How an EMR Can Help with Physical Therapy Billing

Do you frequently find yourself facing claim denials and payment delays in your physical therapy clinic? Well, you’re not alone. With so many rules and regulatory changes, billing for physical therapy isn’t easy—but it doesn’t have to be a total challenge, either. When you use an integrated EMR and billing system, you can bid “adieu” to these three common billing blunders:

Ciao, Coding Errors

Okay, so you probably won’t get rid of all coding errors—your billers are still human, after all—but a great EMR can dramatically reduce those human errors, thereby greatly improving your claim accuracy. According to this cost-benefit analysis published in the American Journal of Medicine, an EMR is better able to capture charges and can “decrease [billing] errors by 78%.”

Plus, cloud-based EMRs are regularly updated to keep you compliant with all the latest regulatory changes (anyone remember ICD-10?). While that doesn’t mean you don’t have to be familiar with those changes, it does relieve pressure from you and your staff. Plus, it ensures your claims won’t get denied simply for failing to meet a new requirement.

Bye, Bye, Double Data-Entry

An EMR that’s integrated with your billing system isn’t just accurate; it’s efficient, too. HealthIT.gov reports that using an EMR reduces the time and resources needed for manual charge entry. Right now, you and your staff likely spend way too much valuable time manually entering data into your billing system. That’s a waste of your limited resources. Instead, choose an EMR that allows all your billing data to flow directly from your EMR to your billing software, so you can scrub and submit your claims with greater ease.

Auf Wiedersehen, Slow Cash Flow

The time between saying “aloha” to your claims and, uh, also “aloha” to your payments should be minimal. This analysis of electronic health record systems found that using one of these systems can improve cash flow by:  

  • eliminating billing errors or inaccurate coding
  • reducing outstanding days in accounts receivable and lost or disallowable charges
  • sending automatic reminders to providers and patients about routine health visits

But without an EMR to speed up the process and reduce the above-mentioned errors, you’re stuck floating along at the rate of snail mail. Don’t settle for slow payments. Get an EMR that can offer you complete documentation profiles, built-in prompts to help keep you compliant, and tools and tips to ensure accurate and complete coding.

__________

An EMR designed for physical therapists can help terminate your billing troubles (but don’t discount the importance of having the right billers on your team). When you find the right EMR for your practice, get ready to say “hasta la vista” to your billing headaches and “hello” to improved billing processes.


Defensible Documentation Best Practices

Defensible documentation—what a buzz word (er, phrase). But it’s not just hot air; there’s a good reason why it’s so trendy. According to the APTA, creating “documentation throughout the episode of care is a professional responsibility and a legal requirement.” As a “tool to ensure safety and the provision of high-quality care,” defensible documentation serves to:

  • Communicate information about a patient’s care, status, and treatment outcome among providers.
  • Tell others about the unique—and valuable—services you provide as a therapist.
  • Demonstrate compliance with local, state, federal, and payer regulations.
  • Help third-party payers determine appropriate payments.
  • Act as a historical account of patient encounters for legal purposes.
  • Provide a resource for policy or research purposes (e.g., outcomes).

So, for your physical therapy documentation to be defensible, it must be able to justify and support your diagnosis and plan of care—and thus, your payments. But, how do you know if your documentation is thorough enough to stand up to scrutiny? Start by taking a few moments to ask yourself these questions (as adapted from this WebPT blog post):

  • Would your documentation provide enough information to recall a particular encounter—and protect you against any questions or possible legal claims—months or even years after the fact?
  • Does your documentation support and justify your diagnosis, treatment, number of visits, and charges?
  • Is your documentation clear and legible to a non-clinician?
  • Does your documentation accurately describe the patient’s course of treatment?

If you can’t answer “yes” to any of these questions—or if you frequently spend time on the phone or writing letters trying to appeal or explain your documentation to a reviewer—then you’re not only losing payments; you’re also losing your rightful place in the continuum of care.

Basically, creating defensible documentation comes down to proving the medical necessity of your treatment. As Deborah Alexander from the PT Compliance Group discussed during her presentation at Ascend 2015, “Your documented services must be at a certain level of complexity and sophistication, or show that the patient’s condition requires services that can only be delivered by a therapist.” That means you must demonstrate that you provided skilled care. To that end, the APTA offers these recommendations to improve your documentation:

  • Provide a brief assessment of the patient’s/client’s response to the intervention(s) at every visit or event.
  • Document your clinical decision-making process (like explaining why you changed the patient’s/client’s exercise program, added or discontinued a modality, or progressed a functional activity).
  • Make sure your documentation is not repetitive (i.e., don’t write the same thing every time).
  • Make sure your documentation leaves no room for doubt that only a skilled physical therapist could have provided the treatment.

Additionally, here are a few more tips for creating defensible documentation from the University of Scranton’s DTP program:

  • Avoid using abbreviations or vague phrases like “patient tolerated treatment well” or “as above.”
  • Date and sign all entries.
  • Complete progress reports, as necessary.
  • Document during the visit, whenever possible.
  • Clearly identify note types.
  • Include all related communication and missed/cancelled visits.
  • Incorporate valid and reliable —and standardized—tests and measures.
  • Produce legible documentation—or risk having your claim delayed or outright denied

One last tip: use a physical therapy EMR.

Not only can electronic medical record-keeping make sure payers don’t have to decipher your notes, but it also can keep you compliant with all defensible documentation regulations. Alerts, measures, and reminders are built into your documentation, note types are easy to identify, and you can conveniently document during (or immediately after) a visit—you know, when you can easily remember what happened and can paint an accurate picture of the patient’s condition and treatment.

__________

Think of it this way (and bear with me): you know how castles have moats? Well, as a physical therapist, your practice is your castle, and defensible documentation is your moat. And like a moat, your documentation is more defensible when it’s full—of crucial information, that is. So, follow these tips to ensure your documentation—and your practice—is safe and sound.

Want more tips and examples of defensible documentation?
Download this chart for defensible documentation tips.


4 Tips for Improving Patient Wait Times

Physical therapy treatment plans are designed to help people get back on their feet, yet your patients may find themselves doing a whole lot of the opposite when they’re at your clinic. Even the best physical therapy practices can experience long wait times now and then, but that can lead to patient dissatisfaction—and a lot of negative online reviews. Although your practice might not be the PT equivalent of the DMV, your patients will invariably spend at least a few minutes in your waiting room, so here are four tips to improve your wait times:

1. Collect patient feedback.

The first step toward improving your wait times is to understand exactly why your patients have to wait. Your gut may tell you to simply hire extra front office staff, but that might not be your most effective option for shortening patient wait time (and it’s certainly not the most cost-effective choice, either). So, talk to your patients, whether that’s through open and honest conversations or anonymous patient surveys. Once you know where your practice falls short, you can make improvements in those areas.

2. Rethink the space.

The above-mentioned patient surveys are a great way to discover what your patients dislike most about their wait (other than the wait itself, of course). That front office water feature you installed to help patients relax? Yeah, they may secretly want to throw it through a window to make the bubbling just stop already (and now that you mention it, where’s the bathroom?). So, consider how temperature, sound, lighting, color, and even the comfort of your chairs impact the environment in your waiting room. Think about it this way: if you’re in for a long flight, you’d be a lot more comfortable in first class than you would be in coach, right? Your patients feel the same way about sitting in stiff, armless chairs with no padding; trade up for something a little cushier.

3. Acknowledge the wait.

Have you ever noticed that the drive to somewhere always seems longer than the drive back? Similarly, if your patients don’t know how long they have to wait—or why—then their wait will seem much longer than it really is. To avoid that, you’ll need to acknowledge the wait time in two ways. First, set expectations by informing patients of your average wait time when they schedule their appointments. Second, if the wait time is longer on the day of a patient’s appointment, you should apologize, explain what caused the delay, and keep the patient updated during the wait. Your time is valuable, but be sure your patients know their time is valuable, too.

4. Use an EMR.

Is your practice having trouble scheduling and managing patient appointments? Patients showing up late and throwing off your whole day’s schedule? That’s where an EMR can help. WebPT, for example, allows you to easily view and edit schedules for your patients, therapists, and treatment rooms. Plus, you can automatically send appointment reminders so patients show up on time.  

___________

Of course, the best tip for improving the patient wait time is to keep it as short as possible. In fact, it’s possible to eliminate the waiting—and the waiting room itself—almost completely, like this practice did. But for the days when emergencies, flat tires, and bad traffic make staying on schedule an impossible task, strive to keep your patients comfortable and informed. The road to recovery for your patients can be grueling, but their wait time at your clinic shouldn’t be.


5 Reasons Why PTs Love Their Cloud-Based EMRs

Some physical therapy clinics seem to have it all together: documentation gets done in a flash, claims are processed—and reimbursed—with ease, and everyone’s up-to-speed on all the latest regulatory changes. Maybe they’re born with it—or maybe it’s their EMR. Great cloud-based EMRs are designed with PTs in mind; these systems help make running a clinic seem like a breeze. Here are the top five reasons why PTs love working with a cloud-based EMR:

1. Affordability

Thanks to the cloud, PTs no longer have to shell out big bucks upfront—or cover the recurring costs associated with manual updates and IT staff—to use server-based EMR systems. Plus, software-as-a-service (SaaS) EMR vendors typically offer month-to-month payment models, making a cloud-based EMR an even less risky investment—an especially crucial selling point for smaller practices. Plus, users of these systems can switch to another EMR at any time. Vendors know this, which means they’re dedicated to providing customers with the highest-quality products and support.

2. Support

Speaking of support, like your best friend (or a pint of ice cream), a good EMR vendor is there when you need it with top-notch customer service. Think you have to bust out a user manual or comb through compiled help files if you have issues during setup or implementation? Not with a cloud-based EMR that’s ready to assist you with how-to guides, extensive knowledge bases, and an expert support staff.

3. Ease-of-use

A great cloud-based EMR is simple, user-friendly, easily scalable, and flexible. PTs love that cloud-based EMR vendors provide constant software and compliance updates to improve the user experience. Some vendors even develop enhancements based on user suggestions. With cloud-based EMR systems, PTs never have to lift a finger to access the newest version of an application or waste time worrying about—or fixing—notes or claims that aren’t up to payers’ standards.

4. Security

When it comes to keeping your patient data safe and secure, never fear—cloud-based EMR is here. With bank-level security encryption, tough password guidelines, automatic data backups, audit trails, super-secure data centers, and specialized staff, cloud-based EMRs have your back (and your front, and your sides, and—you get the picture).

5. Accessibility

PTs enjoy the convenience of working with a truly cloud-based EMR, which can be accessed anytime, anywhere, from any browser, and on any Internet-enabled device (unlike those bulky server-based EMRs, which sit in your office like a bump on a log—and require downloads, installations, and manual upgrades).

________

Cloud-based EMR vendors work hard behind the scenes to make documentation, billing, compliance, and practice management less of a hassle—and less of a hit to a clinic’s budget. But it’s not just about saving time and money (or wearing long-lasting makeup). A truly great EMR makes PTs feel all of the feels. Why? Because these features give PTs the freedom to get back to doing what they love most: helping patients.


6 Ways an EMR Keeps Your Data Safe from Hackers

Sadly, the Internet is full of folks looking to steal your personal information, and while most people probably are keenly aware of the need to protect their Social Security numbers (SSNs) and credit card accounts, many don’t realize that their medical identities also are vulnerable to hackers. According to NBC News, the Ponemon Institute estimates more than 2.3 million adult Americans have either been the victim of or know someone who has been a victim of medical identity theft during or before 2014. Even scarier? The institute’s fifth annual survey revealed that medical identity theft rose by 22% in 2014—and that rate shows no signs of slowing down. Forbes reports that in this year alone, three major health insurers—Anthem, Premera, and CareFirst—were hacked. These major data breaches exposed tens of millions of patient records, leaving those patients at risk for medical identity theft.

Using stolen patient information, criminals can fraudulently receive medical care—inherently altering victims’ medical records and racking up costly medical bills in those patients’ names. If you’re a medical provider, the responsibility of preventing data breaches—and the legal and financial consequences of failing to do so—is on you. But you aren’t in this fight alone. Here are several ways top-notch cloud-based EMR systems keep your patient data safe:

1. Bank-level security encryption

An industry standard, bank-level security encryption scrambles up your information (sort of like my breakfast this morning), so you can safely transmit it over the Internet using a cypher (i.e., an encryption algorithm)—like a 256-bit or better Secure Socket Layer (SSL)—and a cipher key. Furthermore, as this resource explains, “Data transmitted over an SSL connection cannot be tampered with or forged without the two parties becoming immediately aware of the tampering.”

2. Password guidelines

Password-protected access is a given for any technology company worth its salt, but your EMR also should have strict password guidelines to better protect your patient data. For extra security, look for the TRUSTe Certified Privacy badge on your EMR vendor’s website. To earn the privilege of displaying that badge, the EMR must:

  1. employ strict password guidelines that ensure complete login security, and
  2. feature unique password-protected access to ensure HIPAA compliance.

3. Automatic data backups

When was the last time you backed up your data? (Insert cricket noises.) Yeah, that’s what I thought. Not to worry: your EMR has your back. Armed with automatic data backups—with multiple replication processes to boot—your EMR will never lose your all-important patient data, even if you lose power or Internet connection.

4. An audit trail

This special feature helps discourage hackers—and fraud in general—by tracking user activity (criminals don’t want to get caught, after all). So long as providers keep it turned on, an audit trail maintains a chronological record of all attempts to access patient data. It records the data accessed, who accessed it, and when and from where it was accessed.

5. Specialized staff

Great customer service reps are hard to find, but when it comes to protecting your patients’ protected health information (PHI), the search is crucial. That’s why awesome EMR vendors take the time to hire and train staff who are well-versed in online security measures and at the ready to provide you with their expertise.

6. Data centers

To ensure HIPAA compliance, the best EMRs house all their—and thus, your—data at state-of-the-art data centers. These data centers must possess bank-level security and supreme encryption methods that render data unreadable—even if hackers somehow get to it. WebPT, for example, stores all of its data at IO Data Center, a Tier III-Certified facility that provides multiple layers of access control, including a defensible perimeter, video surveillance, biometric screening, and round-the­-clock security guards.

_____________

Often, the victims of medical identity theft remain unaware of the crime for months—or even years. Upon discovery, victims usually have a difficult time determining how it happened, and they often struggle to undo the damage. Make sure your patients don’t fall victim to medical identity theft. Web-based physical therapy software vendors—specifically, those that built their systems from scratch with the Internet in mind—are your practice’s best defense against cyber attackers.


How Much Downtime Should Your Physical Therapy Software Actually Experience?

In your personal life, downtime is great: sitting on a beach, sipping a fruity drink, and doing absolutely nothing. But when it comes to the physical therapy software you use in your professional life as a PT, the last thing you want is downtime. Yet, the sinking feeling of receiving an email from your vendor alerting you to yet another downtime—or worse, logging in to see that the system is down—may be all too familiar. You need your software to work—or else you can’t. And that begs the question, “How much downtime should your physical therapy software actually experience?”

Some companies experience frequent—yet brief—periods of downtime. Others experience chunks of sustained downtime—like Epic EMR, which was out for nearly two days in 2014. In fact, the issue of downtime is so prevalent in the healthcare industry that For the Record magazine even created an emergency downtime plan. But, when it comes “down” to it, system-wide downtime in a web­-based EMR shouldn’t happen very often at all. In fact, some EMR vendors—like WebPT—pride themselves on an uptime rate of over 99%.

And that statistic certainly shouldn’t come as a surprise. According to Fortune magazine, “There is a phrase in information technology called “five nines,” referring to 99.999% uptime, or about 5.26 minutes of downtime per year. Some have called it the “holy grail” of service availability; others have have called it only a myth. (It is not.).” Keep in mind that this rate does indicate a small amount of downtime—and that’s to be expected. Vendors have to perform maintenance, after all, and that requires downtime. But your vendor should always alert you to any maintenance downtime before it happens. Moreover, planned downtime should be set during low-use hours.

While we’re at it, I should mention that not all downtime is your vendor’s fault. Although modern Internet speeds are speedy enough to fit your EMR’s ideal configuration, issues with your individual Internet provider can cause outages. If you experience this type of downtime, take steps to prevent it by installing a backup Internet solution, like a mobile hotspot device. However, if your Internet connection is just fine, it probably isn’t responsible for all that downtime you’re experiencing.

Ultimately, healthcare providers have a choice. As using an EMR becomes the norm and not the exception, downtime will become an important—and pronounced—distinction between vendors. Don’t settle for prolonged downtime (like this unfortunate practice did) when you could be working with an EMR that anticipates—and adjusts for—your needs.


Is Your EMR Hurting or Helping Your ICD-10 Efforts?

We’re several days into the transition to ICD-10, and it seems like most folks made it through to the other side just fine. Many of you might even be thinking the new code set isn’t such a big deal. But is this the calm before the storm? After all, we’ve yet to see whether providers coded correctly, and thus, whether their ICD-10 claims actually will get paid. So, between watching the leaves change color and picking a prime pumpkin from the patch, you’ve got to maintain your ICD-10 efforts. While I’m sure you studied and practiced your tail off in anticipation of October 1, you may have overlooked one key part of a successful switch: your EMR. Here are two reasons why your EMR might be leaving you out in the cold (without your North Face jacket):

Automatic Conversions

Be wary of any EMR that claims it can automatically convert all of your codes or pick an ICD-10 code for you. While it may be tempting to “cheat” your way through selecting ICD-10 codes, taking shortcuts likely will come back to haunt you. As the American Health Information Management Association (AHIMA) explains in this post, thanks to “significant differences in language and structure between ICD-9 and ICD-10,” automatic conversions aren’t all they’re cracked up to be. The article explains that while “ICD-10 conversion can be highly automated [they] cannot be fully automated, and they cannot be finalized without review and evaluation by a person familiar with each system being converted.” In fact, AHIMA warns that “autoconverted ICD-10 systems may not work as intended, and skipping a human review can expose an organization to legal and financial risk once the converted systems go live.” If your EMR has automatically converted all your ICD-9 codes, do your due diligence. If you don’t make sure the conversions are accurate and as specific as possible, no one else will.   

Cheat Sheets

Some EMR vendors have created cheat sheets, and those resources might seem like a great idea, because they convert your most frequently used ICD-9 codes to their ICD-10 code counterparts. But according to this resource, that’s exactly the problem. Why? Because “pain codes…are the most commonly used ICD-9 codes for PTs. In ICD-10, though, you shouldn’t use a pain code as a patient’s primary diagnosis if you can help it. ICD-10 requires a far greater degree of specificity; thus, payers want you to code for the underlying injury or condition first and foremost. Only then should you list the pain codes associated with the main diagnosis.”

Plus, even though seventh characters are required for injury codes, cheat sheets don’t account for the seventh character because this character—and the information it represents—doesn’t exist within ICD-9 (hence, part of why we needed to make the leap to ICD-10). Plus, you must use clinical judgement to determine which seventh character best describes the patient’s condition or treatment phase. Don’t waste your time on an EMR that spends its time creating cheat sheets that put your practice at risk.

Working with an EMR that relies on code selection shortcuts is like wearing Uggs with shorts: just plain ridiculous. So, how do you know your EMR can protect your clinic’s productivity and cash flow post-transition? Look for an EMR that offers these three crucial features:

1.) An intuitive ICD-10 code selection tool

Your clinical judgement is critical to selecting the correct ICD-10 codes. An intelligent ICD-10 tool can assist you with making the best choice possible while simultaneously ensuring that you, as the therapist, make the final judgement call.

2.) Built-in alerts and safeguards

Does your EMR let you know when you’ve selected an invalid or non-billable ICD-10 code? If not, you’re leaving your clinic open to a heap of trouble.

3.) Free training, support, and resources

If your EMR doesn’t offer free training, support, and resources, then figuring out how to use the system’s ICD-10 functionality—and understanding ICD-10 itself—is entirely up to you.

_____________________

Don’t settle for a basic EMR (that doesn’t even like pecan pie-scented candles). When it comes to ICD-10, ensure your EMR isn’t out apple-pickin’ and pumpkin-carvin’ instead of supporting you in your transition efforts. If your vendor is taking shortcuts—or is plain ol’ unprepared—you could be left feeling like someone left the pumpkin spice out of your latte.


How a Physical Therapy EMR Can Work for Occupational Therapists

If you’ve spent any time at all searching for an EMR, you know it’s not one-size-fits-all technology—but it’s not one-size-fits-one technology, either. Despite the name, a physical therapy EMR—like WebPT—isn’t for physical therapists only. Here’s how to make a PT EMR work for your OT practice:

What to look for in an EMR

The reason a PT EMR can work so well for OTs is because both specialties need many of the same EMR features, including:

  • Comprehensive documentation
  • Regular—and free—compliance updates and built-in alerts regarding regulatory changes like PQRS, FLR, and ICD-10
  • Scheduling
  • Practice management
  • Billing
  • Free and easy-to-access customer education and support
  • Cloud-based platform (especially convenient for mobile and in-home OTs)

If an EMR has all these features, you’re off to a great start—but just because an EMR offers them doesn’t mean they all will work for your OT practice as-is. The best way to ensure an EMR has refined the crucial parts of its functionality with occupational therapists in mind is simply to ask.

What to ask your vendor

Because selecting—and switching to—an EMR requires time, effort, and resources, there are lots of questions you’ll want to ask yourself when evaluating an EMR. But asking the right questions of your vendor becomes much more important when your profession isn’t part of that vendor’s primary market. As you talk to potential PT EMR suitors, make sure you ask these questions:

  • How did your company approach tailoring its software to meet the needs of OTs?
    • Did you consult with practicing OTs?
    • How did you conduct industry research?
  • Does your software offer a separate OT user profile?
    • If not, how do you ensure my clinic’s accounts are OT-specific?
  • How does your software brand my documents so it’s clear my practice is an OT clinic?
    • Do you have an occupational therapy label?
    • Can I add my clinic name and logo to my documents?
  • Does your software feature OT billing codes? What about Medicare therapy cap-tracking?
  • What OT-related tests and tools are built into your software?
    • Activities of Daily Living (ADL) profile?
    • Disabilities of Arm, Shoulder, and Hand (DASH) test?
    • Upper extremity functional test?
    • Shoulder pain and disability index?
    • Hand and joint tests?
    • Detailed wrist/hand profile?
    • Ability to document and bill for custom orthoses, casts, and splints?

________

While it might not have been designed for occupational therapists originally, a PT EMR can indeed work effectively for OTs—and it doesn’t have to require a crazy number of workarounds, either. In fact, the right PT EMR won’t require you to do anything beyond selecting your specialty within the application. It might not be easy for you to weed out all the ones that don’t offer OT functionality, but if you keep these features and questions in mind, you’re sure to find a PT EMR vendor that also suits occupational therapists—and makes it easier for you achieve greatness in therapy practice.


3 Reasons Why PT Programs Should Teach Digital Documentation

As a future doctor of physical therapy, you bear a large burden: you’re responsible for not only healing your patients, but appropriately documenting your diagnosis and treatment as well. However, your PT program likely only places emphasis on one of those responsibilities—and that’s putting you at a severe disadvantage when you graduate. Here’s why your DPT curriculum should include digital documentation:

1. Most clinics don’t use pen and paper.

When you get out of school, your chances of landing a job with a clinic that doesn’t use an EMR are slim-to-none—and you wouldn’t want to work for a practice that’s stuck in the pen-and-paper past, anyway (the dream of the ’90s might be alive in Portland, but it won’t survive in PT). EMR is where it’s at, because it offers:

  • streamlined billing;
  • organized, compliant, and secure documentation;
  • built-in reports and alerts; and
  • the ability to access your records anytime, anywhere, and from any web-enabled device (with web-based systems, anyway).

It’s no wonder that over the last few years, EMR has become an integral part of the PT profession—which is exactly why DPT students should be learning how to use this technology.

2. It gives you a competitive edge

If you’re reading this in class, look to your right. Now, look to your left. Think about all the other DPT students out there at other schools, all working to become skilled PT professionals. Those folks are your direct competition for jobs when you graduate, so you need your resume to stand out. Understanding how to document digitally can help set you apart from other candidates—and help you ramp up more quickly once you land your dream job. A big part of being a successful PT is understanding how to market yourself—to future patients, referring physicians, and employers alike—and that should begin in DPT school.

3. Payers demand it.

As the healthcare industry quickly advances toward pay-for-performance payment models, interoperability—which calls for greater coordination among healthcare providers—will become the rule, not the exception. It would be impossible to organize the standardized and seamless exchange of information without the appropriate means of communication and technology. Thus, pen and paper documentation is bound to go extinct. Plus, with the introduction of ICD-10, billing—and actually getting paid—will become more complicated. To make that process easier, you’ll want to know how to use EMR technology.

_____________________________________

To set you up for success as a physical therapy professional, your PT program should train you on all aspects of being a physical therapist—including using EMR to document digitally. If your school doesn’t offer any digital documentation education, take the time to advocate for yourself, your program, and the future of your profession.


Billing Software vs. Billing Service—and How Your EMR Fits into the Picture

In today’s post, billing software takes on billing service, and I’m giving you a ringside seat. In this epic billing showdown, we’ve got two fierce competitors. (Cue the entrance music, please.) Coming in from the cloud and weighing in at, well, nothing is your in-house hero: billing software. And hailing from Anytown, USA, our second contender has fast fingers and laser-sharp focus on timely filing: It’s the trusted billing service!

Let’s have a fair fight, shall we? (Ding, ding.)

Billing Software

Billing is a big job, but someone’s got to do it—and when you use a billing software, that someone is you (or another member of your billing staff). If you’re a billing heavyweight—or if you’re willing to hire someone who is—then billing software is a great option for you. You get all the responsibility, but you also get all the financial insight and control over your claims. Plus, web-based software doesn’t require you to purchase any hardware, so you’ll likely save some moolah. Another major benefit? Keeping your billing in-house allows you to quickly locate and resolve any issues that come up—so long as you have perfected your billing workflow.

But if you lack the desire, expertise, or workflow efficiency to handle your billing in-house, you’ll want to take a closer look at working with a billing service.

Billing Service

Billing software is great if you prefer to fly solo, but when you have a billing service, you and your crew work like tag-team champions. Your front office still has a major impact on the success or failure of the process, but once you finalize and transmit your documentation to your billing service, your revenue cycle management team takes over and crushes those claims into submission. (See what I did there?) If you already work with a billing partner, look for a billing service that integrates with your vendor. Otherwise, choose a full-service billing service that will file claims quickly and correctly—and help you investigate and resolve billing errors and claim denials.

However, keep in mind that most billing services charge 6-12% of your monthly revenue collection. That means that unless your clinic’s monthly revenue remains steady all year long, you’ll probably have a hard time estimating your billing costs, which could be a real blow to your bottom line.

The EMR Factor

Simply put, regardless of the method you choose, it must integrate with your EMR. If it doesn’t, you’ll waste precious time and money on double data-entry and coding errors. Plus, you’ll have to grapple with limited access to crucial documentation and financial data. The future of heatlh care demands interoperability; why settle for a billing software or service that doesn’t communicate with your EMR?

Billing software and services are supposed to help your business—not hinder it—so avoid the ones that could end up costing you big (that includes software or service teams that aren’t up-to-date on the latest billing and compliance regulations and/or don’t understand the particulars of your specialty or region).

__________

Well, the match is over and the judges are split (I made that title belt for nothing). Neither option had a definite edge over the other, because it all depends on your clinic’s particular situation. Deciding whether to keep your billing in-house or outsource it to a billing service is a tough call to make, so you’ll need to take a good, hard look at your clinic’s needs, processes, staff, revenue, and budget before you declare a winner.