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Physiotherapy bill format for IT

good morning guys actually it's evening dark out I don't know why I said good morning uh I recently posted on my Facebook feed a post about declining reimbursement and how therapists need to really find alternative measures to make ends meet to reward our team and to really grow professionally and one of the things that I said was how are we as a profession innovating and using technology to not only improve our patient care and our patient care experience but to reduce the cost of the Services we deliver you know I think it's our responsibility as a profession to work at reducing the expense so that either it's more affordable for more patients to pay out of pocket or it's more affordable for us to negotiate with thirdparty payers for higher reimbursement on the most valuable Services because we're reducing the cost of the less valuable services and I don't think anybody can argue there is plenty of waste to be cut in therapy across any Healthcare but but especially in therapy that I think we are the best leverage to understand how do we stop overutilization how do we reduce billing insurance companies for really non-proven non-evidence-based services that are just ineffective but they might be something that the patient wants in which case the patient absolutely has the right to buy them pay out of pocket for them so anyway that's a different discussion maybe that's a new video I want to share a real life example of one simple scenario that you can use in your practice today to start optimizing cash flow start managing how you do things it doesn't mean you're working harder it doesn't mean you're doing more it means that you're understanding how you get paid what the rules are and how you can leverage those rules in your favor you know we all want to play this game but we want to play the game to win without breaking the rules so let's use a real scenario now I'm not going to use a real patient but these are real examples that I'm going to use let's say for example I've got a patient I'm just going to say It's A 42-year-old male who's working at a local uh business who is an employee he has benefits through his employer he has a high deductible uh plan it's got a $5,000 deductible he's got a $45 per visit co-pay for Therapy Services once the deductible has been satisfied and the out-of-pocket maximum for this plan is also $5,000 okay this is a generally healthy individual he's working he's raising his family he loves the outdoors he goes out with his wife does everything that a normal uh family man would do and with that he ends up falling off ladder he it's the holiday season he's hanging lights around his house he falls hits his shoulder maybe fractures a clavicle and tears his rotator cuff so out of nowhere he goes in for surgery he has a surgery he wasn't expecting he he's nowhere close to meeting his deductible or out of pocket max cuz he hasn't been using his health insurance cuz he's been doing great and so now on Monday let's say he fell on Sunday he gets surgery on Monday on Wednesday he arrives at my physical therapy clinic for physical therapy Outpatient Therapy Services rotator cuff repair clavical fracture um we're going to do an evaluation we call a verify coverage we are participating with his insurance plan and we find out that he has not met his out-of-pocket maximum but we know that his surgical Bill his anesthesia Bill his Imaging Bill his ER Bill the transport none of that stuff has been processed yet none of it has been paid we have a reasonable expectation that those expenses will exceed the $5,000 out- of pocket max now in my clinic we do our billing inh house we are lightning fast with our claims if I'm seeing a patient at 10 10 a.m. on Monday I want that claim finished and sent by 5 500 p.m. the same day I believe that getting those claims as frictionless as possible getting them out getting them paid is the most important part to running my business effectively but this would be a situation where I'm going to recommend we hold the claims now for this particular payer let's say I have a 90-day timely filing limit so I can effectively hold those CL claims up to 90 days before I exceed the timely filing limit but I know that this these other services are going to get processed and paid well before 90 days is even close so I sit on the claims I don't submit them I put them into purgatory and for the next week or two I continue to treat this individual now I know that he's going to meet his out of pocket Mac so I don't have to collect his co-pay I don't have to collect toward his deductible he can come to therapy basically stressfree and we can make it as enjoyable as an experience as possible a week goes by two weeks three weeks four weeks we're checking and verifying utilization of his coverage and then let's say at the 3-week Mark all of the other medical claims have processed now he's met or exceeded his out-of pocket max he's met his deductible he has Zer co-pay zero that he has to pay me for the deductible and now I can release the claims which will be processed and PID at 100% through the third party payer so what's the advantage obviously the patient doesn't have to pay me directly I can get payment from the third party payer that payment will typically go into my bank account automatically so I don't have to worry about going and making deposits I don't have to worry about credit card processing fees because if the patient was paying me most likely he's going to pay with a credit card and I'm going to lose the 2 and a half or whatever the percentage is for processing that I would also have to utilize administ strative time to collect the payment post the payment run the payment none of that happens if the insurance company pays me once he's exceeded his out-of-pocket Max now what about the benefit to the patient well here where I am locally in Ohio most of the hospitals will provide patients with a 40 50 even a 60% prompt pay discount if they pay the full Bill owed in one session whether they pay by credit card whether they pay cash check or however they want to do it so if I can sit back and hold my claims not submit them until the hospital charges have been processed the patient gets the benefit of the opportunity of a promp paid discount if he wants to run it on his credit card he probably gets points back one one and a half% points back on his credit card I don't have the ability to give him the promp pay discount for paying me toward the deductible but the hospital does and they do do and they can so he gets to save 50% 40% from a promp pay discount I get to save the administrative hassles by just getting paid direct deposit from the insurance company and my patient gets the best possible patient care experience because he doesn't have to worry about stressing out about I'm not going to be back to work for 6 weeks 8 weeks 12 weeks maybe he doesn't have a Disability Policy maybe he doesn't have um you know family leave and other things so he's got enough to worry about I don't want him thinking about having to pay me every session that he comes to therapy I don't want him short changing himself because he thinks that he's not going to be able to afford it or it's getting in the way of supporting his family so it's a win-win-win scenario everybody comes out ahead it's a smooth process the only thing that stands in the way of that happening is if the therapy provider doesn't understand how Insurance Works doesn't understand the rules of the game doesn't understand what they're able to do and not able to do but by managing my billing process my cash flow by holding on to those claims and seeing the big picture we all come out ahead I think that we need to take more responsibility on understanding the billing process understanding the rules of the game understanding The Rules of Engagement and then designing a system that is best for the therapist best for the patient best for the third party payer I'm going to share another video where I actually I make more money and I save Medicare money in the process and my patient gets a better patient care experience and better functional outcome I'll see you guys on the next video