US healthcare Archives

Health Insurance and Its Top Three Mistakes or Issues

by Nitin Chhoda PT, DPT | Jun 23, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

There are three major mistakes within the office setting that are contributing to a loss of revenue through non-payment. The errors can easily be prevented and some can be eradicated before patients ever arrive for their appointments.

Clinics across the nation are feeling the effects of longer turnarounds on reimbursements and outright denials by health insurance companies to pay for services.

Verify Health Insurance Information Each Time Services Are Provided
The number one cause of denied reimbursement claims is a failure to verify health insurance information. Loss of employment and changes in insurance coverage can occur at any time. It’s essential that client coverage is verified for each patient anytime services are rendered.

Denials occur for any number of reasons, but the most common is the coverage has been terminated, followed by the patient being ineligible. Many health insurance plans require pre-authorization for procedures and have limits on benefits.

Failure to obtain permission or determine if the client has reached a maximum benefit amount will result in denial of payment. Practitioners should also ascertain if specific services are covered.

Current Patient Information Is Essential
They may seem like simple errors, but incomplete or incorrect patient information is the second most common cause of denials. Clinicians should ensure that the client’s name is spelled correctly and the date of birth is accurate, along with the address, complete contact information and gender.

Some patients have healthcare coverage through multiple providers, requiring clinics to perform additional checks to coordinate benefits. The policy holder and their relationship to the patient must be clear.

Each health insurance provider has its own set of rules for submitting claims and special attention should be paid to ensure those requirements are met.

Diagnosis, Procedure Codes and Sloppy Handwriting
Diagnosis and procedural codes provide essential information to health insurance companies about the patient’s condition, symptoms and treatment. Codes that don’t match the information provided can result in a denial on the grounds that the procedure wasn’t medically necessary or it doesn’t match an authorization.

Clinicians should ensure that their medical billing and coding experts are utilizing current codes and that they’re updated yearly. Another source of denials is poor penmanship on the part of the practitioner, a situation that is easily corrected with implementation of an integrated electronic medical record (EMR) system.

Navigating the labyrinth of rules, regulations and requirements set forth by health insurance providers can be a daunting process.

Human error and failing to verify health insurance information complicates the process, leading to payment denials and loss of revenues.

Vigilance is the only cure for clinics still using paper records. Implementation of an EMR transitions clinics away from wasteful paper records and virtually eliminates the top three mistakes of health insurance claim submissions that rob practitioners of revenues.

Insurance Benefits and the Law: How Clinicians Deal with It?

by Nitin Chhoda PT, DPT | May 12, 2019 | Healthcare Practice Management, Physical Therapy Management

Nitin Chhoda discusses how clinicians can handle the insurance benefits of their employees without jeopardizing the business revenue and have a win-win situation for both staff and private practice business.

As a clinic owner and employer, medical practitioners including that of physical therapy management offices, are subject to the same tenants of the Affordable Health Care Act as the owner of a production plant when it comes to offering their staff insurance benefits options.

Businesses that don’t offer healthcare insurance benefits face stiff fines, but an increasing number of employers in all industries are choosing to pay the penalty as an easy means of managing costs.

The downside to that method is that clinics run the risk of losing the best and brightest staff to practices that offer insurance benefits, no matter how meager.

In an effort to retain staff and comply with the law, many employers are experimenting with a variety of options, from changes in coverage to quirky new insurance benefits plans.

Abbreviated Policies Don’t Make the Grade

These no-frill plans offer very limited benefits and provide reduced rates on the most basic of medical services. With the increasing costs of premiums, deductibles and co-pays, many employees will deem the cost and coverage acceptable, when compared to no coverage at all. Clinicians should be aware that these aren’t considered full insurance benefits plans and don’t meet the government mandated criteria.

Benefits for Employees Doesn’t Have To Include Spouses

While employers are required to provide insurance benefits for full-time employees and dependent children under the age of 26, nothing in the Act ensures coverage for spouses. Clinicians who have traditionally offered healthcare policies that include the employee’s family members are opting to eliminate coverage for spouses.

The assumption is that the spouse is working and will obtain their own insurance benefits and health coverage through their employer.

It’s a solution that allows clinic owners to provide required coverage and save money.

What Does “Affordable” Really Mean?

One of the primary tenants of the Affordable Health Care Act that’s causing confusion for all is the term “affordable”. The Internal Revenue Service proposed rules to take effect in 2014 that indicate an employer-sponsored plan is affordable if it doesn’t exceed 9.5 percent of the individual’s household income.

That definition offers employers some parameters with which to work when configuring insurance benefits packages. It also opens the door for a variety of staff retention problems as talented professionals seek positions that specifically combine higher wages with better benefits.

The word affordable is misleading. The Act mandates coverage, but doesn’t say employers must make it affordable.

Affordable healthcare coverage should be within the grasp of everyone, but providing those insurance benefits can represent a hardship to smaller practices.

Practitioners are forced to run a gauntlet of penalties, less profitability and loss of experienced staff for lack of insurance benefits.

They’re all factors that each medical professional will have to weigh carefully as they will impact clinics and quality of care for years to come. ll have to weigh carefully as they will impact clinics and quality of care for years to come.

Healthcare Insurance Simplified – the Patient’s Perspective of Health Coverage in the New Economy

by Nitin Chhoda PT, DPT | Apr 14, 2019 | Healthcare Practice Management, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Although healthcare insurance can be useful in the case of illness, many people do not understand their insurance coverage and limitations.

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.

Healthcare Insurance and Health Insurance – What Are They?

by Nitin Chhoda PT, DPT | Apr 7, 2019 | Healthcare Practice Management, Physical Therapy Billing, Physical Therapy Documentation

Nitin Chhoda explains the health care insurance, its providers, the Insurance coverages and the Affordable Care Act for patients.

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.

Electronic Medical Records – How to Implement?

by Nitin Chhoda PT, DPT | Dec 9, 2018 | Electronic Medical Records, Physical Therapy Documentation, Physical Therapy Software

Although switching to EMR will make the documentation process better, there are some factors that need to be considered before expecting a smooth transition.

Nitin Chhoda points out that open communication with staff before, during, and after implemenation is important. He will discuss how and why managing your staff’s expectations is crucial, and how to handle any rough patches during the change over process.

Electronic medical records are sometimes feared by clinicians and medical managers because of wrong implementation that may not actually improve the business and remain stagnant instead.

Implementation is going to be the toughest time, as everyone will probably be adjusting their workflow and accomplishing tasks more slowly than before.

But this shouldn’t discourage you from making the necessary changes. You will learn a lot through implementation of your electronic medical records and you can use that to your advantage.

Before Implementation

The best way to ensure that implementing electronic medical records goes smoothly for your practice is to plan and prepare beforehand. You should have a time leading up to implementation when all staff members can give input, voice concerns, and get the training they will need.

Remember this phrase: managing expectations.

If your staff expects the process to be difficult and frustrating, but things go smoothly, you will find that electronic medical records implementation will be easier. But if you try to convince the staff that it will be simple and straightforward, any problems will seem larger than they are in the grand scheme of things.

Make a plan, set goals, get buy-in and feedback, and give your staff the training they will need. Implementation will be a completely different experience if you prepare for the physical therapy electronic medical records implementation process.

When You Hit Tough Patches

There will be rough spots. Accept that now and you are halfway to dealing with them. The same is true for your staff’s attitude towards difficulties.

Let them know that you expect it to take a bit of time in implementing electronic medical records system before everyone has adjusted and that you want them to deal with problems rather than brush over them.

Problems that arise will educate you on how to improve the system to meet the needs of staff. Use each problem as if it is an opportunity. Talk to staff and the software developers so changes can be made right from the start.

Others Have Been There Before

Another important thing to remember is that you aren’t the first practice to implement physical therapy software for electronic medical records management. There are incredible resources out there that can help you along the way. From choosing the right physical therapy EMR to dealing with issues during EMR implementation, you can find resources online.

Electronic medical records system implementation could present some struggles for you and your staff. But those struggles don’t have to be disasters.

Makes sure that you and your staff have access to training materials and resources and that everyone is encouraged to ask questions. If you can manage the expectations of the staff, ensure that they are on board even before electronic medical records implementation starts, and give them support during the process, things will go more smoothly.

Electronic medical records of physical therapy software has been improving, but that doesn’t mean the prefect fit has been established. Another critical part of ensuring that implementation goes well is that you choose the right software. Take your time and do the research to determine what will work best for your practice.

Electronic Medical Records – What Is It?

by Nitin Chhoda PT, DPT | Nov 18, 2018 | Electronic Medical Records, Physical Therapy Documentation, Physical Therapy Software

The latest and most convenient way to process your physical therapy documentation is through the use of electronic medical records. Nitin Chhoda defines this system and how it affects the whole process within a physical therapy practice.

Technology has allowed humans to achieve amazing things, even in the past couple of decades. Consider that less than 40 years ago email was a science fiction dream.

Sending messages instantly from anywhere to anywhere else in the world were seemed impossible then. Even electronic medical records are not developed yet.

Today we take that convenience for granted, even though email and the Internet have made it possible for improvements in efficiency that were previously unimaginable.

What is EMR?

EMR stands for electronic medical record, and electronic medical records promise to be the technology of the future for anyone with any kind of medical practice.

An electronic medical record (EMR) is the digital, or paper-free way for medical practices of all kinds to track a patient’s care, medical history, and progress.

From doctors to physical therapists to dentists, anyone who treats a patient must adhere to certain documentation practices like having electronic medical records. However, until recently the only option was to write everything down on physical forms and review the notes before each visit with a patient.

Electronic medical records allow healthcare professionals to review information more quickly and provide better care to their patients. Consider that a clinician may see anywhere between eight and fifteen patients in a single day.

Some may be new patients, others are coming back for check-ups, and others have specific diseases or conditions for which they need regular testing. Without a photographic memory, it is impossible to keep up with all the details that are important to caring for each patient.

That is why an effective and correct implementation of the electronic medical records is very important. In fact, some clinicians find that just remembering the names of all their patients is a huge challenge.

Recalling Important Details

Medical records are critical to the process of recalling those important details, including things like which medications a patient is currently taking and what was discussed at their last visit.

Electronic medical records make reviewing this information quick and easy.

Rather than having to spend time looking for a medical file, electronic medical records make all the information carried around on a tablet or computer shared between the reception desk computer and the clinician’s computer with the click of a button. Files are pulled up instantly and are always legible.

Of course good medical recordkeeping is a continuous job. Clinicians and other healthcare professionals must update records during and after each visit. In fact, electronic medical records can even help a clinician to remember which questions they should be asking and which tests should be performed, based on what information must be entered into the electronic medical records.

EMR and Billing

Then, with automatic or manually triggered processes, a patient can be billed as soon as the appointment is over. All the appropriate filing for Medicare or health insurance company billing can also be handled by electronic medical records systems. And alerts can be arranged so that if bills go unpaid, the clinic staff can re-bill quickly and easily.

If you want to know what electronic medical records are, think about the way you would manage all patient information, billing, and recordkeeping. Imagine a system that integrates all administrative tasks with a system that allows all kinds of medical professionals to be more efficient and better informed when heading into an appointment.