"So what do you do for a living?"
That very basic question is one that everyone has or will be asked at some point in their life. It’s a conversation starter and often a measurement of your status and potential in the eyes of others. My usual response to this inquiry is, “I handle billing and credentialing for multiple physical therapy practices around the country for StrataPT”. On most occasions, I am met with a blank stare or "Oh that sounds interesting". If an explanation is desired, I then go on to say that I call medical, automobile, and workers compensation insurance companies as well as attorneys' offices to determine why our client has not received payment yet for their services. This can be due to any number of reasons such as notes are required, specific modifiers are needed, there is no W9 on file, the patient information is invalid, authorization is required or needs to be updated and the list goes on and on.
The task does not seem too difficult at face value, however in most cases there is always some form of a "bump" in the road. First, we will begin with automated systems which I believe can be your best friend or your worst enemy. I do not want to praise or insult any specific insurance company but I will say that there are some IVRS (interactive voice response systems) that I actually get excited about calling and then there are others that malfunction and hang up on you if you breathe too loudly (thank goodness for mute buttons). In my experience, IVRS are either extremely user friendly or they are going to make you job extremely hard to get anything accomplished.
A few other obstacles that my coworkers and I constantly run into are being accidentally disconnected, being transferred endlessly, constantly leaving messages, and the best of all - long hold times. Thankfully, I have not personally been disconnected too many times, however it seems that whenever I am disconnected it's only after I have been holding for over a half an hour or the representative answers the phone, obtains all provider and patient information, and then accidentally hangs up when they put me on hold to search for details. Come to think of it, I retract that previous statement...I have been disconnected a lot, thus the process has to start all over again.
Next are the lovely transfers, that mind you, in most cases get you nowhere. Every transfer begins with the promise that they will definitely be sending you to the correct area, plan, state, and representative, so you hold for another ten minutes only to be told that they have no idea why you would be transferred to them in the first place.
Then there is leaving messages which I have personalized my own since I leave so many. Generally I'll say, "Hi, my name is Danielle, I am calling with (insert company) on our patient (insert patient name), his/her (insert CL#/ID#) and I was calling to obtain (insert reason for call), I would appreciate a call back at 866-281-7636, thank you". In a perfect world, representatives, adjusters, and attorneys would actually call back in the next 24-48 business hours as promised by their voice mails. Unfortunately, this is very rarely the case. As a result, anywhere from 5-20 messages will be made in some cases.
And last, but certainly not least...hold times. The thing about hold times is that it does not only refer to the initial time spent just waiting for the first representative to answer your call. Hold times also refer to the time period in which the phone has already been picked up, but now the representative needs to do "further research" which can result in very long hold times. My record was set last week. I have been working on a specific patients' claims now for about three months and without fail every time I call, the representatives cannot locate the patient, cannot locate the provider, cannot locate the claims, have no idea what I am talking about and then finally after three hours find all of the appropriate information only to tell me that they need to escalate the claims inquiry again.
Although I have made the responsibilities of an AR Specialist appear fairly bleak and tedious, it can be very rewarding. Some might question why we fight so hard for just a few dollars or even pennies, but in the large scheme of things, every penny counts. If we let a few dollars go here and then a few dollars go there, by the end of the year, our clients would most likely be short a few hundred dollars; which is unacceptable.
Accounts receivable follow up is one of the most important components of the physical therapy billing process that leads to the financial success of an outpatient physical therapy practice. We pride ourselves in providing our clients with the #1 accounts receivable collection rates in the industry which I believe is a direct reflection of our commitment to ensure that our clients receive every penny owed to them. Not to mention, it feels pretty amazing when payment finally does come through, no matter how small or large it may be!