Ensuring accurate reimbursement is no small task for today’s speech, occupational, and physical therapists. Billing codes are updated annually, payer requirements change frequently, and out-of-pocket costs for patients continue to increase. It’s the perfect storm of challenges that can make or break your busy therapy practice.
The good news is that there are several ways in which therapists can protect the revenue they generate. Following are five tips to consider in 2019 and beyond.
1. Know whether you’re required to participate in the Merit-based Incentive Payment System (MIPS).
Starting in calendar year 2019, speech, occupational, and physical therapists became eligible clinician types. This means these therapists are now required to participate in MIPS if they see more than 200 unique patients with Medicare Part B and provide at least 200 Part B-covered professional services totaling more than $90,000 annually.
Therapists who are required to participate—but fail to do so—will see a seven percent payment reduction for Medicare Part B services starting in 2021. Alternatively, therapists could earn up to a seven percent bonus for favorable participation. Use this resource from the Centers for Medicare & Medicaid Services (CMS) to verify your participation status.
Nancy Rothenberg, vice president of PTPN, provides several tips to help speech, occupational, and physical therapists achieve success under MIPS:
- Use an electronic health record (EHR) that will allow you to submit relevant quality measures to the registry or qualified clinical data registry (QCDR) if you intend to use either of these data submission methods. Note that any practice can use these methods, but large practices (i.e., those with more than 15 therapists) are required to use one or the other.
- Retain documentation of improvement activities in the event of an audit.
- When reporting quality measures, be sure to include the correct ICD-10-CM, CPT, and CPT II codes on the claim or when submitting data to the registry or QCDR. These codes are what trigger the quality measure and include or exclude that measure in the reporting process. If you outsource your billing, ensure that your billing company is aware of these codes and reports them appropriately.
- Review any feedback that CMS or the vendor submitting data on your behalf provides, and make operational adjustments as necessary. This feedback is an important source of information that can help you achieve bonus payments and avoid penalties.
2. Know how changes to the Affordable Care Act could affect your practice.
Starting this year, individuals are no longer penalized for failing to obtain healthcare coverage, which means some of a therapist’s patients could move into a true ‘self-pay’ status, says Aimee Heckman, healthcare business consultant at Ease RCM Solutions. Best practice is to verify eligibility before each visit, and collect payment at the time of service, says Heckman. This is true for all patients—including those with insurance—and especially those with high deductible health plans.
Collecting at the point of service is always critical, but it’s especially important during the first few months of the year when deductibles reset, and most patients essentially become self-pay, she adds. Given the volume of services that therapists render, charges can add up quickly. Once a patient receives services and leaves without paying, the chances of collecting that money decreases significantly.
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3. Don’t forget to monitor payer denials.
Nobody wants to spend time looking at denials; however, the reality is that denial management is an essential step in terms of mitigating future revenue loss, says Heckman. Look at the remark code for each denial. If possible, correct the error and resubmit the claim. Be sure to address the root cause of the denial so you don’t continue to lose revenue.
4. Review your fee schedules, renegotiate contracts.
Look at the fee schedule for the top five to 10 CPT codes you billed in the last 12 months. What’s the average charge vs. payment for each of these codes by payer? Doing this helps identify your lowest vs. highest paying payers. Leverage your value and what you bring to the table in terms of care quality and cost reduction, says Heckman. Don’t be afraid to walk away if the payer won’t budge, she adds.
5. Provide patients with a variety of payment options.
The days of sending a bill in the mail and expecting to receive a check a few days later are long gone. Instead, patients expect the same bill pay conveniences they experience in other non-healthcare industries, says Heckman: Credit/debit card on file, online payment, and mobile app-based payments. The more options you provide, the more likely you will be to collect the revenue to which you’re entitled, she adds.
- Centers for Medicare & Medicaid Services: https://qpp.cms.gov/
- American Physical Therapy Association: http://www.apta.org/MIPS/
- American Speech-Language-Hearing Association: https://www.asha.org/practice/reimbursement/medicare/the-medicare-quality-payment-program/
- American Occupational Therapy Association, Inc.: https://www.aota.org/Practice/Manage/value.aspx
- Support for small, underserved, and rural practices: https://qpp.cms.gov/about/small-underserved-rural-practices