Effortlessly Manage Your Physiotherapy Bill Format for NPOs

Physiotherapy bill format for NPOs

hey guys tony maritado here so i had a great question come in this has been a common topic lately about motor vehicle accidents or just personal injury cases in general so i'm going to do my best to read from the email bear with me so this particular therapist is a mobile therapist they just got a referral the patient was involved in an auto accident the patient has medicare as the primary insurance but in this case the auto accident accident is going to be where all the claims are going i've never worked with this patient or the insurance company before she talked to the adjuster who said the patient does not require pre-authorization which is pretty common for auto accidents there's there's basically two situations you've got the immediate medical costs which are covered by med pay usually med pay has a dollar limit it might be ten thousand twenty five thousand fifty thousand but med pay covers the initial cost it's typically paid out first come first served so if the patient was in an accident yesterday went to the emergency room had imaging had this other stuff going on and then sees you today if you get your claim out printed on a cms 1500 with a w-9 and your notes send it to whoever the um adjuster is then you're gonna get paid and so the faster you get these claims out like literally as the patient's walking out the door you should be printing your claims and you should have a fax number for the adjuster so you can fax them directly or email them if that's an option too but get them to the adjuster lightning fast you will be the first paid you'll get paid you're getting paid at the full bill rate so if you're billing 250 dollars a session you're gonna get paid 250 dollars a session when it's going through med pay there is typically no adjustments there you have no contract with them so they have to pay your full bill rate keep that in mind when you think about the hospital billing twelve hundred dollars for an hour of therapy and you're only billing 250 for an hour of therapy okay so back to this this particular therapist uh she tried to get an idea of the reimbursement the adjuster can't tell you what the reimbursement is because they pay whatever you bill so as long as you're kind of within the scope of reasonable and customary and like i said you've seen my other videos hospitals here locally are charging 285 dollars a unit 650 for the evaluation line item i guarantee you're charging less than that so you want to get those claims in this therapist is saying the patient lives 45 minutes away she wasn't sure if it was something she could do because of the commute time again i mean it's well worth your time and effort and there is no four unit limit per visit so if you're going to make a 45 minute commute there 45 back that's 90 minutes you could look at charging for that travel time but while you're there you could do a 90 minute 120 minute session you could bill for a thera health they're their health telehealth visits if if that's an option for you but this is absolutely worth your time if you can get into that med pay we're going to talk about what happens when that medpay gets exhausted here in just a second so um if i don't get compensated well i can't afford to go out that far to do it so what would you do in this situation okay so like i said i would absolutely treat the patient i'd get the claims in asap so what happens when med pay runs out what happens when now you have to look at the next payer source so typically what's going to happen is medpay pays first that runs out then it goes to what's usually going to be some sort of a settlement now the reality is the settlement could take through two or three years for you to get compensated it usually doesn't here in ohio when we have an auto injury case our settlements usually come within a couple months typically what happens is the attorneys ask us the medical providers to reduce our charges so if we bill say 250 is your bill rate for an hour of therapy whatever your unit charge is they might come back and say can we pay you half of that and then you would negotiate somewhere between what they offer and what you charge i can almost guarantee it's definitely going to be higher than the medicare a lot amount or it better be and you're going to get paid out of that settlement and then of course if for some reason it doesn't go to settlement or something happens then the medicare as the primary insurance is the default that it falls back on in most states so if you don't get compensated from the auto accident you still have medicare and remember medicare has a 12 month timely filing limit so you have up to a year to get those medicare claims submitted now something i will tell you that happens quite frequently especially nowadays is the attorney is going to say hey mr therapist mrs therapist what you should do is send your claims to the insurance company so you get paid now and then will reimburse you after settlement well guess what the reason why they're doing that is because you're in a contract with the insurance company the insurance company is getting a discount because they're sending you volume and so the attorney is getting the benefit of your reduced rate through the insurance company my general advice is you do what's best you you talk to your team but if there is any chance that you can hold on to those claims hold the claims don't send them through the insurance wait for it to go to settlement send it to medpay but once medpay is exhausted hold the claims wait for settlement and then you decide if you're going to accept an adjustment what that adjustment is going to be because it absolutely should not be less than the third-party payer reimbursement would have been but keep in mind if you're dealing with let's say a medicare advantage plan like a united healthcare medicare advantage they only have a 90-day timely filing so you do run the risk that if you go beyond 90 days you won't get the reimbursement from medicare advantage but if you end you might the case might just never end up going to settlement or they might request a lower than expected um negotiated rate at settlement it's it is a little bit of a gamble but that is the way i would approach this whole situation get your claims to med pay lightning fast if that is exhausted get your claims and hold on to them send them to the attorney make sure you're on the attorney's list the adjusters list whomever is handling the case and this way if you're on the list you're guaranteed to get paid assuming it goes to settlement and then worst case scenario that all falls through and you go to the third party payer in this case it's traditional medicare part b i hope that was helpful guys i'm going to answer another question in the next video