How to Choose the Right PT Billing Company

If you are reading this article then either:

a) You are having a questionable experience with your current billing company, or
b) You have someone doing your billing in-house, but you are realizing that may not be the best solution anymore.

Choosing the right PT Billing Company is, of course, a very important decision. You will be entrusting them with a huge responsibility: getting you paid correctly and quickly. The wrong choice can lead to serious financial woes.

Use this comprehensive discussion of 15 items to make the right call for your PT company.

Pricing

Although price shouldn’t be the most important decision point, it is at the front of everyone’s mind, so let’s address that first.

1. The price could be a flat fee (for larger PT groups) or a % of collected income.
2. When comparing two or more bids, be aware of performance related to pricing. Here’s an example to illustrate.Let’s say that Billing company A is performing for you at 100%. They are charging you 5.5% and you gross $100,000 per month. You pay then $5,500 so you are netting $94,500.Billing company B is charging you 4.5% (a 1% discount), but their performance is at 90%. You will gross $90,000 per month. You pay them $4,500, so you are netting $85,500.

   Clearly you are better off paying the extra 1% for the 100% performance (more on performance measurement later).

3. An excellent PT billing company will facilitate an increase in your income by more than their cost. They would do that through:
   i) performing at 100%
   ii) showing you ways to generate more revenue
   iii) help you reduce your errors so that your income increases
4. There are some “tech first” companies that offer very low pricing. Unfortunately, health care billing still requires your billing rep to get on the phone and yell at payer reps from time to time. AI just hasn’t achieved that level of performance yet. If a billing company doesn’t have the well trained staff needed to manage your account, you won’t collect every penny you are due.
5. There are some other companies that offer rock-bottom pricing, but they don’t do all the services that you need. For example, they may not handle your patient balances. This can be the most time consuming component of PT billing, when you include the time it takes to answer these patients’ questions when they call. Of course we take care of all that for you.

Many of these discount billing companies also use off-shore labor, which has a significant potential down side in healthcare billing. More on that later in this article.

Quality of performance

As illustrated above, the quality of the performance of your PT Billing Company is probably the most important thing to consider.

How can you know that your billing company is operating at 100%?

We measure these key performance indicators each month and share it with our clients so they can see exactly how well we are doing for them:

1. 120+ %: this is the percentage of your A/R that is over 120 days. This should be less than 10%
2. ARC ratio: this is a measure of how fast you are being paid. This should be less than 0.8 and can be even lower than 0.5 if the client is not making significant errors at the front desk.
3. A/R Aging over time: we share a graph each month that shows how your A/R has changed over the course of the year. Generally it should decrease to a certain point and then remain at that level. It is very easy to see if something isn’t going quite right if your A/R doesn’t follow that behavior.
4. Writing off balances: If your billing company is (incorrectly) writing off balances, they can make the above metrics look great. Make sure you are aware of (and approve) and write offs before they are done.
5. $0 pay events: Insurance companies play many tricks to try to reduce the amount they pay you. One of the more common ones is to use the common adjustment code CO-45 to incorrectly adjust off the entire claim amount. We track these types of events to ensure that you aren’t falling prey to insurance company tricks.

Customer Service

We feel that great customer service boils down to 3 things:

1. Can you get in touch with your account rep when you need to? When you need help, you should be able to reach your rep on the phone or by email. If for some reason they are out of the office, there should be two other staff members that are familiar with your account that can help you.
2. Do you get the information you need when you ask for it? It is great to be able to speak with a phone answerer, but you need an intelligent response when you reach out.
3. Do they anticipate your questions and share with you information before you ask for it? You should feel that you are always in the know and confident that your billing team has their arms around your account at all times.

Reputation

If a PT Billing Company has been in operation for more than a short time, they will have developed a reputation. It shouldn’t be difficult to find other PT owners with some experience with them.

1. Can they share a lot of client References with you?
2. Are they involved in the PT industry in a way that makes them known to other PT owners?

Coaching

Many PTs are currently leaving money on the table. Your PT billing company should be able
to analyze your practice data and identify the areas that could be targeted in order to generate more revenue (and decrease losses).

A very strong PT billing company should also have enough experience to be able to help
train clinical and administrative staff on how to tweak clinical operations to capitalize on these opportunities.

Every year there are new developments on the Physical Therapy landscape that impact payments. Your billing company should be aware of these changes before they happen and be able to help guide you into best practices related to these changes. Putting our heads in the sand when confronted by new opportunities or challenges is a sure way to lose out on potential revenue.

Tech / AI / Automation

As mentioned above, a “tech first” billing company may not have the ability to mobilize the staff needed to get you paid at 100%.

However, it is essential that your billing company is rapidly evolving as AI and Automation become more available and useful. Your billing company should have a Chief Technology Officer who understands PT billing and is able to implement these technologies appropriately.

As a result of intelligent technology adoption and implementation, the billing processes should become faster and reductions in cost should be passed on to you in the form of lower rates.

In your practice, most of your other costs are going up as reimbursement is declining. Billing services are one area that should be able to provide lower costs over the next decade.

Location

Where the billing company staff are working is a very important question, and one that is often neglected in the information call.

1. Offshore workers pose challenges. Although there can be significant savings by employing offshore workers, there are:
   i. Security and Regulatory issues
   Many payers now have strict rules about what tasks can be carried out overseas AND there are important steps that need to be taken and maintained in order to ensure the protection of patient information. If your billing company isn’t staying up to date and ensuring continuous updates are in place, you could be liable for patient data theft and even compliance breaches.
   ii. Quality issues
   Training and supervision are very difficult with offshore workers. Although the billing company will save on costs, their ability to achieve a 100% collection rate with your account will probably be much more difficult.
2. Remote workers in the US also pose challenges.
   We feel that by having ALL of our team in one corporate office, it ensures a higher quality of work for our clients. Frequently collaboration and information sharing is required between staff. Although online communication is wonderful, there is no replacement for quickly resolving a client payment issue by speaking with a colleague face-to-face.

30 day cancellation policy

You really don’t want to be trapped in a relationship that isn’t working. We want to earn our clients’ loyalty every single month and so we allow a 30 day cancellation policy.

Patient statements

Although many patients still prefer to receive statements in the mail, a growing number prefer the ease of receiving notification by text / email and being able to click to their patient portal to make their payment.

This means faster payments for you, more up-to-date statements and happier patients.

These days it is almost essential that your billing company offers SMS and email notifications and statements as well as a secure online payment portal.

How is your account managed on a daily basis?

We feel that the following are important:
All claims are submitted daily.
All rejections and denials are addressed on the same day as received.
All payments are posted daily on the same day as received.
All unpaid claims are worked every month until they are resolved.

A/R clean up

When you first start working with a new billing company, and when the cancellation period
from the prior billing company is complete, your new billing company should be willing to clean up your old A/R. This may take some time, but it is important to fix previous errors so that you are paid everything you deserve, even if your prior company dropped the ball.

Credentialing

This is an important service for any clinic that occasionally (or frequently) hires new clinicians. Insurance companies throw up roadblocks in this process. We presume at least some of these are designed to achieve lower claim payments.

It is important during this process to communicate with the payer at least a couple of times each month to ensure that everything is remaining on track.

This is a time consuming process and one that most owners should consider outsourcing due to the staff time required to navigate all the hurdles.

Insurance Verification and Authorization Services (utilizing observed intelligent automation)

Over the last few years many payers have made these processes very cumbersome and error prone. When mistakes are made with these items, non-payment for multiple visits is not uncommon. These costly errors must be eliminated.

Unfortunately it isn’t as simple as visiting portals to obtain the information you need. Many of these portals provide incomplete or incorrect information related to outpatient physical therapy.

It is difficult for many front office staff to handle these tasks without errors. If your admin staff
are struggling to manage this well, it is definitely worth asking your billing company to take care of it. They should be able to do this in a timely manner (same day), without errors and at a reasonable price.

Can they handle your size?

Some PT billing companies specialize in certain sized practices. For example, some don’t
like to bill for smaller clinics. Some don’t have the staff to successfully onboard a very large client. Usually having a solid technology base helps a PT billing company to manage any size client efficiently.

It is certainly worth asking if the billing company is comfortable with your size company and will they be able to service you effectively?

Connect you with other experts

Because your PT billing company should be very involved in the Physical Therapy industry, they should have a good knowledge of quality experts in other areas essential to Outpatient PT practice (e.g. compliance, HR, marketing, recruiting, etc).

If you have questions in any of these areas, if your billing company doesn’t have the answers, they should be able to direct you to vetted experts who will be able to help.

As you can see from these 15 points, the process of choosing the best PT billing company for you should take some consideration. Although it can seem like an onerous process, by getting answers on these 15 areas, you will have all the information you need to make the best decision.