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New Physical Therapy Coding Updates for 2017

It’s time again to welcome the new year and with it, changes that will make our practices better than before. Among these changes? Physical Therapy codes.

Recently it was announced that the Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted, and four new codes have been released in their place. These codes will be effective by January 1, 2017.

The new evaluation codes (97161 to 97163) center around services ranging in complexity from low to high, each with a code descriptor specifying required components. To give you an idea of each new code, some of the requirements are stated below:

Code no. 97161 – Physical therapy evaluation: low complexity, requiring the following components:

• A history with no personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
• A clinical presentation with stable and/or uncomplicated characteristics; and
• Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.

In this case, usually 20 minutes are spent face-to-face with the patient and/or family.

Why Trust Medical Billing Technology Today

Technology has penetrated practically every field and industry, and medical billing is no exception.

From training to application, technology has become part and parcel of medical billing and coding. There are online medical billing courses, virtual patient databases and electronic means of communicating with and billing patients. Yet some practices still feel apprehensive about embracing technology when it comes to billing, and their concerns would not be unfounded.

Common Concerns with Technology

The biggest and most common concern over the use of medical billing technology is security. In recent years, we’ve heard of numerous cases of hackers breaking into secure company databases, resulting in hundreds of sensitive and highly valuable client information being exposed to the public or going into the wrong hands.

How to Maximize Your Team to Produce Maximum Revenue

Can you teach an old dog new tricks?

In the case of your current staff learning new ways to maximize your revenue, the answer is definitely yes.

But contrary to what may be implied in the title, maximizing your team to maximize revenue does not mean having your team work to the bone. It’s not just about working hard, it’s more about working smart. When you know how the modern revenue cycle works and what you and your team need to focus on within this cycle, your team can effectively maximize your revenue without much difficulty.

A More Effective Perspective to RCM

RCM or revenue cycle management is the healthcare industry’s financial process that typically starts the moment a patient contacts a medical practice and ends when a patient is discharged and payment is made. But within this cycle is a myriad of opportunities, opportunities to not only ensure that the current revenue cycle comes full circle, but that new ones can be started.

UnderCoding: What You Can Do to Avoid This Pitfall

Is your practice constantly faced with the problem of under-coding?

Under-coding is defined as the process of medical coding wherein the codes used are not reflective of the full extent of treatment that the patient received. It is often the result of failing to abstract every code from the medical record or to select the highest specificity of codes. Like overcoding, it can lead to rejected or denied claims, not to mention decreased revenue. But under-coding can also lead to other, more serious problems, which is why it is crucial to avoid this mistake.

The Problem with Under-Coding

Despite resulting in lower revenues for practices, under-coding is still considered fraudulent and can lead to investigations or audits. Some coders think that under-coding is “playing it safe” when you’re unsure, but really it isn’t. It can be seen as inducement, or the practice of offering a free service to patients in order to encourage them to avail of a service that is covered by the insurance provider. This can lead to legal action on the grounds of fraud and abuse.

8 Reliable Ways to Reduce No-Shows and Cancellations

What’s worse than having a stubborn patient? For a practice, it’s having no patient at all.

No-shows and cancellations are the bane of medical practices. They leave you unable to meet your daily target, cause undue stress and chaos, kill minutes of your time and consequently, the profit you could have earned making those minutes useful. Research shows that practices typically lose an average of 1 to 2 patients a day due to no-shows and cancellations. This can add up to almost $100,000 in annual profits lost! Even if a single no-show a day seems negligible, it definitely won’t be that way in the long run and on your bottom line.

Thankfully there are a number of simple ways you can effectively decrease no-shows and cancellations in your practice, and get paid even when they happen:

1. Always set appointment reminders. Make it a requirement to set appointment reminders with patients the moment they set an appointment with you. Ask your patients whether they would prefer email, text message or phone reminders, and also at what times they would prefer to receive the reminder. In most cases, it’s most effective to set these reminders after hours, when patients are less preoccupied with daily tasks.

How to Deal with Patients with Insurance Payment Problems

It’s inevitable for practices to come across patients with insurance payment problems every now and again. These can range from patients simply being confused about why they have to co-pay or don’t understand their explanation of benefits statement; to irate patients who refuse to pay or withhold payment that was mistakenly sent to them by their insurance company. When these situations arise, it’s important for your staff to know how to handle them properly as their actions or inaction can affect how the entire practice will be viewed. They also directly affect how efficiently your practice will get paid and consequently, your bottom line.

So how should you deal with patients in these types of situations?

  • Remain cordial and professional. In these instances patients are not only sick, they may feel insecure, frustrated and fearful which shows outwardly as anger directed towards staff. Make sure your staff are well aware of this and that they should not take these kinds of reactions personally. They must remain calm, cordial and professional, assuring the patient that they will do everything they can to resolve the matter.
  • When Is the Best Time to Outsource Your Billing?

    To outsource or not to outsource? That is the question that a lot of medical practitioners face when it comes to their billing. After doing billing in-house for years, some practices may find shifting to outsourced medical billing services as more of a risk, as it turns majority of the control on collections over to the billing services provider. But outsourcing can be extremely beneficial, if it is done within the right circumstances.

    So when is the best time to outsource your billing service? Below are some of the scenarios where outsourcing has proven to be the better alternative:

  • When it’s more economical. The main concern that most medical practitioners have when it comes to outsourcing is cost. What if it only ends up costing more than in-house billing? Or worse, what if the costs end up higher than the practice’s revenue? To set your mind at ease regarding these concerns, make sure you assess the total cost of outsourcing versus in-house billing before making any decision. If outsourcing proves to be more economical and beneficial, then that would be a good time to outsource.

  • Make Sure You Avoid These Common Errors when Filing a Claim

    It’s a fact that a large part of a practice’s revenue comes from successfully processed claims. And it’s also a fact that even one small error in the processing of these claims can mean immediate rejection or denial, and the loss of revenue.

    These facts are the reason why it is absolutely critical that claims be filed free of errors. In an office that handles numerous claims daily however, it can be difficult to keep track of every single detail in each claim. Knowing the most common errors committed when filing a claim can remedy this. By taking note of the most common errors or having a checklist of these nearby when filing, you can make sure to avoid most, if not all rejections or denials.
    It’s a fact that a large part of a practice’s revenue comes from successfully processed claims. And it’s also a fact that even one small error in the processing of these claims can mean immediate rejection or denial, and the loss of revenue.

    Areas Where Your Practice Could be Losing Money

    Does it seem like you’re working more hours on your practice yet not making more money? It may be because you’ve got several “leaks” in your practice.

    These leaks are areas in your practice that unknown to you do nothing but consume your revenue. From before the actual patient visit to well after the patient leaves the clinic, medical practices can lose a lot of money because of these leaks. Could your practice be among those plagued by these leaks? Read on to find out and plug those leaks before they pull the plug on your practice.

    Before the Patient Visit

    Even before the actual patient visit, practices can lose a significant amount of income due to negligence in verifying insurance eligibility, which leads to claim denials and delays. According to the American Medical Association (AMA) 25% of private payer denials are directly caused by patients being ineligible for benefits.

    Common Billing Mistakes that Can Cost You Money

    In the busy billing office of any physical therapy practice, mistakes are bound to happen. With so many details to take care of and information to sift through, it’s literally impossible to be totally error-free. For practices to maintain good cash flow however, it’s not about avoiding mistakes altogether; it’s about avoiding the ones that can cost you the most. Below are some of the most common of these costly errors:

    1. Not filing claims in a timely manner

    As we’ve pointed out before, the late submission of claims is one of the recurring reasons why claims end up denied or delayed. Many payers set a filing limit that can be as little as a month after the date of service. Go beyond this limit and the claim may be denied.

    To avoid denials, it is crucial that claims be filed on time, ideally as close to the service date as possible. This greatly improves your chances of collecting and consequently keeps your cash flow

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