Four Signs It’s Time to Revisit Outpatient Therapy Billing

In the perfect world, outpatient therapy billing is a seamless process that ensures all parties are appropriately billed, compensated or reimbursed for services rendered. After all, it’s a daily routine in your practice, so it should run smoothly 99% of the time, right?

Right! Except we all know that’s often not the case. The Government Accountability Office (GAO) found that up to 25% of healthcare claims are denied. That adds up to a lot of lost revenue!

When it comes to outpatient billing, traditional approaches and legacy systems routinely fall short. And it’s a shortfall that outpatient practices can’t afford to ignore.

What are a few signs that your billing process may be costing you time and money unnecessarily?

Here are four key indicators to look out for:

-High claims denial rate—If you don’t know your denial rate, then check this metric. The total dollar amount of denied claims divided by the total dollar amount of claims submitted will give you your denial rate. If it’s above 5%, then you’ll want to investigate the issue. You may be having problems with certain payers or your billing process. If you don’t know, you can’t fix it.

-Constant staff turnover—If you’re practice experiences a lot of turnover, then your billing process may be taking a hit. Outpatient billing requires precision, attention to detail and expertise. There’s little room for error. Unfortunately, as staff members leave, they take their knowledge with them. Unless you have a good transition process in place, new staff may have to learn your process on the fly, increasing the likelihood that a piece of critical information will be overlooked or entered incorrectly.

-Growth of your practice—Is your practice growing? If so, then you have to make sure your billing process and therapy billing software are likewise scaling to support your needs. All too often, outpatient practices become victims of their own success. The strategies and billing tools they used in earlier days no longer work as they see a spike in the number of patients and staff and/or additional practice locations.

-Lack of control or visibility—Maybe your billing process worked just fine for years…but lately things are getting a little unwieldy. It could be due rapid practice growth, changing regulations or all the manual back and forth about claims errors or denials. Whatever the reason, this lack of visibility or control can quickly lead to reimbursement issues and frustrated staff.

If any of these scenarios sound familiar, then it’s time to take a closer look at your billing process. The question is…how do you remedy the situation? Do you invest in more staff and resources, or perhaps upgrade your EMR billing software? Or maybe you should offload some of the burden to a third-party billing provider who is well-versed in outpatient therapy billing?

Each method has its advantages and disadvantages—and it depends on the specific needs of your practice. Find out how which billing approach may work for you in our new tip sheet – “Should You Outsource Your Therapy Billing? Get the Pros and Cons.”