How to Maximize Speech Therapy Reimbursements by Improving Your Claim Submission Process

Feb 10, 2020 9:00:00 AM

Insurance reimbursements are key to cash flow and clinic profitability. Many independent clinic owners and therapists are leaving money on the table because they aren’t getting reimbursed properly. Or they’re receiving reimbursements late because claims are regularly rejected and must be resubmitted. Usually, these problems are due to how they’re submitting insurance claims. In this post, we’re looking at six important steps that will help you boost your speech therapy reimbursements and receive them faster.

1. Use a Checklist-based Process

Checklists are well-known as being the tool that transformed surgical safety. But the value of checklists isn’t limited to the actual practice of medicine. Checklists can be just as helpful when used in the management of medical practices. 

Following a checklist ensures you perform precisely the same steps every time you go through a process.  Basing these steps on best practices and lessons learned from past mistakes will help you improve. For example, if you know that your claims are frequently denied because you forget to include applicable modifiers to your CPT codes, one checklist item could be “check for applicable modifiers.” 

Here’s a simple process to create a claims submission checklist. It will be most helpful to involve your biller or whoever is handling claims submission.

  • Create a list of every step that is a part of the claims submission process. 
  • Identify the specific reasons why your claims have been rejected or denied in the past. 
  • Consider actions that would prevent these mistakes from happening, and add those steps to your list. 
  • Create your final checklist, print copies, and post them where they will serve as a prompt and quick reference.

2. Double-check Patients’ Insurance Coverage

While you want to be sure that patients receive the services they need, it’s just as important that you receive reimbursement for your services. If possible, double-check that the patients’ insurance covers your planned service prior to scheduling. 

Sometimes you can adjust the service you provide to fit within what the insurer will cover. Other times, you will need the patient to sign an agreement to pay whatever the insurance company doesn’t cover. (It’s a good idea to have each patient sign an agreement of this nature as a standard procedure to cover you regardless.) 

A couple of best practices:

  • Don’t rely on memory. If you work with certain insurers often, it’s tempting to assume you remember what they cover and what they don’t. But insurers often update coverage, and you may remember inaccurately.
  • Always ask at the beginning of each year if patients’ coverage has changed. Since different plans cover different services, and people tend to move between plans, it’s important to know this information.

3. Automate Where You Can

The fact is that humans make mistakes. Automation can dramatically reduce the opportunity for human error, resulting in fewer claim rejections. Automation can be used for many processes and tasks, including:

  • Billing reconciliation
  • Submission to multiple payers
  • Claim creation
  • Payment processing

Automation does more than reduce instances of mistakes, however. It also makes your practice more efficient. Staff time is no longer being wasted correcting and resubmitting claims. And you can reallocate all the time that your staff used to spend on the now-automated tasks to more valuable activities (like running reports and making recommendations, which we’ll cover shortly). 

4. Know Which Codes are Best for Which Procedures

One of the best things you can do to maximize your speech therapy reimbursements is to use accurate ICD-10 and CPT codes. First, accurate coding will improve your claim acceptance rate. Second, when you use accurate codes that cover all the services and time you’ve spent with patients, you’ll increase the amounts of your reimbursements. 

Know the most common ICD-10 codes and CPT codes for speech therapy that you most often encounter and deliver. But don’t stop there. Familiarize yourself with all of the codes that are used by speech therapy practices. Ideally, you’ll work with a biller or billing service that is experienced in speech therapy codes. 

5. Track all Time

Reimbursements for time spent can be complicated. Some CPT codes are time-based, and others aren’t but allow for “atypical” situations that require additional time to be billed using a modifier. It’s important that you understand the rules governing how time is reimbursed and what time is allowable. While this topic goes beyond what we’re able to cover in this post, this article serves as a great resource.

It’s smart to get into the habit of tracking all time spent with patients, whether or not the CPT code you’ll be using is time-based. The reason for this is that it’s difficult to remember to time-track unless you make it a habit every time you’re with a patient or working on allowable activities such as interpreting tests.

6. Run Regular Reports

To run a profitable practice, you must know your metrics. What are your claims acceptance rates and reimbursement rates? What are your most profitable codes? What is your average time to reimbursement? Knowing your metrics allows you to identify opportunities for improvement. For example, if you see that you’re getting a lot of rejections asking for a write-up justifying use of a certain modifier, you could change your process to include a write-up every time you use that modifier. As is often said, “What gets measured gets managed!” 

Ideally, you’ll be able to run regular reports with these metrics, allowing you to spot trends or bottlenecks. Look for analytics software specifically designed for medical practices to ensure that reports are easy to run and deliver the insights you need. 

Learn how Fusion Web Clinic helps therapy clinics gain important insights into their practice’s performance. 

Speech Therapy Reimbursements are Key to a Profitable Practice

In order for your speech therapy clinic to be sustainable, it must have reliable cash flow. While most clinic owners and therapists want to focus on providing care, it’s just as important to think about the financial side of the business. Having sufficient cash available when you need it will ensure you can keep providing the care your patients depend on. With these best practices, you’ll know that you’re on your way to a more profitable (and thus more sustainable) practice.

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