Physical therapy medical billing in Oregon is a specialty service which exists at the intersection of knowledge, technology, process, and geography. Each of these facets are critical to receiving prompt payment from insurance companies and patients, and failure of any area can result in critical delays to practice cash flow. Unfortunately, there have been many private practices within Oregon, the Pacific Northwest and beyond, who have failed to master the physical therapy medical billing process, and have experienced the dire consequences associated with reduced flow of cash through the business.
In an effort to help physical therapy practices in Oregon understand the factors required for success in medical billing, I’ve outlined a few of the important elements of the specialty below.
Medical Billing Knowledge
Knowledge of medical billing within the physical therapy discipline is a prerequisite to receiving prompt and full payment from insurance companies and patients. Many physical therapy medical billing specialists have received informal, on-the-job training, and may not be required of their employer to stay up-to-date with the latest laws, regulations, and best practices available.
To ensure that a physical therapy practice is working with from a medical billing knowledge base familiar with these necessary rules and regulations, it is imperative that medical billers be encouraged or required to seek some level of formal education and/or certification within the specialty. The American Medical Billing Association (AMBA) is an excellent resource for such medical billing information and knowledge, providing the opportunity for medical billers to earn the Certified Medical Reimbursement Specialist (CMRS) credential as evidence of their knowledge base.
Medical Billing Technology
Technological advances in the area of medical billing for physical therapy practices have grown leaps and bounds in the past few years. Once a specialty of the paper world, physical therapy medical billing now lives predominantly in electronic format, driven by keystrokes, ones and zeros. The benefit of such technology for medical billers and the physical therapy practices they serve has been profound.
Claims submission processes which once required the postal service to inform insurance companies of a claim are now realized in split seconds via the web. The remittance of payment, also once reliant upon snail mail for travel, can now be received via electronic remittance advice (ERA) and electronic funds transfer (EFT) by the provider, compressing service-to-payment times from months, to mere days. While the medical billing technology now exists to allow the secure and rapid transport of information resulting in swift payment to physical therapy practices, not all medical billing providers use the most current technology available, and as such may risk payment delays or avoidable claim denials which can result in dire consequences for the physical therapy practice.
Medical Billing Processes
Knowledge and technology are critical facets of the physical therapy medical billing specialty, however the physical therapy back office can still be rife with error and confusion in an absence of efficient process. An effective medical billing process requires the smooth coordination and hand off of responsibilities among medical billing team members based on the nature of the information at hand.
Some medical billing teams divide roles into those who specialize in claims submission, others who post payments to patient accounts, and specialists who focus solely on the collaboration with insurance companies and/or patients to realize payment of aged accounts. Regardless of the size of the medical billing team, the physical therapy practice will be wise to inquire about the process that will be used in such areas as claims submission, insurance follow up, statement processing, remittance and posting, and transfer of accounts to collections when necessary.
Medical Billing in Oregon
While physical therapy medical billers throughout the United States face the same knowledge, technological, and process-related challenges regardless of state geography, it is important to realize that medical billers in Oregon have a specialized knowledge base useful to physical therapy practices located right here in our own backyard. This knowledge is borne of familiarity and experience with Oregon health insurance companies, workers’ compensation and automobile insurance, as well as Oregon laws pertaining to state Medicaid and other payor regulations.
Physical therapy medical billing is a critical competency to pursue for all practices, and whether the physical therapy practice is able to achieve such expertise in-house, or through partnership with a physical therapy medical billing provider, it is critical that the four features above be considered thoroughly before deciding on a solution. The challenge of staying atop the changing reimbursement landscape is not one soon to pass, and physical therapy practices large and small will be required to adapt to this landscape for years to come.