts, the term myocarditis translates into muscle heart inflammation – or inflammation of the heart. An idiosyncrasy of medical terminology is that the words can be somewhat out of order from what most people are used to seeing.

Prefixes of medical terms work independently of root words and specific prefixes will always refer to one thing. For example, the prefix endo will always refer to inner. It’s essential for billing and coding specialists to be familiar with common prefixes and suffixes used in medical professions.

It’s also helpful to know something of anatomy, as many terms refer to a specific area of the body.

A Tried and Tested Technique for Learning Medical Terms
The best way students in all branches of the medical profession have devised for learning medical terminology is to learn groups of three roots, prefixes and suffixes.

For those with a limited knowledge of anatomy, it helps to learn the root words of common body parts and then associating prefixes and suffixes with a specific part of the body.

Medical terminology sounds extremely complicated, but many people have heard and retained information about medical terms without even realizing it.

Some even use the terms, but without fully understanding how prefixes and suffixes reflect a diagnosis. Learning a few medical terms at a time is more effective than trying to memorize dozens all at once and suffer information overload. Those who approach the task by learning small groups will be surprised at how fluent they become in a very short time.

The business of selling insurance is a multi-million dollar industry, the sole purpose of which is to make money for the company providing the services.

Patients no longer visit their local insurance provider to obtain coverage. Insurance is packaged and sold like cars and the latest deodorant through state-of-the art advertising agencies.

Supply and demand dictates that if there’s a consumer need for a service or product, someone will provide that product or fill that need.

The Law of Supply And Demand

Consumers mistakenly believe that as more customers enter the market and purchase insurance, the cost will eventually go down. In a capitalistic system, that’s not necessarily true. If the revenues to be made are great enough, the cost will continue to increase as insurance providers strive to make ever greater profits.

Healthcare insurance providers charge the maximum amount that the market will allow for premiums.

The result is that consumers pay more for their healthcare insurance and malpractice insurance continues to skyrocket for medical professionals. Practitioners must charge sufficiently for their services to cover these costs and make a profit, while remaining competitive enough to attract new clients.

Payments versus Actual Costs

Healthcare insurance typically pays hospitals, labs and medical providers a set fee for services. In many instances, that payment doesn’t cover the actual costs involved.

Medical professionals must then decide if they will accept the insurance reimbursement as full payment, bill the difference to patients and face additional costs involved in collecting the debt, or if they want to offer the service at all.

To offset costs, medical providers need to create multiple revenue streams. Depending upon factors that include geographic location, clientele, patient load and availability, clinicians can do this through a wide variety of means. They can charge parking fees, write a book, schedule speaking engagements, add new services or develop new products.

Playing the Money Game

The primary way practitioners are paid is through reimbursement claims, which is normally prepared by medical billing professionals, to insurance companies, but there’s a dirty little secret lurking in the shadows. Insurance companies invest the funds they collect from clients to make more money. Each month that the firm can retain those funds, the company makes more on its investments.

That means healthcare providers are often forced to wait for up to three months to be reimbursed for their services. Insurance providers have teams of specialists whose job it is to calculate the fair market price for medications, office procedures and surgical interventions.

Insurance companies say these teams are eliminating waste, but the truth is that their job is to identify ways to reduce reimbursements paid to medical professionals.

Clinicians who choose not to offer specific services run the risk of losing clients to competitors who do.

If they accept insurance company reimbursements as the total payment for services rendered, they lose money.

Increasing patient numbers is one way to grow a clinic’s revenues, but creating multiple revenue streams is the most desirable. Funds coming in from a wide variety of sources will benefit practices in times of feast or famine.

Staff and medical coder are aware that they can’t share personally identifiable information with outside sources, but what they don’t realize is that a casually made comment can also break the bonds of ethics and the law.

Medical billing and coding specialists deal with confidential information each day.

It’s important for them to perform their tasks with alacrity, but it’s imperative that their moral and ethical standards surpass their typing speed.

Practice owners want reimbursement claims filed as quickly as possible, but they can’t overlook or tolerate a breach of confidentiality no matter how efficient the medical coder is.

Practitioners have a myriad of state and federal agencies with which they must comply or they open themselves to lawsuits. A medical coder who gossips and shares patient information with anyone else is placing themselves at risk, along with the practice owner and the entire medical facility. Penalties can be leveled through civil, state and federal agencies.

Don’t run afoul of common, statutory, administrative and case law.

There are four law classifications by which clinics’ owner, staff and medical coder must operate – common, statutory, administrative and case law. They can be confusing and vague, but it’s essential that clinicians become familiar with each.

A practice is considered common law if it’s accepted as fact by the majority of the population. Common law practices don’t have the force of a governing entity behind them.

Statutory law is legislative in nature and can be created at the local, state and federal level. Administrative law encompasses sets of rules made by government bodies or officials that allow them to administer statutory laws. Case law is made by courts when they interpret administrative and statutory laws.

The penalties for loose lips are severe.

The penalties for breaking confidentiality not only by the medical coder but the rest of the practice staff are significant, far reaching and determined through civil law if a patient decides to sue. The court can rule to award monetary amounts to clients for medical expenses, lost wages and distress. In civil cases, some practitioners choose not to go before a jury, admit no guilt, and settle out of court for a specified monetary amount.

Medical coder may find themselves facing misdemeanor or criminal penalties for their lack of discretion, as well as the clinic owner by extension.

The consequences are fines and jail time for a misdemeanor. Those who violate HIPAA standards could serve jail time for a felony. Fines in such cases have ranged from $50,000 to over $4 million.

Medical coder must treat each client’s data as highly confidential, even if it seems that a particular bit of information is common knowledge.

Stay vigilant

Patients must give permission before their information is shared and they must designate with whom. Those medical coder or other members of the practice who violate HIPAA codes in any way must be prepared for the consequences.

Failure to adhere to HIPAA regulations will result in litigation that can damage a practice so severely that it never recovers.

Even if everyone, including the medical coder involved, are found innocent, clinicians will contend with a loss of reputation, clients and revenue.

No matter how skilled a coder is at efficiently submitting claims, it’s not worth the risk if he or she doesn’t come equipped with a superior set of ethics.

Nitin Chhoda explains why this type of software can be a critical component of the ‘big picture’, allow your entire physical therapy billing process to become streamlined and profitable.

The first step toward solving a problem is always acknowledging that a problem exists. In physical therapy billing, this means evaluating the revenue cycle and the staff that is responsible for billing.

Nobody likes to have their job evaluated, especially when the goal is to find inefficiencies and problems.

Revenue cycle management software allows the practice to evaluate and make the necessary changes to physical therapy billing processes at the same time as the billing staff gets exciting and powerful new tools.

Giving the Staff Reason for Optimism

Start the process of evaluation of the revenue cycle with one question in your mind: which tasks could the right software take from the billing staff?

In other words, don’t look for what the staff is doing wrong, look for the places where their jobs could be made easier if you implement physical therapy billing software that includes revenue cycle management improvements.

If the staff feels they are being evaluated, you will have a harder time identifying problems, and making improvements will be more of a challenge.

But if the staff understands that the process of evaluation is impersonal, that the hope is that their physical therapy billing job will get easier, then they will cooperate and be upfront about the problems they experience.

It will be easy to get the staff to talk about problems with duplicate entry. However, physical therapy billing staff members will be protective about admitting to error frequency and revenue recognition delays and errors. The best way to get everyone on board is to make sure they don’t feel threatened.

Revenue Cycle Management Software Solutions

There is a lot of good news in the EMR world these days. New physical therapy EMRs provide revenue cycle management solutions that are very successful at improving efficiency.

In particular, you will find that duplicate entry is eliminated and not just within the physical therapy billing department.

With a fully integrated and mobile EMR, you can reduce the entry of patient information to a single occurrence, and it will happen when the patient picks up the tablet computer and enters their information.

Streamlined Billing

Of course the real time saver will be software that handles recurring billing in a streamlined and intuitive way. Physical therapy billing staff still needs access to each claim that is being submitted, so they can review and make changes based on the actual visit.

But if the treatment plan is set and pre-approved, the entire billing schedule can be set up to generate claims automatically. The biller only has to enter the information once, and then their job is to check for errors or inconsistencies.

Changing the job of physical therapy billing staff should be a priority for every physical therapy private practice manager or owner. Even if you hire a billing company, there are incredible advantages to planning and preparing so that each time the company sends a claim, you are much more likely to receive the payment in a timely manner.

Managing the revenue cycle will bring more visibility, make compliance more simple, and make the physical therapy billing team more productive.

Nitin Chhoda elaborates on the importance of the HITECH to practices that are just starting to use electronic medical records.

Implementing electronic medical records system is an expensive undertaking, but assistance is available to defray the cost as part of the American Recovery and Reinvestment Act (ARRA) of 2009.

Federal funds were allocated in the act to help ease the cost of transitioning to an EMR and to facilitate an increase in their usage.

The portion of the act that deals with financial assistance is the Health Information Technology for Economic and Clinical Health Act (HITECH).

HITECH Act

Depending upon the vendor, an EMR can easily cost $45,000 or more, an amount that takes a big bite from the budgets of smaller practices. Through HITECH, physical therapists can apply for financial aid as “meaningful users” of EMR systems.

The act makes provision for $18 billion through Medicaid and Medicare reimbursement systems, $2 billion for necessary infrastructure, and $1 billion for acquiring IT professionals, along with repair and renovation of health centers.

HITECH also sets aside $550 million as an incentive to purchase equipment and services, and $400 million for research on the impact of EMRs. In addition, $300 million has been earmarked towards health information exchange among providers and $40 million to facilitate the submission of disability claims to the Social Security Administration.

EMR Implementation

Implementing an EMR requires training of authorized users and grants are available for training centers for IT staff needed to support necessary infrastructure. Practice owners that can exhibit meaningful use of EMR-certified technology are eligible for a variety of HITECH funding, but many clinicians still aren’t aware the money is available, or that incentives are only being offered until 2015.

Many incentives hinge on the HITECH’s “meaningful use” clause and it’s a term that’s been confusing to many clinic owners. Meaningful use is a three-pronged approach to the incentive program established by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT.

Stage One

Stage one encompasses 25 criteria and consists of 15 core requirements. Of the remaining 10, therapists have the option of choosing five to comply with requirements.

In stage one of HITECH Act, therapists must adopt an EMR by Dec. 2014 that meets government requirements to qualify for federal funding. To qualify for the maximum amount of HITECH incentive money, clinicians have to attain meaningful use standards at least 90 days before the end of Sept. 30, 2012.

Stage Two

Stage 2 of meaningful HITECH use launches in 2014 and is a continuation of stage one.

It includes increased demands for electronic transactions, the exchange of health information electronically, and online access for patients to their health data. Stage three activates in 2016.

Therapists must continue to meet the requirements in previous stages and demonstrate that the quality of client care has improved.

With all that clinicians must keep in mind when implementing a qualified EMR, it’s easy to fixate on the cost and lose sight of the federal incentives available.

Therapists must implement an EMR, but they don’t have to shoulder the burden of expense by themselves.

Federal funding is available through the HITECH Act to assist practice owners purchase, equip and implement an EMR, install the needed infrastructure and obtain training for staff members. Deadlines are attached to federal dollars, making it essential that clinic owners begin evaluating their options as soon as possible.

There are some important points to consider when deciding about the company you want to work with, whether to outsource and hire a medical billing company, or train in-house personnel.

Selecting a medical billing company is a major decision and one that must be considered carefully.

Some practitioners choose to handle their billing needs on-site through their EMR, while others simply turn that aspect of their business over to a company that specializes in billing, coding, recovery and collections.

Therapists that choose that path should approach the process in much the same way they would to hire an accountant or financial planner.

The Role of Medical Billing

Medical billing is a highly specialized field and clinic owners should seek a medical billing company that employs certified medical billers that have the education and training to understand the more than 120,000 new codes involved when ICD-10 is implemented.

Insurance companies have a wide variety of requirements and restrictions, and the firm’s medical billers should have a working knowledge of them all. Clinicians should also seek a medical billing company that treats their money as if it was their own and has a proven history.

Don’t be afraid to ask for references and proof of recovery percentages, along with the average turnaround time on reimbursements and their annual write-off rates. The medical billing firm must meet and maintain HIPAA standards, work to recover the maximum amount of revenue for the clinic, and provide regular reports on the financial state of the practice.

For many physical therapists, outsourcing their medical billing needs represents considerable savings for the practice. In-house medical billing may require hiring additional staff to handle the complicated and time-intensive process competently and efficiently.

It can also require significant upgrades to the practice’s current hardware and software systems. Smaller practices may benefit most from outsourcing their billing department and it may present the most cost effective solution.The 21^st century practice doesn’t rely on paper records and neither should the clinic’s medical billing company.

Medical Billing Companies

Today’s billing companies offer a variety of services that includes many of the capabilities available with an EMR, encompassing patient scheduling, client reminders, verification of insurance coverage and a 24/7 call center. They also provide therapists with information to track demographic groups, cancellations, referrals, no shows and new patients.

Billing, coding and collections are processes that continue to become more complex.

Hiring a medical billing company relieves therapists of a time consuming task, while providing clinicians with additional time to focus on patients and their care and an improved cash flow for the clinic.

Billing firms have the financial resources to hire the most experienced and knowledgeable staff, and purchase the sophisticated software and hardware systems.

A facet of the medical billing company that many therapists overlook is the quality of the customer care that’s provided. The medical billing company will often be required to deal directly with the clinic’s clients and will represent the “face” of the practice.

Customer Service Standards

It’s imperative that the medical billing company adhere to the highest customer service standards and represent the clinic appropriately.

Ultimately, practice owners must decide if the cost of outsourcing their billing and collection needs outweighs the expenditures of maintaining an in-house billing department. Therapists with an in-house system should examine their practice to ascertain the efficiency of the clinic’s system. If costs are high and collections are low, hiring a medical billing company may be in the practice’s best interests.

Nitin Chhoda emphasizes the importance of flexibility in your EMR so that it can be used on any device (laptop, PC, iPad, Android device) with an internet connection

Consumers demand portability in the products they purchase to accommodate a mobile lifestyle, and physical therapists should expect the same convenience in their electronic medical records.

EMRs Should Be Flexible

An EMR that doesn’t offer flexibility and portability is even worse than being chained to a bulky computer and using old-fashioned paper records.

An EMR for physical therapy practices is designed to propel clinicians into the 21^st century. That includes the ability to customize as needed and take the system wherever it may be required.

Customization is a key element of an EMR. Physical therapy clinics have their own particular documentation needs and requirements, and an EMR should reflect that.

It should be easy to create custom documents that fit into the clinic’s normal workflow, along with other environments that includes billing and coding, patient communications, and registration. Like a one-size-fits-all garment, a general EMR may work for some clinicians, but it will lack critical features and disrupt the productivity and efficiency of every department.

HIPAA Compliant

Maintaining HIPAA compliance can also be a problem. Some clinicians have encountered difficulty with phrasing that prompts the system to produce unwanted results and is counter intuitive to providing care.

Charting a patient’s care, treatment and results shouldn’t require a call to tech support, and many EMR vendors that claim the ability for complete customization have a very strange idea of what customization entails.

EMR customization should reflect the way patients are seen and the way therapists practice their profession. It should import, export, store, save and organize data in standard document formats.

Portability is key when implementing an integrated EMR system and it should be compatible with tablet technology, allowing clinicians to take advantage of a wide range of revenue opportunities.

EMR Transition

An EMR should transition easily from the exam room to the billing department with equal ease.

Therapists provide a wide array of occupational, therapeutic, sensory and sports related services.

There is also a wealth of additional opportunities available to enterprising practice owners in the form of corporate wellness programs, senior citizen facilities, in-home care and even spas.

A portable EMR can be accessed from any location where an Internet connection exists, allowing clinicians to take their tablet on the road to a wide range of far flung venues.

Most patients think in terms of rehabilitation when physical therapy is mentioned, but the importance of therapeutic massage is gaining traction with clients. Spas and health clubs are just some of the businesses that are contracting with professional therapists to offer those services to their clients.

Portability is Always Important

A portable EMR system provides the means to capitalize on those opportunities with complete evaluations, documentation, insurance information and billing from any location.

Therapists provide essential services to assist their patients maintain or regain mobility, end pain and enhance quality of life. A portable and customizable EMR allows clinicians to accomplish those goals through increased efficiency and productivity.

An integrated EMR system will play a growing role in how therapists practice their profession, deliver services and interact with patients. It’s essential that a clinic’s EMR provide the ability to grow with the practice, while allowing clinicians to take advantage of the many income opportunities available.

Nitin Chhoda discusses how the act is evolving from time to time and making the coverage adjacent to the healthcare that the average people need. However, health insurance has become more and more expensive.

The Affordable Care Act was designed to extend coverage to those who had none, right inequities in coverage and lower healthcare practice management costs across the board, along with improving the quality of care for all Americans.

Some of those goals are beginning to be realized, but the cost of healthcare and insurance continues to increase with no abatement in sight.

The ranks of the uninsured will continue to swell as workers lose their employer-based healthcare insurance through job loss and outsourcing.

Healthcare Insurance are Expensive

The Affordable Care Act penalizes employers that don’t offer a healthcare and insurance option to employees, but the fines are far less than the cost of providing healthcare policies.

A growing number of business owners are choosing to pay a penalty that’s a fraction of what a single healthcare insurance policy would cost. The current state of healthcare reform establishes a system where costs for healthcare insurance continue to increase and benefits decrease.

The Affordable Care Act, created to extend healthcare and insurance to the majority of citizens, still leaves millions of individuals uninsured. It further penalizes individuals for their financial inability to purchase insurance, as well as those who have “high-end” policies.

Taxes on high end insurance programs beginning in 2018 encourages people to select less costly healthcare and insurance plans where they shoulder more of the financial burden with higher premiums, co-pays and deductibles.

To avoid penalties and skyrocketing costs, individuals will choose the most inexpensive policies available and delay seeking medical attention when they can’t afford out-of-pocket expenses.

Part of the provisions in The Affordable Care Act provides programs to encourage clinicians to eliminate waste, improve care and safety for patients, and reduce expensive testing and procedures.

The “less is more” mentality brings the quality of care into question as healthcare and insurance providers attempt to meet the demand of millions of new patients flooding into the system.

The Effect

Therapists and other healthcare and insurance providers are being backed into a corner with the untenable position of sacrificing allotted time with patients in a system where clients have extensive waits for appointments.

Clinicians could be forced to pick and choose patients based on their insurance coverage or ability to self-pay, simply to keep their clinics solvent and continue to practice their profession.

In an effort by insurance companies to reduce their costs, homeopathic solutions could easily become the treatments of choice. Healthcare providers face increasing pressure by insurance companies to eschew a wide variety of tests and provide more extensive documentation to justify their decisions.

Therapists are effectively being second-guessed by those in organizations that have little or no medical experience, and no idea of the practicalities of a physical therapy clinic.

The Affordable Care Act provides for an array of essential services that new healthcare and insurance policies must provide, but consumers will ultimately pay the price for that coverage through increased out-of-pocket expenses.

Physical therapists will feel the effects through reduced reimbursements, a potential loss of patients, and increased collection costs.

The Future

In a perfect world, access to affordable healthcare would be available to all, insurance companies would forego record-breaking profits in favor of the common good, and clinicians would be free to treat patients as their profession calls them to do.

The future of affordable healthcare and insurance, benefits without penalties, and accessible treatment for all is in jeopardy. As currently written, all avenues lead back to many of the same problems that the Affordable Care Act was created to fix.

Nitin Chhoda shares the different perspective of healthcare insurance; from that patient’s point of view to the healthcare service provider.

Patients and therapists view healthcare insurance from an entirely different perspective.

For patients, it’s a way to defray costs when they require a wide range of services, from prescriptions and hospitalization to well patient check-ups and ongoing physical therapy treatments.

For therapists and healthcare practice management providers, healthcare insurance is the primary means of reimbursement for services.

Healthcare Insurance

Older clients, parents and those who have experienced the need for an extended hospital stay are well acquainted with the value of maintaining a comprehensive healthcare insurance policy. They may complain about the cost of premiums, copays and deductibles, but they know the benefits far outweigh the monetary sacrifices they may make to keep their coverage up to date.

Younger individuals tend to eschew healthcare coverage or purchase less than they need. For this demographic, accidents and healthcare emergencies are incidents that happen to “other” people.

The entire healthcare insurance industry is a mystery to most patients. They’re unsure of exactly what they’re paying for, the terms of their coverage and their financial responsibility.

Healthcare insurance is often far more expensive than they anticipate, may not cover a wide variety of treatments and procedures, and involve high deductibles that must be met before coverage is available.

A Patient’s Perspective

Millions of individuals across the nation live in constant fear of becoming ill, injured or incapacitated, even when they have insurance. When they do become ill, it may be difficult to find a healthcare insurance provider that accepts their brand of insurance.

Patients often delay treatment, spreading potentially dangerous diseases. When no other option exists, those same clients resort to emergency room treatment that contributes largely to the increasing cost of healthcare costs.

As it exists, the healthcare industry in the U.S. forces patients to make decisions that can radically influence their lives and future finances.

The Affordable Care Act provided coverage to millions who were uninsured or underinsured, but it also created a deficit of healthcare insurance providers in relation to the number of new patients coming into the system.

Those who don’t understand their coverage represent a major loss of income for therapists. When claims for non-covered expenses are rejected, patients must pay the bill and collecting those funds can be a costly endeavor.

The first steps in healthcare reform have been taken, but more must be accomplished. The future of healthcare insurance in the new economy will require patients to pay more for their healthcare coverage and shoulder more of the financial burden in terms of co-pays and deductibles.

Coverage and Limitations

Coverage caps and limitations could very well become the norm. For therapists, the result of such trends is a loss of income and a potential move toward more self-pay patients, a strategy that could effectively eliminate many from the healthcare system and cost practices in the long-term.

The experience and expertise of a good therapist can’t be understated and they deserve to be compensated for that acumen. Therapists are the chief advocates for their patients’ needs, but are often forced by healthcare insurance companies to accept far less for their services than the actual value or are second-guessed by insurance company officials.

It’s neither an efficient or cost effective system, and one that can potentially place patients in harm’s way while contributing to a system that makes it increasingly difficult for therapists to operate a financially sound practice.

He also discusses the importance of knowing the limitations of patients’ insurance so that patients and service providers know what to expect at the time of treatment.

Healthcare practice management costs that continue to rise and unforeseen medical emergencies are the two overriding reasons individuals buy healthcare insurance.

Essentially, patients purchase insurance against the risk of becoming ill or encountering a potentially expensive and unforeseen medical need.

Accidents and catastrophic medical emergencies happen in the blink of an eye. Healthcare insurance helps defray patient costs and insures healthcare providers receive payment for their services.

Insurance Provider

Patient healthcare insurance is most often provided through an individual’s employer. Business owners contract with insurance companies to provide an established range of healthcare services that can include hospitalization, vision and dental coverage, along with office visits, prescriptions and lab tests.

Available coverage varies widely, with employers shouldering a major portion of the costs while the individual is responsible for co-pays, deductibles and monthly premiums. Medicaid and Medicare represent another form of healthcare insurance. Medicare is administered through the federal government.

Medicaid is funded through federal and state governments and distributed at the discretion of each state. Medicare is accessible by retirees and the disabled. Medicaid typically covers low-income children and adults with no other available options.

Insurance Coverages

Dwindling funds and budgetary concerns have led to coverage limits in both Medicaid and Medicare, making it essential for therapists to verify a patient’s coverage before treatment.

There’s been a push by healthcare insurance providers and employers for patients to shoulder more of the monetary burden of their healthcare, giving rise to a wide variety of special clauses and exclusions in healthcare policies.

Cancer, long-term healthcare needs and disability claims are costly for insurance providers and many policies now require clients to purchase additional, specific coverage for certain conditions. The result of shifts in healthcare insurance policies and practices has resulted in a lack of sufficient coverage for much of the population.

Underinsured clients and those with no coverage present a major problem for therapists who must balance the desire to practice their profession and render aid to those in need, with operating a practice that remains solvent and profitable. The first line of collections when a patient receives treatment is the healthcare provider.

To ensure reimbursements are received in a timely manner, practitioners submit claims to the patient’s insurance provider.

Any amount not covered through the client’s healthcare plan is the responsibility of the patient. It’s essential for therapists to determine a client’s coverage before the time of treatment to ensure the patient receives necessary services and clinicians obtain the payment to which they’re entitled.

The Affordable Care Act

The Affordable Care Act extended medical coverage to millions of individuals who previously had no insurance, but significant limitations and gaps in available services still exist.

Clinicians must ensure they have current insurance information for every client they treat before the patient arrives at the office.

It’s an unfortunate reality, but the direction of current insurance company policies may force therapists to decline patients with limited or no coverage to ensure their practice isn’t at financial risk.

Insurance companies represent the first line of reimbursements for clinics, followed by state and government programs, and self-pay patients. Changing and evolving healthcare insurance will require practice owners to examine the state of their businesses and the patients they treat with an increasingly stringent set of criteria.