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Monday, December 05, 2011

Businesss Changes

At A Balanced Approach, I"m undergoing a huge business change. I"ve decided to have clients submit their own bills to insurance for re-imbursement, as opposed to Winona (my office manager), submit all claims to insurance.

Lots of small physical therapy clinics are shifting to this model of care; having clients submit their own claims to carriers. Insurance companies take anywhere from 3 weeks to 6 months to re-imburse a provider, but will send a check to clients (from what I've heard) in several weeks. Insurance Carriers want to keep their customers happy and cut checks faster to them and with less hassle than to providers.

OLD WAY: Client gives me their insurance card. I submit their bill to insurance for re-imbursement. It takes anywhere from 3 weeks to 1 year to get money back from insurance. I submit the remaining balance to the client for payment.

NEW WAY: I give the client a Super Bill that has my Physical therapy provider identification Number, and the services provided. The clients pay me directly for the physical therapy. They send in their Super Bill to Insurance. The insurance company sends the client reimbursement for physical therapy services directly.

I started seriously thinking about making this change last fall. I took a womens health class in Seattle last fall from a lady who owns a very successful PT clinic in Massachusetts and this is the re-imbursement model she uses. She guides people on how to find out about physical therapy coverage for their policy, then gives them the sheet of paper they need to send in to their insurance company for re-imbursement. A friend in Anchorage also runs her clinic this way, and has been successful with it for years. And she says people have no problems submitting the "Super Bill" to insurance for re-imbursement.

A Balanced Approach will be the first PT clinic in town shifting to this model. Part of me is nervous about the change, only because I hope that I still get business. I think/hope I will. I'm typically a 3 week wait for new clients, and hopefully this won't deter people from coming to A Balanced Approach. I"m excited to have my office manager Winona free from spending hours calling on various claims...1-800 #'s, on hold, finding out that more information is needed for processing.

I believe for small PT clinics, this is the current shift and trend in health care. We'll see how it goes. I"ll still be billing Tricare (the coast guard government insurance) and Medicaid, as with those insurances people will not be able to submit their own claims for re-imbursement.

Today was my first day. I have to remember that my clinic has always run a bit differently than others. I"m the only physical therapy provider, there is lots of 1:1 attention and this billing system will be also unique to my clinic. I also emphasize on my intro paperwork that I am willing to work with people on payment plans that work for them and provide pro bono care as necessary.

I'll post more with how the transition goes in the months to come.


...and tomorrow evening I"m excited to host the first "Cesarean Recovery Class" for 10 women who have undergone cesarean birth in the past year. They are going to learn all about how to help heal best from cesarean surgery. I"ll go over abdominal health, scar healing and care, back health, etc. Excited to finally offer it in Kodiak! More to come after the class runs.


Paige Jennifer said...

Having spent over a decade in the business, I can confidently say that no one wins in the health insurance game. Employers struggle to control the escalating premium costs, employees struggle to manage the escalating copays/deductibles, and providers struggle to make ends meet as they await payouts from carriers.

Your new model mirrors that which many dental and mental health providers use. And while change is rarely initially embraced as a good thing, patients will surely settle in just fine. Excellent care is worth it.

Zoya, Patrick, Nora and Stuart said...

Thank you for your comment, Paige. I feel the same way about no one winning in the health insurance game. And yes, I am hopeful that clients will settle in and understand.