Rehab medical billing may be the exclusive source of revenue for rehabilitation centers, but it is also an important part of billing and coding for physical therapy groups, physician groups with multiple specialties, individual and group practices and hospitals.
The challenges faced by all medical organizations apply to rehab billing, but there are some situations that are especially likely to be relevant concerns. Physical therapists and occupational therapists alike struggle with getting paid properly, and despite updates and changes being made to regulations and billing codes, the overall process isn’t getting much easier.
The Effects of COVID Continue to Have an Impact
Rather than having found a cure for COVID-19 by 2021 as we had hoped, we are going into the new year with the number of new cases continuing to rise. After things had seemed to settle down over the summer, new cases started spiking in larger cities.
Then the Thanksgiving holiday, the largest travel time of the year, arrived and many people who had been staying local since the beginning of the coronavirus lockdowns visited family in other states. Maybe the stable numbers being reported for a while had given us a false sense of security or perhaps people had just waited as long as they could stand without seeing those that they love, but the travel and group gatherings led to the virus making its way into new circles.
Regardless of the reason behind the spread, however, until the new vaccines are broadly distributed and proven effective, COVID-19 patients will require rehab services. From a business perspective, COVID patients generate revenue like any others, though there are likely to be more changes to the billing codes and regulations than normal and the state of emergency that was declared due to the spread of the novel coronavirus means that changes happen much faster than usual.
Providers are expected to keep up with the changes and will lose revenue if regulations change and their billing practices lag behind. Outsourcing rehab medical billing to a professional billing company can be especially beneficial under these conditions.
As healthcare providers, therapists need to be able to focus on patient care, not administrative duties—and no one providing medical services in this economy can afford to lose revenue to errors made when filling out claims or not having enough time to follow up on submissions that are rejected or denied.
Surprise Medical Bills Continue to Be an Issue
There has always been a problem with insurance and government payers omitting some treatments from what they will cover, and patients have never been happy to receive an unexpected bill. The issue got widespread attention in 2020 because people knew that insurers had been instructed by the government to cover costs of COVID treatment, so they did not expect to incur high bills.
Because the viral infection could become life-threatening very quickly and treatment facilities were limited, many patients were transported by ambulance and even air ambulance, which has a high cost. Transportation is not included in the treatment cost, so many patients received very high unexpected bills for that.
Surgical assistants and physical therapists can also be the source of surprise medical bills when they provide services at a hospital or other practice but they are out of network for the insurer that the physician is billing. Patients generally have no control over who provides services in the hospital, so are justifiably upset to find out that even though they made sure the hospital and doctor are covered by their insurance, other services are not.
There is no easy answer in sight. Two senators have come up with a bill that is supposed to solve the problem, but it does so by allowing payers to decide how much they will pay for anything, which medical trade organizations claim will drive reimbursements down and result in fewer providers and facilities being available.
Expect to Provide Documentation for Everything
In July of 2020, the Department of Justice settled rehab billing fraud allegations involving a management company and 27 affiliated skilled nursing facilities for $16.7 million. The corporation was accused of pressuring therapists to hit targets for billable rehab minutes that fell into the “Ultra High” category of the Resource Utilization Group (RUG) payment system, which, of course, bill at a higher rate.
The RUG system has been replaced with the Patient-Driven Payment Model (PDPM), but application of the new system will result in some close inspection to make sure it is not being abused and skilled nursing facilities are not being overpaid.
Our success at Medcare MSO is the result of nearly a decade of medical billing and revenue cycle management experience. We work with our clients to ensure that they get the maximum reimbursement possible. Our transparent reporting process lets you keep track of your KPIs at every stage of the revenue cycle. Call us today at 800-640-6409 to find out how you can be free of the complexities of rehab medical billing and have a more solvent practice.