With insurance reimbursement rates getting lower and the cost of operations increasing, managing a private practice can be overwhelming. The pressure is even more intense with billing because if it's not handled properly, it could mean loss of revenue as well as the risk of payer scrutiny.
Whether you decide to do it all on your own or go through a billing agency, getting paid while maintaining an ethical relationship with your patients can be a tough balancing act.
Tips on Insurance Reimbursement
Keep detailed documentation: Aside from a patient's personal information, detailed records of a patient's diagnosis, the type of therapy provided, patient's progress, the aim of the therapy, and the duration of the therapy sessions should be kept.
File on time: It's vital that you submit your insurance claims within the allowed time, otherwise they will be denied. Because it varies from insurance companies to insurance company - anywhere from 90 days to 18 months, you should always check with the individual insurance companies you're contracted with for direction. Better still, create a fixed billing schedule for your practice. That way no claim gets submitted late. It could be every 15 days or every month, as long as it is followed strictly and is well below a 90-day cycle. At Ondaot, we process all our clients' claims to insurance companies daily as it is the faster way we can help them get paid and able to address any issues that may arise.
Update patient information regularly: Patients can change their insurance policies and forget to inform you. To avoid your claim getting rejected, you should verify your patient's coverage and eligibility regularly.
Track your claims: Claims filed should be tracked and followed up on at regular intervals. This way, it's ensured that if there's a problem with the claim, the patient changed policies, doesn't have insurance anymore, or it has been denied for another reason - it's caught and can be remedied before the time limit is exceeded.
Verify all new or potential patient information directly: Some insurance have online platforms where you can run the potential patients' information, like their member ID, date of birth, and get their benefits. Although sometimes, the information pulled up online is not correct, calling the insurance to double check information is way to avoid rejections and denials.
Find out when pre-authorization is needed: Most insurance companies do not require pre-authorization for basic or initial therapy visits. However, for situations like having multiple sessions in a week or in a month, different insurance companies have different rules. You should always check beforehand whether pre-authorization is needed. Without an approved pre-authorization, your claim will be denied and will eat up a lot of time to submit appeals to insurance companies to try to get reimbursed.
Educate support staff: If you have support staff at your practice that helps you carry out your billing, be sure to educate them on the right medical codes for every service. Keep them updated on coding changes. Doing this ensures that: - You avoid under-coding or up-coding - The service code always matches the pre-authorization granted
Transitioning From Accepting Private Pay to Accepting Insurance
To get the best out of deciding to accept insurance, you should get credentialed by some insurance companies if you wish to become an in-network provider. And to set up your practice up for success, you should do the following before applying for credentialing with an insurance company:
Find out which insurance companies are popular in the area you serve
Find out which insurance companies cover for the services you offer at your practice (Acupuncture, PT/OT, Mental Health Services and other therapy services)
Ensure you're providing accurate information about your practice
You can still accept insurance and submit claims for your services if you are not credentialed by any insurance company. However, you are limited to payment only by patients whose insurance policies provide for out-of-network benefits.
Billing the right way makes sure that all providers get paid for all the services they provide and no revenue is lost.
At Ondadot, we have feature you need to get paid faster with dedicated, ongoing support.
On-the-dot submissions - All claims submitted within 24 hours. - No duplicate entries, zero to lesser errors
On-the-dot collections - Our billing team ensures that your claims are paid on-time from patients and insurance companies
On-the-dot tracking - We monitor all claims, check status, and see what is being done to get you paid faster
On-the-dot support - We're just an email, text or a call away - Prompt response from your dedicated Billing Coordinator
Let the experts at Ondadot ensure that your medical billing and claims are being taken care of properly. Sign up today for a free consultation to learn more about how we can help you.