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Tip Sheet: Six Billing KPIs You Should Be Tracking

outpatient rehab billingAccording to the principles of the Hawthorne effect, that which you pay attention to improves. Therefore, if you focus on some specific key performance indicators, you could see some improvement in those areas.

Here are a few KPIs that most practices should be tracking — both monthly and year to date (YTD).

Download the tip sheet: 6 Billing KPIs You Should Be Tracking

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In-Network Vs. Out-of-Network: Which Is Right For You?

In-Network vs. Out-of-Network: Which is Right for You?

in network vs out of network

When starting up new clinics, rehab professionals often wonder if they should choose in-network or out-of-network payment systems. There’s no right or wrong answer, but there are a few differences to keep in mind as you decide what’s best for your clinic. Here a few facts that will help you make an informed decision:

In-network pros and cons

Clinics who choose an in-network payment model must agree to accept contractual rates, which may not always be desirable. This is not as good as if you billed out-of-network and received the full billed charges, but it does give you access to more patients as an in-network provider.

Referring physicians appreciate the ease of “one-stop shopping.” They want to deal with clinics that are in-network across the board, so there is value in being an in-network provider despite having to accept the often-undesirable network reimbursement. And certainly patients want to make the most of their health insurance, so they’re more likely to choose providers within their networks.

Out-of-network pros and cons

Clinics that are out-of-network can bill according to their own pricing and don’t have to accept contractual rates. Out-of-network providers can also bill patients for whatever their insurance plans don’t pay – or not. When you’re out-of-network, you aren’t bound by the terms and conditions of that payer, and you have the ability to negotiate. If you’re in-network, you’re contractually obligated to collect copays, co-insurance, unmet deductibles, etc. Waiving those could constitute insurance fraud. But if you’re out-of-network, you’re not bound by the payers’ rules and can bill patients as much or little as you want.

Note: This does not apply to Medicaid beneficiaries. In most states, if you’re not an in-network Medicaid provider, you can’t bill patients for what Medicaid would have but does not pay you.

Therefore, your reimbursement per visit is generally better when you’re out-of-network, but you’re likely to be selected by fewer patients in need of therapy.

What’s the best choice for you?

Providers must decide strategically, and there’s no right or wrong answer. Evaluate what is more important to your clinic – volume or profitability on a per-claim basis? When in doubt, we recommend being in-network, but this is a strategic decision that only you can make for yourself.

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Recorded Webinar:
Best Practices for PT/OT Billing

Maximize collections with these proven principles for your front desk, clinicians, billers and management

Fill out the form to the right to watch the recording now!

flatirons-thumbEffective revenue cycle management begins long before claims are coded, and continues long after payer reimbursement. This fast-paced webinar will cover best practices throughout your facility that greatly reduce the risk of underpayments and denials. Explore a comprehensive revenue-building workflow covering…Whether you work in a private practice or hospital department, maximizing collections is critical to your rehab organization’s success. Yet too often, this responsibility is placed overwhelmingly on the billing department.

  • Front-Desk Practices
  • FLR Coding
  • Proper Modifier Use
  • Accounts Receivables Management
  • Key Performance Indicators

Any rehab practice or department can benefit from this concrete action plan to enhance revenue. Listen to this informative webinar recording with David Allen, CEO of Flatirons Practice Management as he uncovers the opportunities and points out the pitfalls involved in maximizing PT/OT collections.

 

 

David has an MBA from the University of Tulsa and has done additional post-graduate work in Healthcare Systems Management at the University of Denver. Before acquiring Flatirons Practice Management, David spent 20 years on the corporate-side of healthcare working for industry leaders such as GE Healthcare and Quest Diagnostics in various senior management roles.  It was at Quest Diagnostics that David was trained in Six Sigma and championed several projects including a billing accuracy improvement project.  These experiences have enabled David and his team to provide superior customer service and superior business results for their clients.

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