Maximizing Billing, Reimbursements and Collections

Today I want to talk about billing and reimbursements so you can maximize your collections. This is an important topic for any private practice owner if they are to sustain their business.  

Billing Insurance Companies Effectively and Maximally

There are three main billing and collections areas you should focus on. The first is billing the insurance company. Make your insurance billings effective by ensuring they are done: 

  1. Ethically
  2. Maximally
  3. Correctly 
  4. In a timely manner

We’re only going to bill for services we provide. This is how we train all our staff to do billings. We always maintain a high standard of ethics in billing. 

At the same time, we want to bill maximally. By that, I mean that we want to look at every skill and technique we provide and make sure that we’re able to bill in a way that we can get maximum dollars back.

Using the AMA Medical Therapy Codes

It’s very expensive to keep our therapists trained up, always expanding their skill base so that they can better help our patients. We have to make sure that we find coding that matches their skill levels and allows us to get reimbursed effectively. Get the AMA coding books and look through them at the therapy codes. There’s only a handful of codes we typically use in our practices. Learn how to use each one. 

You can study how to do this online because it’s not that difficult. There are also courses available on using these codes, but the process is pretty simple because we only use a limited number of codes in our practices. 

You’ll also need to learn how to use modifiers like Modifier 59 which describes a distinct procedural service. Learn the right way to use different modifiers so you’re getting paid and avoiding denials for the codes you’re billing.

Keys to Success: Billing in a Timely Manner and Setting Quotas

Make sure you bill out in a timely manner for all your visits. You should also be able to accurately measure what you bill out and collect. I learned how to do this through the Effective Reimbursement Program with Survival Strategies, Inc. They have amazing programs that teach therapists how to effectively run their businesses, which I didn’t know how to do when I started out. 

When you get trained on how to do the job, running your business becomes quite easy. Believe it or not, it becomes fun and stress-free. 

You also need to know how to quota your billings. First, figure out what your maximum billing is and what your average maximum billing is. Then work out your average billed out per visit. You can then set your quotas for the visits that you want to hit each week. By taking these steps, you will work out the maximum number of visits that your team can truly push for.

Then take that average billed out per visit and multiply it times visits seen. That gives you the quota for billings that week. Now you know the number of visits needed to hit your billed out quota. You’ll also have to bill out maximally to hit your billed out quota. 

Breaking Your Quota Down into Doable Steps

Break down that billed out quota into the steps you need to take each week. You can make checklists like this. 

  • How many evaluations do you need to get in per week? 
  • How many re-evals do you need to get in per week?
  • What are the codes that pay higher in your state?
  • Do you want to go after those codes and have a quota for those codes as well?

Control your billed out, understand your coding and your team and what you can motivate them to do. That will help you reach billing quotas.

Learning to Control Your Billings the Right Way

It takes time to learn how to completely control your billings. I learned how through the Effective Reimbursement Program from Survival Strategies. If you want control over your billed out and collections, you have to seek out training and educate yourself to a higher level. Get yourself trained as an owner and you’ll know how to control your collections.

Ensuring You Receive Maximum Collections

Billed out is the first thing to learn to control. The second thing is collections. Once you are billing ethically, maximally, correctly and timely and you hit your quota, look at collections.

The important thing for collections is to know what your billed out is and then what percent of your billed out you usually collect. You want a high percentage here as that means you’re collecting most of what you billed out. To calculate this figure, just divide your collections by your billed out. 

Working With Insurance Companies on Collections

To set a quota for collections, look at your billings four weeks ago because that’s how long most insurance companies take to pay, according to the contracts they have with you. Hold insurance companies to that contracted agreement. You can learn how to do this in the Effective Reimbursement Program. Survival Strategies has a wonderful method of making sure that you reach out to insurance companies in just the right way to collect on billings.

The Patient Portion of Your Collections

The third part of billing and collections is the patient portion. Create a policy in your company to collect copays, co-insurances and deductible balances at the time of your patients’ visits. This keeps their balances low which makes it easier for every patient to pay the balance.

Take a look at what your collections are per day and per week and have your team go after 100% of those patient collections. If you can warn a patient before they come in so they’re ready for that balance, that makes collecting it much easier. If you’re afraid of a cancellation if you tell them, don’t be afraid. You don’t want them to come in if they can’t afford the appointment.

Summary: The Three Parts of Maximizing Income

The three ways that you can be successful in maximizing your income are:

  1. Bill accurately, timely, ethically, maximally and consistently. 
  2. Ensure your collections are effective.
  3. Make sure you collect not only balances from insurance but also patient balances.

I’m cheering you on to great success and getting in that income so you can have a successful, profitable business!

In the book Keys to Private Practice Success, you’ll learn many more very specific skills to make your practice successful. This book contains data you really shouldn’t be without. Get Keys to Private Practice Success today and go straight to Section Four which is all about controlling practice finances. This valuable manual is only $29.95. Click here to order now.

About Diane Crecelius

Diane Crecelius is a physical therapist and founder of a multi-million-dollar, multi-location practice with well over 3,000 visits per week and 200 staff! In the past several years, Diane has worked tirelessly to support the Peds-A-Palooza group and the success of Private Practice Owners. Diane has presented at nearly every Peds-A-Palooza live and virtual conference since the first sold-out conference in 2018. Her extensive knowledge derives from her decades in practice and from being trained and consulted by Survival Strategies, Inc. She uses this training to help Private Practice Owners learn how to thrive and expand while keeping their stress low.