“Clean” Claims Produce Quick Victories

Author: Paul Singh

Whether you are a physical therapy practice owner, a physical therapy billing employee or an outsourced physical therapy billing provider, most would agree that getting a claim to pay is considered a victory.  To achieve this victory as quickly as possible, it is very important for claims to be submitted “clean.”  The term “clean” in this context refers to the assurance that all required claim information is accurate and reliable based on the most up to date payer rules and regulations.  There are a number of different factors that can lead to a claim getting denied, but a large majority of denials can simply be attributed to the submission of inaccurate patient demographic and/or insurance information.  Examples include things such as an inaccurate policy number, DOB, or the indication of an incorrect dependent.  Although these errors appear to be an easy fix, they ultimately lead to a delay in claims processing and payment for the physical therapy services provided.

When collecting patient demographic and insurance information, it is extremely important to ensure that all information is fully obtained with great detail and complete accuracy from the start.  The slightest reversal of a number or letter will lead to denials, re-submission, and delay in payment.  If you are collecting patient demographic information over the phone, it is best practice to present that information to the patient upon their first visit so that they can review and sign off on the accuracy of the information entered into your physical therapy software.

In addition to collecting accurate information to ensure a clean claims process, it is also very important when it comes to checking patient benefits.  If you have ever called to check benefits, you know that many of the prompts that are required before talking to an actual human being are dependent on the provided information.  If the patient’s date of birth is off by one digit or the alpha prefix at the beginning of a policy ID is wrong, the insurance company will not only be unable to provide you benefits but additionally will deny your physical therapy claim.  Even though these may seem like very minuscule errors, they can end up leading to both a very frustrating and inefficient workflow and a delay in payment.  Using a physical therapy billing system that automatically verifies the benefits for each new patient will save a tremendous amount of staff time, prevent unnecessary denials, and improve your revenue cycle.

Lastly, in order for your physical therapy treatment to be covered, many insurance plans require that a referring physician order the therapy. The referring physician’s information must be attached to the claim.  To ensure that accurate information is provided to the insurance carrier, claims are required to be submitted with the physician’s full name and NPI.  Since there could be several Dr. Smith’s in your town, it can be time consuming for your billing staff or billing service provider to determine which Dr. Smith referred your patient. Confirming this information upfront is vital in avoidance of unnecessary denials.

In summary, one of the easiest ways to submit clean claims the first time is to obtain and submit clean information.  The more concise the information is provided the first time, the faster you will be able to obtain payment for your services.  Using a physical therapy billing service that verifies the benefits for every new patient and checks the patient demographic, diagnosis codes, referring physician and insurance information for accuracy prior to claim submission will provide your practice with much more efficiency and much less headaches when it comes to your physical therapy billing operations.

Source: StrataPt

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