Practice-management technology can not only manage work flow, it can also play a big part in decreasing the number of denied claims.

Every physical therapy practice owner must face the inevitable advancement of technology to help the practice stay on top of its own business and trump outside competition. Learning about and incorporating technology into various aspects of practice management can not only help streamline processes such as appointment scheduling and patient documentation, it can also help boost revenues.

A computer-based system—which would provide everything from business and billing functions to medical records and clinical diagnosis aids—should be implemented throughout physical therapy practices. Physical therapists who are computer illiterate should learn to make full use of those systems, become familiar with medical resources on the Internet, and become comfortable using email and image-storage and image-transmission programs.

Streamline Processing

Perhaps one of the biggest advantages to having a technologically enlightened practice is that physical therapists gain a virtual ally when conquering backed-up claims. Because the average number of patient visits per week can reach into the hundreds, and the time needed for any staff member to navigate through the paperwork is nonexistent, it is highly likely that claims processing will pile up. 

With an electronic practice-management system, patient information can be quickly entered and easily accessed when claims are processed. Those claims may also be paid earlier, since the data is more accurate and more legible than hand-written records. Some software programs are even set up to incorporate existing CMS codes and will typically prompt therapists to use the correct ones, encouraging a higher number of payments and fewer denials.

Say No to Denials

Modern practice-management software decreases the number of denied claims by also improving billing functions. Most billing applications will identify problems with claims that should be rectified prior to their submission, which will improve the chances that the claims will be processed by the payor after the first submission. This will help reduce the time spent researching denials and resubmitting claims, and it may positively affect cash flow.

Advanced claims-management functions significantly reduce the number of denied claims by also streamlining a physical therapy practice’s payment process. For example, some software contains functionality that edits claims and determines the appropriate code for each payor based on cumulative data collected over time.

Although no health care practitioner wants to think of each patient as a "business," the best ammunition against denied claims is knowledge. If one is to be in a debate about revenue, it is best for one to arm oneself with thorough and accurate information about each patient claim. Point-of-service data collection via integrated systems allows the acquisition of outcomes data, patient-satisfaction information, and indicators of compliance with mandatory clinical evaluation and management criteria.

Though providing top-notch health care is always their main focus when dealing with patients, physical therapists need to be in control of all aspects of their business. Practice owners already know many management strategies, but they should also understand the need to "computerize" the services they provide according to defined protocols, such as treatment codes. Every patient contact can be reduced to data points that will play a role in diagnosis, treatment, billing, collections, and outcome evaluations.

Managing the practice means understanding how to best maximize reimbursement by performing specific procedures in the office. It means knowing reimbursement codes and regulations. It might also entail adopting computerized diagnosis, pain-assessment, and musculoskeletal-examination technologies. Also, it requires a fundamental knowledge of business principles, including business planning.

The Overall Advantage

Physical therapy practice owners may reduce their labor costs using claims-management technology. Some practice-management systems allow clinicians to enter claims as services are delivered to patients. This, in essence, eliminates the need for an extra staff member to collect and enter claims into the system, eventually helping to reduce the time and labor involved with manual upkeep.

Finding a practice-management system that decreases denials and integrates well into a physical therapy practice’s existing work flow is also very important. Many practice owners have realized that work-flow-management capability is an essential emerging feature that can further streamline operations and ultimately help them manage costs.

Work-flow management involves the automation—in whole or in part—of the business processes during which documents, information, or tasks that require action are passed from one participant to another according to a set of procedural rules. For example, an event takes place, and the system doles out its constituent tasks by distributing email reminders to staff members. Then, another event takes place, and the system adds tasks and drops others. All the while, the staff members merely have to do the individual tasks that the system tells them to do. No single staff member is required to be responsible for coordinating the constantly changing array of tasks. Instead, the system automatically determines, in real time, what needs to be done based on a set of preprogrammed rules that constantly intersect with the ongoing events of the day.

Because work-flow-automation functionality documents the relationship between specific work steps and the completion of tasks, it could potentially eliminate many unnecessary steps in the overall process, which will result in significant efficiency improvements in the physical therapy practice. For example, work-flow management can help excise inessential parts of the patient-registration process. Instead of receiving a variety of extraneous information from patients, the system prompts staff members to ask only for needed information at patient check-in. Then, depending on the type of visit, the system automatically sends a notice to the clinician or staff member who needs to see the patient—eliminating the need for another staff member to track down the appropriate personnel.

In addition, work-flow-management functionality enables practice owners to formally document the work rules and processes that govern the day-to-day operations at the practice, making it possible for work to continue uninterrupted despite the temporary or permanent loss of personnel.

Clearly, a practice-management system can solve many financial and logistical concerns for physical therapy practice owners. Investing in a suitable system can help practice owners realize a substantial return on their technology investment without breaking their budget. Further, as practice owners continue to implement more advanced systems—and explore the functionality of these systems—even more benefits are sure to emerge in the future.

Brian Schultz is a contributing writer for Physical Therapy Products.