Medical Payer : Who Is It and Who Has the Money? Part 2

Medical Payer : Who Is It and Who Has the Money? Part 2

Most patients have a commercial healthcare insurance plan that pays a portion of the cost should they become ill or require medical attention.

Commercial plans account for the bulk of a practitioner’s reimbursements, but an extensive array of government operated insurance plans are available that offer an added source of revenue.

Nitin Chhoda wraps up his two-part series on medical payers with a look at government-funded healthcare insurance.

medicalThe federal government sponsors an array of healthcare insurance medical programs for military personnel and their dependents, the elderly and disabled, low-income individuals, and employees that are injured at work.

Originating at the federal level, some programs are administered by individual states or through regional contractors.

Medicare
The largest government operated insurance plan is Medicare, serving the disabled and those 65 or older. It’s essential for practitioner to verify a patient’s Medicare coverage.  Medicare is confusing to medical clients and many mistakenly believe they’re enrolled for services when they’re not.

Medicare prefers to pay providers via electronic fund transfer and most claims are paid without problem when submitted correctly. Use electronic medical record technology whenever possible to facilitate the payment process. Medicare is comprised of four components.
•    Part A – Pays for home healthcare, hospice, in-patient hospital stays and skilled nursing facilities.
•    Part B – is optional and pays for medically necessary services.
•    Part C – is a replacement plan for employer-based policies that allows individuals to enroll in a private healthcare plan if they desire.
•    Part D – covers prescriptions.

Medicaid
For low-income individuals and some Medicare recipients, Medicaid assists by paying all or a portion of their medical bills. The program follows federal regulations, but may be administered by private healthcare companies. Practitioners may find it difficult to verify a patient’s eligibility status and Medicaid maintains a fee schedule that’s not negotiable.

Tricare
Funded by the Department of Defense, Tricare is used by active military personnel and their dependents. Coverage is separated into three parts to address the different healthcare needs of the individual.

The medical plan pays a set amount and practitioners are expected to accept that amount as full payment, without billing patients for the difference.

•    Tricare Standard – is used by active, reserve and retired military personnel, and eligible family members.
•    Tricare Prime – serves the same individuals as Tricare Standard, but requires members to seek treatment from network providers only.
•    Tricare for Life – is a supplement for former Tricare members who are eligible for Medicare.

CHAMPUS VA
The Civilian Health and Medical Program of the Uniformed Services provide coverage for VA patients who don’t qualify for Tricare, along with spouses and children of veterans disabled or killed in the line of duty. CHAMPUS works much like an HMO, and requires referrals and prior authorizations.

Workers’ Compensation
Employees who have been injured or disabled on the job, or acquired an occupation-related disease, are eligible for Workers’ Compensation. Providers must enroll and be assigned a Department of Labor number. Medical services must be medically necessary and receive prior authorization. Clinicians of healthcare practice management must ensure all procedures are reported and have a verified diagnosis code from Workers’ Compensation.

Medical records must be included with the reimbursement claim and practitioners must provide regular follow ups. Even then, clinicians aren’t guaranteed payment, which is distributed according to a pre-determined fee schedule.

medical payersPayments are made via electronic fund transfer. Workers’ Comp claims are submitted to one of three divisions – Federal Employees’ Compensation, Division of Coal Mine Workers’ Compensation and Division of Energy Employees.

Government-funded healthcare plans offer practitioners additional source of revenues, but claims must adhere to the strict standards set forth for each program. Filing a medical claim can be a time consuming process, but can be facilitated through the use of an EMR to ensure accuracy and timely reimbursements.

The Life of a Claim: How You Get Paid

The Life of a Claim: How You Get Paid

The clock starts ticking on the life of an insurance claim the moment a patient makes an appointment and doesn’t end until the practitioner is paid. To better understand the life cycle of an insurance claim, Nitin Chhoda offers a first-hand look at the process.

claimFirst Contact
When clients contact a practice, it sets in motion a process in which it can take up to three months for the clinician to be paid.

Before patient arrives at the office, staff should already have obtained and verified the individual’s healthcare insurance information to ensure the policy is in force, hasn’t lapsed and who is covered, along with any limitations or restrictions.

Insurance benefits can be tricky to navigate. Clinicians must ascertain exactly what’s covered under the patient’s claim insurance, their deductible and co-pay when they make an appointment. It will impact the client’s available treatment options. Some individuals have coverage under more than one insurance provider. Both policies must undergo the same rigorous verification.

Patients will also be required to sign consent forms allowing the practitioner to bill the insurance company and be paid directly, release information for billing, and for the client to pay any amount not covered by insurance claim. A copy of the client’s identification and insurance card is required, along with a complete health and medical history.

Enter the EMR
All the client’s information must be entered in the practice’s EMR for medical billing. Incorrect or incomplete information will delay reimbursements to the clinic, as will failure to obtain an authorization for procedures. Insurance providers will deny a payment if the correct forms aren’t used, information is incomplete and for other breaches of the company’s particular set of rules.

To document the client’s visit, clinicians will create an encounter form that provides pertinent information about the patient’s complaint, exam, diagnosis and procedures performed. Any secondary problems that are observed must be documented and all the information entered into the EMR. Each diagnosis and procedure code must match or the claim will be denied.

Calculating Fees
Clinicians can now enter the cost of the visit utilizing their schedule of fees. Each procedure and all materials must be calculated into the final cost, from the use of the exam room to bandages. It’s also time for the patient to determine how they’ll pay for any portion of the cost for which they’re responsible.

That can take the form of cash, check, debit or credit cards, or a payment plan. Collect at least a portion of the payment before the client leaves the office.

Submitting the Claim
A reimbursement claim must be prepared and sent to the client’s insurance carrier, complete with documentation of the patient’s financial and clinical information from their visit. Each claim should be double checked to ensure that codes and patient information match, and that there are no omissions, or the claim will be delayed.

The claim will examined in extensive detail by the insurance company to ensure the client is covered, any restrictions and limitations were adhered to, accurate coding was included and information is complete. insurance claim

If a problem arises, the clinician will be asked for additional information or to resubmit the claim.

Practitioners can appeal the decision, collect any unpaid amount from the client or write off remaining costs.

It can take a typical claim up to three months to be reimbursed, even without any difficulties. Using an EMR ensures HIPAA compliance, protects against loss, decreases processing time and accelerates the entire process for quicker deposits and better cash flow.

Physical Therapy Marketing: Limiting Exposure to Bad Payers

Physical Therapy Marketing: Limiting Exposure to Bad Payers

Searching for the best insurance companies maybe hard to find, but it doesn’t mean that they do not exist. Nitin Chhoda exposes simple techniques on how to identify and contract with the best payers so that your practice will have continuous income.

Knowing the bad payers when it comes to your physical therapy practice is not as hard as you might think. Nitin Chhoda reveals ways you can recognize bad payers in order to avoid them, and spend more of your time caring for patients.

physical therapy marketing limitsEvery physical therapy marketing in a practice goes through the process of determining which are the best paying insurance companies. You may find that one of the best ways to learn about bad payers is by asking around.

Of course, you may not feel like going into the competitor’s office as part of the physical therapy marketing plan, but there are ways to get information that don’t involve any risk.

Call Around to Other Healthcare Service Providers

The best information will come from other physical therapy marketing services and practices. Some insurance companies may have better policies for certain types of medical care than others.

However, if you are unsure about contacting other physical therapy managers and owners, you can also talk to those healthcare providers that you already have a relationship with.

Are there other physical therapy marketing and management offices where you refer your patients to when they need a different kind of care? Do surgeons or specialists send their patients to you when they need physical therapy?

Get in touch with the people you know and ask them a few questions about their best payers and their worst. Most professionals will be happy to share the information.

Same State, Different City

Another way to get good information is to get in touch with other physical therapy marketing services of other practices that are in the same state as you, but in a different city or town. This may feel a bit awkward at first, but the benefits of learning about bad payers are well worth a little confusion.

Remember to talk to the other managers as your peers. Remind them that you’re all in the same boat and you think this kind of information should be shared so that you can all avoid insurance companies that are bad at paying their bills.

In fact, you may find that someone has started to compile a list already. There tend to be way more resources out there than you expect – it’s just a question of finding them.

It may be that a local physical therapy marketing business group has already identified some of the worst and best payers and they might be willing to share the list with you. You never know if you don’t try.

physical therapy marketing payersStart a List of Your Own

Of course as you go, you will learn which companies you prefer and which seem to always reject your claims.

Keep track of those companies, mostly for your own physical therapy marketing practice and so you can adjust who you contract with, but also because perhaps one day someone will call your office asking for advice.

Physical therapy marketing in a practice can benefit from working together, and in some cases a good deed will pay dividends. If a practice becomes overwhelmed with new patients, perhaps they will send some your way if you’ve done them a favor in the past.

Running a healthy and thriving physical therapy practice is a lot of work. There are some very important decisions to make, and they will keep coming. The more you can work with others and build relationships with those payers that are good, the better off your physical therapy marketing practice will be.

Physical Therapy Management: Understanding the Patient Healthcare System in the United States

Physical Therapy Management: Understanding the Patient Healthcare System in the United States

Nitin Chhoda discusses the current patient healthcare system in the United States.  He explains how the current system will change the status of physical therapy management, its transition to EMR, and its effect on patients’ security of information.

physical therapy managementPhysical therapy management healthcare reform has been a long time coming and President Obama’s initiatives represent a beginning with enormous possibilities.

At the core of healthcare reform is providing access to quality health care services to all in an affordable cost.

Health information technology for physical therapy management is essential in achieving that goal, but to realize its full potential, it’s important to understand the patient healthcare system in the U.S.

Healthcare costs and physical therapy management in the U.S. exceed those in many other countries, yet the quality of patient care can vary widely among providers and regions of the country.

President Obama has a goal of utilizing electronic medical records (EMR) by 2014, a move that can radically improve patient care across the board.

The Healthcare System

The healthcare system in the U.S. can be slow, ponderous and delay essential treatment due to a lack of patient records or availability of insurance. Coordination of care is one of the largest problems facing any healthcare provider and efficient physical therapy management depends on accurate records from all available sources.

Partial records and lost documents result in redundant testing and expensive procedures, when funds could be better utilized to treat patients.

Healthcare in the U.S. is a multi-tiered system administered by a variety of physical therapy management providers, facilities and reimbursement plans. It’s a reactive system that focuses on treating illness, ailments and conditions after they occur, rather than emphasizing ways to avoid problems before they happen.

Effective patient treatment and physical therapy management are built through ongoing relationships, but continuity of care is often broken when a client loses their insurance.

physical therapy management understandingThe EMR Technology

Information technology of physical therapy management, such as EMRs, provide physical therapists with a complete, integrated record for each patient that will significantly reduce costs on all levels by eliminating redundant tests, therapies and treatments.

The implementation of health care technology and effective physical therapy management are essential for better patient care and to meet the healthcare demands of a growing population.

Physical therapy clinics must remain profitable, but many patients seeking physical therapy management and services are those insured through Medicare, Medicaid and similar programs that dictate unrealistic reimbursement limits and caps.

Health information technology that includes electronic medical record systems allows therapists to offer an enhanced level of patient care and verify insurance coverage to expedite the treatment process.

Protection of Patients

The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. The law provides for increased access to healthcare services to many who had none before. It further seeks to limit expenses for consumers and move to a system of electronic medical records that offers extensive advantages for physical therapy management services.

EMRs represent the first generation of electronic records to manage patient health care more efficiently and assist in meeting the government’s goals of expanded access and overall savings within the healthcare industry.

For physical therapists, health information technology provides greater profitability through electronic billing submissions. Therapists have access to complete patient records, eliminating the need for costly physical therapy management and redundant testing that can delay critical treatments, while facilitating change in the patient healthcare system.

Physical Therapy Marketing – Diversifying Income with Cash Paying Programs

Physical Therapy Marketing – Diversifying Income with Cash Paying Programs

Having a variety of cash-paying programs can increase the profit of your physical therapy business. Nitin Chhoda elaborates the importance of setting-up different cash-paying programs so that your practice does not depend on insurance claims alone.

physical therapy marketing incomeIn any other service industry, cash paying programs are a given. Consider the food service industry; every time a service is provided, the customer pays immediately.

In healthcare practices, like in physical therapy business, the system is quite different.

The patients are not usually the ones paying the bill, and if they are, they probably only pay a part of it. Additionally, patients have little to no idea what their financial responsibility is, as it relates to their insurance plan.

Physical Therapy Billing is Different

So in general,  physical therapy practices, even with good  physical therapy marketing, are in a position to provide a service which they do not know will be paid for, until the cash comes in.

Add to that fact, insurance companies will use any excuse to reject or deny a claim, and the cash flow of the practice can look very bleak. More and more practices are looking for ways to bring in cash through cash paying programs.

Physical Therapy Services Are Not Just For Injuries Anymore

One way that you can start to bring in cash is by starting a great physical therapy marketing campaign that focuses on the many ways that physical therapy can help people. For example, as we age our muscles and bones get weaker and we are more prone to injuries.

Most elderly people do not consider going to a physical therapist until they are injured and need to recover. But more and more physical therapy marketing messages focus on prevention rather than just dealing with an injury. Physical therapists can help elderly people to stay stronger and healthier, which will reduce the risk and likelihood of an injury.

Offer a Variety of Programs

For many physical therapy marketing strategists, this is a message that is often targeted towards the children of elderly parents. If you can bring in a few clients who are simply there to get into better physical shape through targeted exercises, the income you make will be in cash.

When we say cash in any business, we don’t necessarily mean dollar bills. Cash refers to any form of legal tender that immediately becomes available once the transaction is complete. This can include cash, credit card payments, and checks.

physical therapy marketing diversificationFor a  physical therapy service like strength training for the elderly, the physical therapy marketing program will need to be marketed carefully and the right audience needs to be targeted.

That way, when people walk through the door they will be expecting to pay for the visits they get.

Using an EMR to Better Track Patient Payments

Another important way to ensure you have some cash flow is by implementing a more efficient physical therapy marketing system for determining just how much each patient will pay.

Medical EMRs make it easier to track a patient’s responsibility in regards to payment, and well-organized physical therapy marketing of practices now ask for up-front payment of the portion that patients are responsible for, whether that is a co-pay or refers to the amount of their deductible that they still owe. The state of insurance is complex, and getting a little bit of help from an EMR is almost necessary to track it accurately.

Physical Therapy Marketing: Understanding and Choosing the Best Payers For Your Practice

Physical Therapy Marketing: Understanding and Choosing the Best Payers For Your Practice

Contracting with payers can be like playing with landmines. Discover strategies to contract with the best payers and understand different types of payers, so you can negotiate increased pay rates.

marketing physical therapyPhysical therapists quickly discover that not all payers reimburse at the same rate, forcing clinic owners to make tough decisions.

In the new economy, that can effectively eliminate a significant number of potential patients and works to defeat the purpose of the Affordable Care Act.

It also presents a moral and ethical quandary for physical therapy marketing and management.

Having Sufficient Income Is Very Important

Therapists provide essential treatments and services to relieve pain, restore mobility and enhance quality of life. They must also generate sufficient income to operate the practice and make a living, which can be difficult to achieve when insurers are reducing coverage, limiting visits and capping payments.

To provide access to the greatest number of patients, it’s essential for therapists not only to have effective physical therapy marketing, but also to identify and contract with insurers that maintain the best reimbursements.

Different Methods of Payments

A preferred provider network (PPO) may look attractive, but therapists can find that those offering such contracts pay a set fee that often falls far short of the actual cost of treatment. Clauses and exceptions may require the therapist to accept the PPO reimbursement as total payment.

A wealth of these types of situations will prove financially detrimental to the physical therapy marketing practice.

A fee-for-service (FFS) agreement is a similar arrangement. The advantage is that therapists can provide coding for  billing purposes that explains each service, including physical therapy marketing and management, in detail. Some insurers offer per-visit payments that deliver a flat reimbursement rate each time the client is treated.

Per-visit payments resemble an FFS, but insurers often use this lump sum payment method as a means of capping the total amount paid per visit. An increasingly popular reimbursement program is the per-payment method, a bundled solution that provides payment for all services connected with a single incident/injury, while Medicare and Medicaid impose per-year payment caps on business and physical therapy marketing services.

physical therapy marketing jobsMore Methods of Payments Discussed

Capitation is a bundled payment method in which therapists receive a lump sum amount each month.

An insurer pays the therapist for each of their covered members that the physical therapy marketing practice owner treats.

This method pays well if the client requires minimal services, but it’s financially destructive for the therapist when patients needs multiple or complicated treatments.

Not as common, but equally detrimental to the financial health of a physical therapy marketing practice is the multiple procedure payment, also known as a cascade payment.

This model reimburses at 100 percent for the patient’s initial visit, but reduces payments by a set percentage for each visit thereafter. It’s becoming more popular within Workers’ Compensation programs.

Self-pay programs require payment from the patient at the time services are rendered, either in cash or via credit card. The method allows for increased cash flow and eliminates the submission of bills to insurers.

The disadvantage of the system is that many patients may not have the financial resources to pay for services, eliminating a significant number of individuals from the pool of patients.

Make Sure to Have a Balance Income

Each therapist must balance their desire to bring relief to their patients with the need to be paid adequately for their services.

Part of superior physical therapy marketing and management includes a careful examination of all contracts and a thorough understanding of how each mode of payment will affect the bottom line of the practice.