Shift Left: Solving RCM Challenges With a Proactive Approach FAQ

Can Revenue Cycle Management be used for insurance authorization and verification if not used for billing?

While we can’t speak for every RCM service, WebPT RCM doesn’t handle insurance authorization and verification.  

At what point in the patient registration process would you suggest using a patient cost estimator tool?

Ideally, you’d want to provide patients a cost estimate at the point when you’ve established a plan of care and the scope of services required, but before you’ve provided services. For uninsured or self-pay patients, the No Surprises Act requires that you provide a good faith estimate when the patient schedules care or upon request. The law also states that for individuals with certain types of coverage, providers are required to submit good faith estimates to the individual’s plan or issuer. 

What are the best ways to decrease patient A/R? What are some proactive resolutions, and how do you handle it when patients are ignoring statements?

As outlined in the webinar, the best way to decrease your A/R is to avoid having it grow in the first place. Otherwise, you can have your billing team work your A/R more frequently, make it easier for patients to pay, and emphasize getting claims out the door faster, especially for payers you know take longer to reimburse. If you’re really having a hard time collecting, you can hire a collections agency to help you track down payment. 

How do you determine what denials you can pass to the patient and what denials you have to write off? Can you charge the patient if insurance ends up not paying the provider? 

If you’re talking about balance billing, the answer to your question is maybe. As we discuss in The Dos and Don’ts of Balance Billing, you need to consult your state laws and your contract with that payer as to whether you’re allowed to bill a patient—and make sure that they’re not a qualified Medicare beneficiary either. Before you send that bill, it’s worth checking whether the payer is incorrectly failing to pay for services that should be covered.   

Does Anthem allow for billing for time spent with a tech? According to the payer guidelines, they bill by CMS timing conventions, which would then lead us to believe that they follow CMS guidelines for not billing for time spent with a tech.

We checked with our resident billing expert, John Wallace, for this one, who said, “This is determined by state law/regulations. Only 12 states allow billing for treatment by Techs who are directly supervised by PTs/OTs. If you are in a state where it is not allowed and ABCBS can tell by reading the notes/flowsheet, they will disallow the treatment. They do use their own version of the CMS 8-minute rule.”

How would you handle denials due to a change in insurance payer where you can no longer obtain authorization?

We turned to Wallace for this question as well, who advised, “The provider should rely on the ERA/EOB and to whom the balance was assigned: the patient or the provider. If the balance is assigned to the patient, the member can collect. Typically, it will be assigned to the practice (if they are a preferred provider).”

If you missed our live webinar, you can check out the replay to get answers to all the questions our panelists answered.