Start on the Right Foot
Collecting correct information from your client is essential for your business’ billing process and can be completed efficiently during the first phone call to your clinic. Your clinic’s confidence in completing this step will limit the call-backs, confusion, and help you earn what you deserve quickly.
When the client first speaks with you they want to find a knowledgeable and reliable provider for their therapy needs. A formalized process during the intake call not only provides the correct billing information for your center, it also puts the prospective client at ease knowing that they are working with a professional team.
They are looking to you as the expert in both therapy and billing.
It’s up to you
In addition to creating a happy client, being paid for your services is equally important. Your Policy and Procedure agreements may outline the client’s role in ensuring that the client provides accurate billing information, however, ultimately, gathering the correct details is your team’s responsibility.
If the team stumbles on the initial call and the important questions are missed, backtracking with the client causes more work for your team and can cause the client to have lower confidence in the clinic. Even though their goal is to meet their therapy goals, any interaction they have with your team impacts the potential for a positive word-of-mouth referral.
Be proactive at the first call and answer the client’s insurance questions confidently.
Upon the initial call, ask if the client is planning on using insurance. It may seem blunt but, with our help, you can confidently create a well crafted conversation. Keep in mind that in order to share the correct out-of-pocket estimates, you have to gather the right details.
What to ask
Understand what information is required by reviewing our list below. Also, check that your EMR requires these items when collecting on your client portal. Are your intake forms requiring these steps? Or are they just suggestions? The following should be required for efficient billing.
Client’s legal first and last name
Middle name may be required by insurance
Date of birth
Sex according to the insurance company
Responsible Party for Billing (if different from client)
Relationship to client
Client/Responsible Party’s choice to use Self-pay or Insurance
Credit card and expiration date
Good Faith Estimate per your practice’s policy
Superbill policy, if applicable to your practice
Patient’s relationship to insured (if different from client)
Insured’s full name
Insured’s date of birth
ID number and Group number
Insurance address and phone number
Condition related to employment, auto accident, other accident, if applicable
Photo front and back of the insurance card ID
Credit card and expiration date (according to your card-on-file policy)
Insurance-based questions for provider
KX modifier and medical necessity documentation (if applicable)
Note about Medicare vs Medicare Advantage
The client may have an incomplete or incorrect understanding of their insurance coverage which could mean that if you are relying on them it may leave you in the dark. Here are the typical Insurance pain points for your clients:
For Managed Medicare (Medicare Advantage), clients can easily think that Medicare is their primary since they have a Red White and Blue Medicare Card, however:
Having the card does not guarantee that they have Medicare as primary
If they have Managed Medicare, a commercial-based insurance is primary.
Solution: ask for front and back photos of all insurance cards, and specifically ask “do you have a Managed Medicare plan?”
Have client call insurance to verify benefits,
Have your team call the number on the insurance card, or
Have you team look up in the insurance portal
Customer service: Create a required checklist that your team reviews with clients that are of Medicare age (65 years old or older) to obtain all facts available from the client.
Insurance is confusing to the clients and they want to feel in control of the situation.
Keep in mind, if you are providing Physical Therapy, Occupational Therapy, and/or Speech-Language Pathology services as skilled therapy, you must bill Medicare. That means, you must be a participating Medicare provider and accept Medicare Assignment.
The clients that continue with your practice for a period of time will likely have a change in their insurance due to the new calendar year or a qualifying event. Other changes that can occur that would impact your billing include a change in their credit card-on-file or their address, or starting a skilled Part A service such as home health services. Although they may have signed an agreement to provide you with the most up to date information, you can be proactive in making sure the Patient Registration is accurate.
Check periodically for any changes in their Patient Registration. Depending on the frequency of your clients, completing a check-list with all of your active clients at the beginning of the calendar year and half way through the year would be the minimum.
Get used to asking, “are there any changes in address, phone number or insurance?"
Accurate Patient Registration is the best way to proactively address any billing issues.
Using EMR Programs
Your Electronic Medical Record (EMR) program might suit your team but does it require all the Patient Registration details? For example, SimplePractice has a spot for the client to fill out and upload their insurance card but doesn’t require the step to be completed. You could be without a front and back photo of the client’s insurance card without this being flagged in your EMR. Adding a step to audit your client’s files will aid in making sure all the needed items are completed before starting therapy and, in order to reinforce this process, this would have to be reflected in your clinic’s policy.
Ultimately the way to be paid starts from accurate Patient Registration information.
Find your easy-to-use checklist here!
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