Eli's Rehab Report

Front-desk staff and billers aren't the only ones who should get involved.

With the decrease in reimbursement therapists are experiencing across the board, capturing every dollar you can is essential. Arm your employees with the skills they need to bring in the dough.

Your office staff will undoubtedly be the ones mainly involved in billing and payment collections -- but that doesn't mean your therapists should be out of the loop.

Example: "We make sure the [therapy] staff directs the patient back to the reception area after treatment," says Meryl Freeman, MS, PT, manager of outpatient rehab for Rex Healthcare in Raleigh, N.C. It may sound simple, but you don't want patients walking straight out the door thinking they'll get billed later. While walking patients to the reception area, Freeman's staff often asks patients if they've paid for their visit yet, and if not, shows them to the front desk.

"It's a team effort," agrees Stacy Carlile, CPC, director of records and reimbursement for North Texas Rehabilitation Center in Wichita Falls, Texas. "Our billing office communicates with all therapists on what payer guidelines are so they are aware of all the requirements, restrictions, etc."

Knowing payer policy is especially important for small practices where therapists and therapy aides may play multiples roles.

Critical: Therapists understanding payer policies is key when it comes to visit authorizations. If the therapist, during treatment, starts discussing with the patient a once-a-week treatment plan yet doesn't know that the patient's insurance policy only authorizes two rehab visits per month, the patient will be in for a rude awakening when he goes to the front desk to book his next appointment -- or even worse, comes in for his next appointment and realizes his insurance doesn't cover the visit.

Good idea: When a payer requires authorization, Carlile's billing staff gives the authorization timeframes and visit amounts to the therapist so the therapist knows how many visits are covered and can request more visits as needed -- and be on the same page with billing staff and the patient.

Many therapy directors rave about rehab-specific electronic medical record (EMR) systems. Just make sure you find an EMR system that meets your needs -- many good and bad options are out there.

Carlile's facility invested in a new EMR billing system that's helped them in many ways. "One thing that has made a big difference is that the system reminds the therapists when authorization or script renewals are due."

Until the therapist has turned in the appropriate paperwork to renew the authorization, the system prompts the therapist 10 days prior to an expiration noting, "Progress Note Due." This system also doesn't allow the therapist to sign off on a SOAP note until the authorization is current,

which is "very effective," Carlile says. In fact, "our total accounts receivable has been reduced by 51 percent" since incorporating the new EMR software, she claims.

Important: Don't let an EMR system be a replacement for knowing the billing policies. Being on top of the policies yourself gives you the ammunition to find mistakes, submit appeals, talk intelligently to payers and auditors, and stay that much more compliant.

Deal with money matters before the patient's received treatment. The number one thing Freeman's clinic does to ensure timely payments is to collect co-payments up front, Freeman says. "Many hospitals do not stress upfront collections, but we do."

On the other hand, you may have to make some creative exceptions considering the economic times, Freeman says. Currently, "we allow the patient to pay what they can afford and make sure they know there may be a balance in the end after they are discharged," she says.

Try this: "We verify benefits for all clients before they are even seen for intake," Carlile says. This allows the facility to evaluate co-pay per visit amounts or to make a close per-visit estimate if the patient owes a deductible or co-insurance. "We then put in a note for the front desk" that shows the co-pay, co-insurance/deductible, or self-pay amount for the patient "so the front desk person is then comfortable with the amount they should be asking the client for and does not hesitate to collect that amount."

Plus: "We discuss all information thoroughly during intake and discuss a payment amount that will work for both of us, and have the patient sign a payment agreement," Carlile says. Her facility does intake the same way for self-pay clients.

Another way: "For coinsurance or percentage-charge patients, we set a flat fee of $25 each time the patient comes in," Freeman says. "We tell them up front that they may owe a balance, or that they might get a refund if the insurance warrants it."

Most importantly, "avoid surprises for the patients," Freeman stresses. "You can reduce your number of dissatisfied patients if you make sure the patient is educated about your process from the beginning."