While professional administrators handling physical therapy software and documentation are supposed to have the primary impact on pricing and determining the cost of services they provide, the real party that drives the reimbursement process is the health insurance industry, according to licensed physical therapist and marketing expert Nitin Chhoda. As a public service, Chhoda recently exposed this aspect of the industry in a recent blog post.
Denville, NJ (PRWEB) July 10, 2013
Health insurance has undue sway in determining the cost of services reimbursed in physical therapy billing, according to a key observer of the business. Health-related pricing is typically calculated based on market considerations and equipment costs, along with associated overhead related to physical therapy documentation and miscellaneous expenses.
Chhoda explains this normal mindset is complicated by the middleman in the health industry, the insurance companies, who are the primary payers for health services. The payers have standing policies and rules regarding how they will pay for services and what kind of coding and documentation format must present it for them to approve the claim for reimbursement.
What complicates, or rather defeats market considerations in healthcare for physical therapist, is that the frequent inflexibility of major insurance payers, and their tendency to reject reimbursement if they unilaterally deems that the physical therapy documentation inadequate.
This may mean that the provider ends up settling for what the insurer will pay, instead of what all costs wire in terms of pricing. Stressing all the expenses incurred in delivering service may jeopardize reimbursement, as the expenses may not be documentable as far as the payer’s policy is concerned, using current physical therapy software or documents.
“Much of the reimbursement process relies upon the medical billing and coding specialist entering the correct codes, and ensuring documentation complies with the payer’s submission specifications,” says Chhoda. “Insurance companies call all the shots when it comes to reimbursements. Clinicians must be vigilant when negotiating contracts with payers to ensure they’re receiving the best return for their services.”
Chhoda also points out government payers may be the most inflexible and what they will pay for, while also insisting on the EMR transmission of information in order to make payment decisions. As long as this is the case, providers will have to adjust services to match the policies and records transmission scheme desired by the insurers.
Chhoda’s office can be reached by phone at 201-535-4475. For more information, visit the website at http://www.emrnews.com.
About Nitin Chhoda
Nitin Chhoda PT, DPT is a licensed physical therapist, a certified strength and conditioning specialist and an entrepreneur. He is the author of "Physical Therapy Marketing For The New Economy" and “Marketing for Physical Therapy Clinics” and is a prolific speaker, writer and creator of products and systems to streamline medical billing and coding, electronic medical records, health care practice management and marketing to increase referrals. He has been featured in numerous industry magazines, major radio and broadcast media, and is the founder of Referral Ignition training systems and the annual Private Practice Summit. Chhoda speaks extensively throughout the U.S., Canada and Asia. He is also the creator of the Therapy Newsletter and Clinical Contact, both web-based services to help private practices improve communication with patients, delivery better quality of care and boost patient retention. Reported by PRWeb 8 hours ago.
Denville, NJ (PRWEB) July 10, 2013
Health insurance has undue sway in determining the cost of services reimbursed in physical therapy billing, according to a key observer of the business. Health-related pricing is typically calculated based on market considerations and equipment costs, along with associated overhead related to physical therapy documentation and miscellaneous expenses.
Chhoda explains this normal mindset is complicated by the middleman in the health industry, the insurance companies, who are the primary payers for health services. The payers have standing policies and rules regarding how they will pay for services and what kind of coding and documentation format must present it for them to approve the claim for reimbursement.
What complicates, or rather defeats market considerations in healthcare for physical therapist, is that the frequent inflexibility of major insurance payers, and their tendency to reject reimbursement if they unilaterally deems that the physical therapy documentation inadequate.
This may mean that the provider ends up settling for what the insurer will pay, instead of what all costs wire in terms of pricing. Stressing all the expenses incurred in delivering service may jeopardize reimbursement, as the expenses may not be documentable as far as the payer’s policy is concerned, using current physical therapy software or documents.
“Much of the reimbursement process relies upon the medical billing and coding specialist entering the correct codes, and ensuring documentation complies with the payer’s submission specifications,” says Chhoda. “Insurance companies call all the shots when it comes to reimbursements. Clinicians must be vigilant when negotiating contracts with payers to ensure they’re receiving the best return for their services.”
Chhoda also points out government payers may be the most inflexible and what they will pay for, while also insisting on the EMR transmission of information in order to make payment decisions. As long as this is the case, providers will have to adjust services to match the policies and records transmission scheme desired by the insurers.
Chhoda’s office can be reached by phone at 201-535-4475. For more information, visit the website at http://www.emrnews.com.
About Nitin Chhoda
Nitin Chhoda PT, DPT is a licensed physical therapist, a certified strength and conditioning specialist and an entrepreneur. He is the author of "Physical Therapy Marketing For The New Economy" and “Marketing for Physical Therapy Clinics” and is a prolific speaker, writer and creator of products and systems to streamline medical billing and coding, electronic medical records, health care practice management and marketing to increase referrals. He has been featured in numerous industry magazines, major radio and broadcast media, and is the founder of Referral Ignition training systems and the annual Private Practice Summit. Chhoda speaks extensively throughout the U.S., Canada and Asia. He is also the creator of the Therapy Newsletter and Clinical Contact, both web-based services to help private practices improve communication with patients, delivery better quality of care and boost patient retention. Reported by PRWeb 8 hours ago.