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Top 5 Billing Tips For Private Practices

Follow these five tips to improve your practice


Billing is one of the workflows that can cause the biggest growth in private practice, or cause a significant amount of stress for providers in private practice. One of the reasons why providers don't take insurance is because of the headache that medical billing represents and the lack of clear education materials on how to bill.

This blog is intended to help give the top 5 tips that the Practice Solutions team recommends when starting to think about billing insurance or if you are currently billing insurance.


1. Keep on top of billing compliance

Even the word "compliance" makes some therapists' stomachs churn. Thoughts of fear start to creep in about learning compliance code and regulations around medical billing.

But don't fear!

There are good resources available that will help you bill your claims in a compliant way. Before we get to solutions around ensuring billing compliance, we can't understate or minimize the impact that non-compliant billing can have on your finances and reputation.

In 2017, inappropriate Medicare billing resulted in $29 million of debts against doctors and healthcare providers by the federal government.

According to Loryn Einstein, Managing Director of the Medical Billing Experts and Member of Association of Fraud Examiners found that the 2017 Professional Services Review Annual Report showed that, for the first time since the inception of the PSR scheme, the PSR recovered more in funds than its Treasury appropriation.

The PSR recovered more in funds than its Treasury appropriation. Meaning that providers refunded more in claims than the government allocates for health spending!

This means that healthcare providers and organizations ended up refunding the government more money than the government budgets for healthcare spending. Therefore, non-compliance in billing actually is profitable for the government.

To avoid the serious ramifications to your practices of the PSR activities, Einstein suggests doctors and healthcare providers need to be diligent and well informed with all billing compliance for the year ahead. That might sound like a scary idea, but here are some simple actions that you can take to ensure that your billing is compliant and you don't fall prey to recoupments:

Compliance Checklist

  • Know (like, really know) the contracts that you have with the insurance companies. You need to know if you are allowed to bill as a supervisor, what the rates are, what the termination clause is, and what your responsibilities are as a provider and what their responsibility is as the insurance company

  • Know the timely filing limit for the insurance companies that you are apart of

  • Make sure that you are billing the patient for their share of the claims

  • Learn what modifiers (if any) you need to use in order to bill insurance

  • If you do psychological testing, make sure the coding is perfect for every claim

  • Create a process to ensure that notes and financial records are kept accurately

  • Save and store accurate and detailed financial reports

2. Check you are billing correctly

Patient engagement software AutoMed’s founder, Peter Demaio, suggests an easy way to improve financial viability is to charge the proper fee for a consultation.

“Charging for items such as 36, HCPs MHCPs, SIP Diabetes and SIP asthma ensures your doctors’ work is being valued and the practice is properly remunerated,” he says. “Make sure you review the HCPs regularly so that your team is billing appropriately.”

That might sound like Greek to you, but what Demaio is saying is that you need to 1) charge an appropriate fee schedule for your area and 2) charge for every service that your practice performs.

Let's use a hypothetical situation to illustrate. Let's say you run a successful private practice and with every intake, you administer a Beck Depression Inventory (BDI) as a standard practice to establish a baseline of Depression symptoms in your patients. You see this as a clinical necessity and since the BDI takes 10 minutes to administer you have baked the process into your practice. You don't bill for it but you are documenting everything in the patient's chart.

In this scenario, the practice and the clinician are missing out on an opportunity to collect revenue that the insurance company would otherwise pay. In other words, the practice is shortchanging themselves.

The practice owner would do well to identify the missed opportunity and bill the appropriate psychological testing code for this particular brief assessment.

Even if the reimbursement is not substantial for each assessment the provider in this situation can increase the revenue to the practice, and increase the value of the practice itself.

Don't deprive your practice of potential revenue when you are already doing the work to get paid from the insurance company.

3. Integrate Electronic Fund Transfer and a Point Of Service credit card system for fuss-free billing

By far the biggest missed opportunity that the Practice Solutions team sees is the lack of systemization around electronic fund transfers. Most insurance companies have a system where they can deposit money directly into your bank account. The benefits of a system for electronic fund transfers can hardly be overstated.

Here are some of the benefits of EFT:

  • Faster cash-flow (your practice depends on it)

  • Accurate financial record keeping

  • No middle man (i.e. the postal service)

  • No mix up in revenue that has or hasn’t been deposited

  • Less trips to the bank

If the insurance companies that you work with offer EFT, then you definitely should take this. This will ensure that your money is deposited into your bank account much faster than paper checks.

The other side of the EFT equation is setting up a point of service collection method for patient payments. Cash and checks are going the way of the dodo, and private practices need to make the switch to digital payments much sooner than their counterparts.

Using systems such as CardPointe or even the credit card processing system within your electronic health record system is a better option. Most importantly, if you are going to use a point of service credit card system, then you need to use it.

Train your staff to collect copays and deductibles at the front end of the services or at the end of every service. The likelihood of collecting a balance after the patient has left your office is very low, and it is critical for compliance and cash flow that you collect from your patients at every service.

This is one of the biggest opportunities for practice growth that you can capture today!

The right EFTPOS system needs to be able to integrate with your practice management software. A solution like Tyro works seamlessly with your practice.

“We really like how MedicalDirector’s software and Tyro integrate seamlessly,” Jennifer Surie, Operations Manager of the Family Doctor, says. “They work well together and are both very stable, fast and easy to use. Features like online reporting, the ease of setup and ongoing support also make our clinics more efficient as we continue to grow. We’ve even had patients comment on how streamlined our payment and patient experience is for them.”

4. Streamline billing with the right practice software

The right practice management software needs to have a robust, stable cashflow, billing and accounting functions to meet the needs of a busy practice.

Selecting the right practice software is more important than most clinicians think. More importantly is knowing how to use the software. In an increasingly digital world, the literacy of your staff within your electronic healthcare system is going to impact not only the compliance aspect of your private practice but also the financial one.

Most practice owners do the bulk of their accounting work out of the EHR, and with that as the reality, you will need to select an electronic health record system that fits your needs and is easy to use. pray

There are many electronic health record systems that exist, but the system that the Practice Solutions team recommends is TherapyNotes. TherapyNotes really makes the process of billing insurance, patients, and reporting seamless. TherapyNotes automates the process of ensuring your practice is functioning properly and in a compliant manner.

TherapyNotes is also affordable and can be used easily by staff of any age or a billing company that you are going to partner with. It is not an option to use an electronic heath record system that is difficult to use or is too expensive for your practice.

We recommend signing up for the demo or scheduling a call with the vendors that you are looking at to make sure that the software is going to be the right fit for your practice. Once you make that decision stay with it, learn it, and build around the capabilities around the software.

If you would like to learn more about TherapyNotes you can contact them directly or you can reach out to the Practice Solutions team and we can discuss the pros and cons of the system with you.

5. Ease Medicare bulk-billing stress with the cloud

It is now well within the bounds of cloud technology to make processes such as prescription management, patient booking and patient data and billing management even more simple and efficient.

Users of innovative cloud-based software are already enjoying the benefits of faster, more accurate seamless patient processing. Award winning software like Helix already performs automatic Online Patient Verification (OPV) checks.

So imagine how much time could be saved every day if primary healthcare providers and practice managers could tap into the potential of technology to automate administrative elements of care provision and practice management, from bookings to billings.

TherapyNotes offers bulk billing to insurance payers that help to take the burden off of your practice and help streamline the process. By outsourcing this process to a biller you can save more time and stress.


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