John Wallace, cofounder and president of BMS Reimbursement Management, Claremont, Calif, recently spoke with Physical Therapy Products about his company’s unique place in the market as a rehabilitation-specific billing service.

Tell us about BMS Reimbursement Management.
BMS started in 1988 when I owned my practice. I partnered with someone who had accounts receivable experience, we bought software, and my practice became the first client. I had previously tried a medical billing service that mostly did physician billing, and it was not able/willing to provide the extra time and service needed to properly handle physical therapy claims. About 20% of physical therapy claims must be handled manually to get proper payment—much different than in physician billing. Unfortunately, that is where the profit margin is for most therapists. For this reason, we focus only on rehabilitation billing. We have grown gradually over time and now serve more than 160 practices in 35 states.

What are the challenges in your market niche?
Two primary trends have driven change in the billing and collections process. The first is the transition from paper billing forms to electronic data interchange (EDI) in 1988, when electronic claims submission was in its infancy. Now, 70% of our claims go electronically. As changes in the Health Insurance Portability and Accountability Act filter down to individual state workers’ compensation systems, this number will grow dramatically. Electronic remittance and automated claims posting is coming quickly—many Medicare carriers will no longer provide paper Explanations of Benefits.

The second is the volume and rate of change of the regulations associated with Medicare medical necessity and the return of the cap with the exceptions process. We have had to become a training source and information clearinghouse for our clients. We offer more than 10 hours of training per month with no additional charge to our clients. This includes CPT coding training, Medicare compliance training, therapy cap exceptions process training, and LCD training when individual Medicare carriers post these changes.

Where do you see the industry heading?
That depends largely on the payor community and Medicare, but I expect that in the next 5 years most claims will be sent and accepted electronically and all payment information will be electronic and posted in automated processes. Collections activity will focus on exception reporting that will be followed up by collections staff. This will require significant technology upgrades for therapists in their bill/collect operations.

We are preparing ourselves for this by constantly upgrading our software and hardware systems to take advantage of these things as they develop. We believe we can help most practices best by providing tools that will help practice owners manage the technology, rules, and regulations of billing and collections.