The purchase of billing software should be the beginning of a positive, long-term relationship. In fact, buying the wrong software system can complicate problems now more than they could be in the days of manual billing and filing. If you have an established practice, whether to keep your current billing application and interface with a documentation component or to start completely over with a new billing and documentation system will significantly impact the purchasing decision and implementation process.

PURCHASING DECISIONS

Before any purchase, honestly evaluate your billing system as to whether it meets your current and future billing needs. If you are satisfied with your billing system and don't want to go through months of disruption by implementing a new one, find the best documentation application and interface it with your current billing program. Get references from the vendor of other clinics that are successfully interfaced and satisfied.

FEATURES

Billing features should allow for electronic or paper claims without much hassle and should include claim checks for missing information to help avoid rejections. Statistical information should be available so physicians can know where their patients are coming from, where the money is, and when claims and bills are overdue.

One of the most important features is making sure that both programs can integrate together, especially if they are purchased from separate companies. If you can purchase only one program at a time, find out what other available companies' software will work well together with your planned system. For example, if documentation software is integrated with billing software, then the charges and diagnoses entered into the documentation software for today should appear in the billing software at the front desk. Another good feature to look for in your billing software package is a way to review claims for their accuracy before they are printed or sent.

It isn't just the features available, but also the depth of the features and how they are implemented. Workflow within the office needs to be considered. How many times per day does the typical office find the need to either modify or delete account or billing entries? Accounting programs, by necessity, will lock information after period closing. Billing programs, on the other hand, can be designed to allow modifications and deletions as long as audit trails are maintained that include the user who made the change. When in a patient's account, how many steps does it require to move between billing, ledger, condition, patient information, or scheduler? A program may be called robust due to the number of features or the depth of the features.

BILLING SERVICES EXPERTS

Many new clinic owners are caught in a catch-22. They do not have the volume of charges to afford a billing manager, and yet they do not have the time or expertise to do the billing themselves. Many new owners are tempted to have someone do double duty on the front desk and billing. It is important to realize that not all medical billing is the same. Physical therapy and rehabilitation billing and compliance are different from physician or other medical billing. Just as you would never trust someone to supervise treatment for a patient if they were not a licensed PT, you should not trust your billing to someone without significant experience in rehabilitation billing and reimbursement.

One successful approach is to hire a billing service. By relying on a good service, you can pay for your billing as you grow. Billing service fees are based on what they collect, not on your gross billing charges, and are usually a small percentage of the collections paid after the money is collected and deposited in your account. It does not make sense to pay someone a salary when you do not have the volume in charges to support that personnel.

Every new clinic owner has heard a horror story about billing services. Whenever you entrust someone with your clinic's money, you are taking a risk. You can cut down on that risk by getting recommendations from colleagues and by using a billing services company that gives you a way to keep tabs on your business and hold them accountable. Their software system should provide a portal that allows you to check their follow-up status, patient accounts, and reports on the aging of your accounts receivable. You should be able to get any information you need to feel comfortable that they are following up as you would. Some billing services also provide free clinic management software, which helps improve efficiency and further cuts down on your initial out-of-pocket investment.

OPTIONS AND SOLUTIONS

The following companies offer billing services and/or billing software solutions for your practice.

BMS Reimbursement Management (www.bmsreimbursement.com)

BMS focuses exclusively on rehab services, with a comprehensive understanding of the reimbursement issues that most directly affect rehabilitation professionals. BMS can help to increase the speed of collections, reduce and effectively manage accounts receivables, and help therapists stay in regulatory compliance. BMS solutions integrate with a number of documentation systems.

Clinicient (www.clinicient.com)

Clinicient Billing Services offers a comprehensive approach to reimbursement services by handling all aspects of billing, including: HIPAA-compliant electronic claim submission; clearinghouse setup, management, and claim submission; electronic payment advice posting; and payor follow-up including patient statement, and secondary and tertiary payors. Users of Clinicient Billing Services have free access to Clinicient Insight™, an Internet-based registration, scheduling, and clinical documentation system that electronically collects and stores all data required for successful billing in a centralized database accessible by the company's trained staff at its central billing facility.

DB Consultants Inc (www.dbconsultants.com)

DBC software supports the following electronic billing options: direct to Medicare via ANSI Standard 837; almost all carriers, including those who accept only paper claims via Emdeon (formerly known as WebMD); and direct to any carrier allowing and accepting NSF or Standard 837 direct submissions. DB Consultants has supported the CMS mandated ANSI Standard 837 format for electronic data, which has been a requirement for Medicare submissions for many years.

EON Systems (www.eonsystems.net)

EON Systems offers the TPS2000 HIPAA-compliant billing software. TPS2000 incorporates two types of electronic data interchange transactions: 837 Professional Health Care Claim (ASC X12 837 Version 004010X098), which is the form that is used to send the charges to payors; and 997 Functional Acknowledgment (ASC X12 997 Version 004010X098), which is the form that is returned from payors. The Health Care Claim Transaction for Professional Claims/Encounters (837) provides all necessary information to allow the destination payor to at least begin to adjudicate the claim. The Functional Acknowledgment (997) transaction is used as the first response to receiving an 837. The 997 informs the 837 submitter that the transmission arrived.

HealthLink Technologies (www.getintouch.ca)

HealthLink Technologies' software offers billing and accounts receivable features, including: full multiple-payor billing management; extensive funding maximum tracking, reporting, and flagging; HCFA-1500 paper and electronic billing; integrated super bills and billing sheets; robust processing of incoming payments and balance transfers between payors; adjustment and bad debt processing; invoice, receipts, and unbilled service accounting interface journals; extensive aged receivables reporting; and detailed audit trail on all services performed (invoices, payments, adjustments, and transfers).

PT Billing Solutions (www.ptbillingsolution.com)

With PT Billing solutions, users can manage accounts payables and accounts receivables by entering charges, reviewing claims, and restricting available billing codes by patient type. Billing features include electronic insurance claims, claim billing capabilities, separate cost centers, and Microsoft Office integration.

PTOS (www.ptos.com)

PTOS software features include billing functions, practice-management reports, scheduling, documentation, general ledger, and customer support.

Raintree Systems Inc (www.raintreeinc.com)

Raintree's billing features flexibility in centralized or decentralized billing models and personalized paper or electronic billing; expedited reimbursement with automated, accurate, and timely statement mailings and claims processing; higher collection ratios with the ability to facilitate rebilling, ledger notes, follow-ups, and single claims more directly from the Onscreen Collection Worksheet; and efficient collection tracking with automatic accounts receivable balancing, easy-to-reference worksheets listing payor sources, patients covered, amounts owed, and aging breakdowns using estimated or contracts-based collection amounts.

ReDoc (www.rehabdocumentation.com)

The Rehab Documentation Company provides the ReDoc Suite, an intuitive software application designed to optimize the efficiency and quality of the documentation process. ReDoc Suite streamlines the implementation of computerized documentation, by presenting the most sensible workflow process for therapists. ReDoc Suite interfaces with many billing software and applications on the market today, such as PTOS, Medisoft, Eclipse, Lytec, and most any vendor who uses HL7 Industry Standard.

Spectrasoft (www.spectrasoft.com)

SpectraSoft's integrated approach to physical therapy software brings together applications for front desk associates, therapists, the billing department, and management under one unified system. The system captures every billable charge, avoiding incidences of therapists underbilling for services by "rounding down" time or omitting "minor" items. DocuPRO ensures that you always bill the full, legitimate amount for each visit by generating charges directly from the documented activity.

TherAssist (www.therassist.com)

TherAssist offers scheduling, documentation, and billing management solutions, designed to maximize efficiency for administrative and clinical staff, centralize multisite operations, increase reimbursements, and seamlessly integrate with billing. TherAssist works in LAN and WAN configurations, or as an ASP via the Internet. The software is easily customizable to meet the needs of multidiscipline, multisite, or specialty practices.

TherapySource (http://sourcemed.net)

TherapySource offers coding, billing, and collections features. The system automatically extracts charges from documentation, generates the appropriate code, and produces a bill—all in the same day the patient receives treatment. TherapySource's self-auditing chart functionality also ensures HIPAA, CMS, and other payor compliance. TherapySource's coding and compliance features help clinics to: automate code generation based on documentation; comply with Medicare rounding rules for time-based procedures; and format daily charge extractions in either HL7-compliant format, text file, or Excel spreadsheet.

Ken Fischer, PT, is owner and CEO of Performance Physical Therapy, which operates three facilities in Dallas. For more information, contact .