A recent consumer study found that 88% of respondents reported massage therapy was beneficial to their overall health and wellness. Want to offer massage therapy services to the veterans in your community, but aren’t sure how to manage billing the VA? We’re here to help you understand this process better so you can deliver quality care to veterans at your holistic practice.
There are numerous methods of massage therapy, including:
- Medical massage
- Hot stone massage
- Swedish massage
- Reflexology
- Trigger point massage
- Thai massage
Each method implements a particular set of movements that target muscles in order to increase blood flow, promote relaxation, alleviate physical pain, and encourage overall wellness.
Does the VA Cover Massage Therapy?
It depends on the specific circumstances and location. Some VA facilities may offer massage therapy as a form of rehabilitation for veterans, but it is not a widely covered service under VA benefits. It is best to check with your local VA facility or speak with a VA representative to determine if massage therapy is covered in your area.
Benefits of VA Massage Therapy
Massage therapy has been proven to treat a wide array of conditions veterans might be suffering from, including:
- Chronic pain: Massage therapy treatments help stimulate blood flow to parts of the body experiencing pain, which helps promote the release of natural painkillers; since massage therapy results in relaxation, overall chronic pain conditions can be managed with treatments. This is an especially timely holistic approach in light of the ongoing opioid epidemic.
- Depression: One study found that 11% of veterans were experiencing elevated levels of depression; massage therapy can help alleviate the physical symptoms of this mental condition, such as back pain, body aches, sluggishness, and more.
- Anxiety: A 2016 research study demonstrated that Swedish massage therapy treatment was successful in reducing the symptoms of Generalized Anxiety Disorder (GAD). Veterans often experience complicated symptoms of anxiety linked to PTSD and homelessness, which can increase the risk of suicide; incorporating a massage therapy treatment plan into an overall wellness plan can help mediate these symptoms.
How To Start Treating Veterans at Your Massage Therapy Practice
The US Department of Veterans Affairs recognizes clinical massage therapy as “one of the evidence-based, complementary and integrative health (CIH) approaches within the VHA Whole Health System of care” and covers the cost of this care when deemed necessary. Follow these steps to start treating veterans with massage therapy at your holistic practice!
Apply for Your National Provider Identifier (NPI)
A National Provider Identifier, or NPI, is a 10-digit identification number issued to healthcare providers in the U.S. by the Centers for Medicare and Medicaid Services. Your massage therapy practice will need to apply for an NPI if you are a HIPAA-covered health care provider or if you bill insurance for your services.
Determine Your Region
The VA Community Care Network (CCN) is divided into six regions that cover the continental United States in addition to Hawaii, the Caribbean, and the Pacific Islands. TriWest manages the western networks while Optum handles the eastern regions. Find out which region your practice resides in.
Get Credentialed
In order to provide quality care for veterans at your holistic practice with massage therapy, you’ll need to be credentialed with the region’s third-party administrator. This process typically takes at least three months to complete. Depending on your region, contact the following to get started with the credentialing process:
- Region 1: 888-901-7407 (Optum)
- Region 2: 844-839-6108 (Optum)
- Region 3: 888-901-6613 (Optum)
- Region 4: 866-286-4174 (Triwest)
- Region 5: 877-226-8749 (Triwest)
The VA has not officially contracted with an agency for Region 6; contact information is pending for that region.
Complete Registration Paperwork
Upon completing the credentialing process, you’ll need to submit the necessary paperwork to become fully registered with the network. This paperwork is submitted electronically and will include details regarding any final requirements that must be met in order to finish the credentialing process.
Receive Patient Authorizations
Once your holistic practice has been verified and authorized by the VA’s network, you’ll start to receive referrals to treat veterans who are approved to start massage therapy treatment. Your CCN administrator will provide the patient’s authorization letters before the patient’s first visit to your practice.
Checklist for Initial Claims Processing
When submitting an insurance claim to the VA for the first time, you’ll need to submit all the authorization letter pages together with the claim. Make sure you transmit all the following information with your massage therapy claim to avoid a denial:
- A cover letter
- The date range for services
- Authorization numbers
- The total number of visits authorized
- The patient’s demographics including address, date of birth, and social security number
- Documentation and CPT codes of treatments administered
By following this checklist, you can ensure your Veterans Administration insurance claim will have all the accurate information it needs for a smooth billing process.
Maximize Your Reimbursements for VA Insurance Claims with Holistic Billing
As a medical billing provider with a special focus on holistic and integrative health practices, such as massage therapy practices, Holistic Billing Services can help you get credentialed by your region’s CCN and help you start treating veterans right away. We have plenty of experience navigating the unique VA billing guidelines, which allows us to maximize your reimbursements and keep your practice’s revenue flowing.
To learn more about how you can get started providing acupuncture for veterans and active service members without worrying about having your VA claims denied, talk to our massage therapy billing and coding experts today!
When evaluating the success of your holistic practice, where do you start? It’s too short-sighted to worry only about keeping the lights on, but planning for the future on a broad, subjective scale can feel intimidating or overwhelming. That’s where tracking top healthcare KPIs can benefit your holistic practice. Healthcare KPI tracking can provide a tangible record of your operations across a variety of categories and aspects.
What Are Healthcare KPIs?
KPIs, also known as Key Performance Indicators, are metrics that can objectively measure various components of your holistic practice over time so you and your team can reflect on how the practice is performing and make educated decisions for the future. There are dozens of potential healthcare KPIs to track at your holistic practice, but try not to feel overwhelmed by the amount of data you’ll be collecting—each facet of your practice can be analyzed and optimized, but it doesn’t have to happen all at once. To start, select a few of the most important metrics that need immediate attention, then expand to measure other aspects of your operations.
Common Healthcare KPI Examples
As mentioned above, there are a variety of healthcare KPIs track that may or may not apply to your particular holistic practice, with categories including:
- Operations: These metrics focus on how efficient and effective your practice is at delivering care
- Finance: KPIs related to the financial performance of your practice measure the top and bottom line of your practice—your cost of operations and how much is returned
- Internal: Metrics relating to your internal operations track staff performance and administrative efficiency
- Public health: These KPIs reveal how your practice is impacting your community, whether in terms of child immunization doses, vaccine clinics, or educational seminar attendance numbers
- Emergency: In an emergency healthcare environment, it’s crucial to monitor how effectively your patients are receiving care, average wait time, patient mortality rate, and more
- Care quality: By keeping tabs on how many providers you have in relation to the number of patients you serve, patient satisfaction survey results, and more, you can evaluate how well your practice is serving your community
Why Are Healthcare KPIs Important for Your Holistic Practice?
It takes a lot of time, energy, and resources to operate an efficient and effective holistic practice. How can you be sure you’re succeeding in every aspect of your practice? Key performance indicators are your best bet to gain a comprehensive insight into your operations, finances, public perception, and more. These figures can help you understand the current status of your practice, observe historical trends, and make informed decisions regarding how to improve or further grow your practice.
The Best Healthcare KPIs and Metrics to Track For Your Holistic Practice Management
There are numerous key performance indicators you should consider tracking when evaluating the performance of your holistic practice; be sure to consider the specificity of your holistic practice, community, and overall operations when outlining which healthcare KPIs to monitor. The following breakdown is a foundational place to start and is by no means a comprehensive list of potential metrics to keep track of:
Patient Experience Metrics
The goal of your practice is to deliver quality care to your patients; after all, your practice can’t sustain itself without them! When measuring patient experience metrics, consider the following factors:
- Patient satisfaction: Utilizing patient satisfaction surveys can tremendously benefit your holistic patient care because you can solicit feedback or points of improvement from the very people you’re trying to please: your patients. Plus, by implementing a method of communication regarding their perception of your practice, you demonstrate how important they are to your success. When you establish an objective manner of measuring subjective components of your practice, such as ease of scheduling follow-ups or how comfortable the waiting room is, you can gain valuable insight into your practice’s performance.
- Referral mix: This healthcare KPI indicates what type of patients your holistic practice is treating and who referred them to your practice. Tracking this metric helps you understand which patients are finding you from word-of-mouth recommendations, which in turn affirms the success of your holistic practice’s mission of delivering quality care.
- No-show patients: It happens. Patients forget appointments or simply ghost your practice and never return your calls or attempts to reschedule. However, when this becomes a pattern at your holistic practice, do your best to get ahead of it and monitor these behaviors. If you find that a significant number of your monthly appointments are no-shows, it might be time to implement a no-show policy to discourage that!
Staff Performance Metrics
Your team is a reflection of your practice and keeps your practice running smoothly for your patients; when gaining insight into your staff performance, consider the following:
- Staff-to-Patient Ratio: Do you have dozens of weekly appointments for only a handful of providers at your practice, resulting in faster burnout or longer patient wait times? It’s crucial to consider how much time and attention your providers can give to patients for top quality care. If they’re stretched too thin, it’ll catch up to your practice sooner or later and you’ll have to hire additional staff to manage.
- Trainings and Certifications: When working in healthcare, it’s absolutely essential that your staff is HIPAA certified and follows best practices when handling patient information; it’s also beneficial that each member of your team have certifications in their pertinent areas of service.
- Mistake Events: This self-explanatory metric simply refers to the frequency and type of mistake or error made, whether administrative, related to medical billing, patient confidentiality, or another type of mistake. This metric can provide insight and help you determine the best course of action to correct the problem, preventing it from becoming an internal pattern.
Medical Billing Metrics
How well do you know the details of your holistic practice’s finances? If you’re only measuring the short-term successes of paying your monthly bills, there’s a lot you’re missing! Dig into the many facets of your financial performance and learn which areas to improve moving forward, including:
- Days in Accounts Receivable (A/R): This metric reveals how many payments remain outstanding at your holistic practice, either due to insurance reimbursement processing delays or out-of-pocket services. Ideally, the average time a bill spends in A/R should be about 30-40 days—the less time spent waiting for payment, the better. By tracking this metric, you can identify friction points along the payment cycle, such as billing and coding errors or not following up on claims, and redirect your efforts to streamline this process.
- Net Collection Ratio: One key financial metric to monitor is the net collection ratio, which calculates how much potential revenue your practice nets after insurance adjustments are made. While the exact figure will fluctuate from specialty to specialty, aim for collecting about 95% of potential revenue for services, whether by patient payers or submitting clean claims. If this healthcare KPI falls consistently dips below 90% then that tells you something needs to be addressed in your revenue cycle.
- New Patient Ratio: You can probably guess which figure this metric tracks; part of overseeing the financial health of your holistic practice is to sustain and grow your practice, which means a certain percentage of your patients are first-time visitors. When monitored over time, this healthcare KPI can help you determine if your holistic practice offers a desired balance of services for the price. Like with many other metrics, the exact figure to aim for can change from specialty to specialty; however, for general wellness practices, new patients can make up about 25% of visits, while specialty care practices could see up to 50% new patients each month.
Transform Your Medical Billing with Holistic Billing Services
By creating a monthly summary sheet to track healthcare KPIs, you can begin to identify and resolve problem areas in your holistic practice that are holding back growth and revenue.
Our experts here at Holistic Billing Services believe our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house. With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.
Treating Medicare patients not only entails serving a greater population in your community, but it also means that your holistic practice may be subjected to Medicare audits. These can lead to suspension of payments and Medicare fees if your holistic practice isn’t up to snuff with current regulations and laws.
Unfortunately, healthcare waste, fraud, and abuse lead the Centers for Medicare and Medicaid Services (CMS) to be diligent in recovering as much federal money as possible. Of course, there is no way to avoid facing a Medicare audit—sometimes they’re random. But there are ways to prepare for one to reduce any negative outcomes.
Which Holistic Modalities Does Medicare Cover?
While Medicare currently doesn’t fully cover the many services offered by holistic practices, there has been a significant push to include coverage for practices that manage and promote holistic wellbeing.
For example, CMS recently introduced verbiage to cover acupuncture—with a few clauses related to back pain. According to Medicare, back pain can be covered if it meets the following conditions:
- It has lasted 12 weeks or longer
- There is no known cause (not related to cancer that has spread, inflammatory, or infectious disease)
- Pain not associated with surgery or pregnancy
Additionally, original Medicare pays for only one chiropractic service: manual manipulation of the spine if deemed medically necessary to correct a subluxation when one or more of the bones in your spine are out of position.
This procedure, when performed by a chiropractor or other qualified provider, is covered through Medicare Part B, the component of original Medicare that includes outpatient services; Medicare will pay 80% of the Medicare-approved rate for this procedure.
Overall, Medicare won’t cover therapies unless deemed medically necessary. Regardless of coverage status through Medicare, many insurance companies follow the same policies. Staying up to date on these regulations and the consequences attached to them is important for your holistic practice to stay efficient and effective.
How Audits Impact Your Holistic Practice
By identifying errors and devising remedial actions to eliminate them, audits serve a vital role in a healthcare organization’s compliance plan.
Medical audits provide a mechanism to:
- Review quality of care provided to patients
- Defend against federal and payer audits, malpractice litigation, and health plan denials
- Educate providers on documentation guidelines
- Optimize revenue cycle management
- Ensure appropriate revenue is captured
- Determine if organizational policies are current and effective
What Are CMS Audits?
The goal of audits—in any industry or business—is to see how compliant that organization is with whatever set of rules and regulations is established and relevant. That’s essentially the same goal of audits conducted by CMS of holistic practices.
These program audits measure compliance in terms of its contract with CMS, in particular, the requirements associated with access to medical or holistic services, drugs, and other enrollee protections required by Medicare.
The program areas for the 2021 audits include:
- CDAG: Part D Coverage Determinations, Appeals, and Grievances
- CPE: Compliance Program Effectiveness
- FA: Part D Formulary and Benefit Administration
- MMP- SARAG: Medicare-Medicaid Plan Service Authorization Requests, Appeals, and
- Grievances
- MMP- CCQIPE: Medicare-Medicaid Plan Care Coordination Quality Improvement Program
- Effectiveness
- ODAG: Part C Organization Determinations, Appeals, and Grievances
- SNP-MOC: Special Needs Plans – Model of Care
What Is the CMS Program Audit Process?
There are four phases to a CMS audit:
- Audit Engagement and Universe Submission: Six weeks before fieldwork is conducted, an organization is notified that it has been selected for a program audit and is required to submit the requested data, which is outlined in the respective Program Audit Data Request document.
- Audit Field Work: Over the course of three weeks, program audit fieldwork is conducted, mostly via webinar with the exception of the CPE review, which may occur onsite during the last week.
- Audit Reporting: Audit reporting occurs in multiple stages beginning at the conclusion of audit fieldwork. CMS first shares audit results with the holistic practice at the exit conference via the preliminary draft report, but the findings in a preliminary draft report are subject to additional review and evaluation after all supporting documentation has been received and evaluated, at which point classification occurs.
- Audit Validation and Close-Out: This is the longest phase of the program audit process, taking approximately six months to complete. During validation and close-out, an organization has an opportunity to demonstrate to CMS that it has corrected the noncompliance that was identified during the program audit.
What Does CMS Look For in Audits?
By conducting audits, either at random or as suspicious activity is reported, CMS works to prevent, reduce, or address a holistic practice exploiting CMS money or information, regardless of intention. Such issues to address might include falsifying claims that are billed to Medicare, charging excessively for Medicare services or supplies, making false statements on applications to participate in federal programs, and more.
Part of this stems from CMS regulations updating from year to year, so paying attention to their regulations on a continuous basis is important to maintaining compliance.
How Much Will CMS Increase Audits in the Future?
CMS’s budget for fraud, waste, and abuse mitigation doubled from 2021 to 2022 as the agency sought a $50.5 million increase in funding for “conducting greater levels of review.”
Medical review activities include pre- and post-payment audits and also encompass the Targeted Probe-and-Educate (TPE) process. CMS also requested additional funding for modeling and analytic tools aimed at identifying fraud, waste, and abuse.
The funding increase also allowed CMS to hire more administrative law judges (ALJs) in an attempt to reduce the backlog at the third level of Medicare provider appeals, which currently sits at five years.
5 Tips to Avoid CMS Audits
Perform a Self-Audit
Perform your own random mock audits based on the same criteria as a Medicare auditor to uncover what they would find and address any issues before they bring them to your attention. Visit the CMS website for the most up-to-date information on submitting claims that comply with Medicare guidelines.
Conducting internal audits at your holistic practice is important because it further ensures your practice is following all policies and procedures. Or, on the other hand, it points out areas of improvement for yourself and your team.
Prevent Billing and Coding Mistakes
Generally, Medicare pays claims based solely on your representations in the claims documents. Utilizing a standardized set of medical billing codes facilitates the billing process by bringing uniformity to the billing process.
When the coding on the claim does not meet the Medicare requirements and Medicare pays the claim anyway, the audit may discover this mistake. That’s why it’s so important to submit accurate claims and ensure appropriate coding is employed.
Provide Accurate Documentation
Holistic organizations need to make sure that everything is documented, including data presented on meaningful use reports generated by EHR and all other evidence. Auditors will be looking for discrepancies along the practice’s decision-making process.
By knowing the right procedures and eliminating errors with better technology, discrepancies can be kept to a minimum. Practices that have the appropriate documentation of every decision made—and each process change—will be able to easily find any potential trouble areas.
Review Every Process
Reviewing every process pertinent to the medical billing and patient information systems side of your holistic practice is important in preventing CMS audits.
As medical billing and patient information systems become more integrated, the need to review every process becomes more critical since a simple change could require an organization to upgrade multiple other systems to be successful. This is a good habit to establish with your holistic practice, especially if the coding of a specific holistic procedure changes.
Train Your Staff
One of the most common reasons a healthcare organization fails an audit is due to human error. This is where a well-trained and experienced billing team can be considered the most important driver of revenue for holistic practices. Billers and coders who are credentialed and certified from the proper associations are less likely to make mistakes and understand how to properly manage these solutions.
A qualified and confident staff is also more likely to be aware of industry changes that impact operations and can implement changes to remain up-to-date. This kind of staff is also more likely to advance principles that can make a bigger difference in the revenue cycle.
Avoid CMS Audits with Holistic Billing Services!
Our experts here at Holistic Billing Services believe that our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house.
With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.
Your holistic practice’s health insurance denial rates are some of the most significant indicators of your medical billing success. Unfortunately, they’re also one of the most difficult elements of your billing operation to improve. If you’re not paying close attention to your insurance claim denials rate, you’re jeopardizing the financial stability of your practice. By following these best practices guidelines, you can avoid insurance claim denials and achieve your holistic practice’s overall revenue potential.
What Are Insurance Claim Denials?
The medical billing process is integral for practices to receive reimbursements from health insurance companies. When patients utilize insurance to pay for treatments, healthcare providers have to submit claims so they can be paid for their specific services from the insurance companies. While medical billing ensures that holistic practices receive their due payments for treatments, it’s also a complex process. 
If claims are missing information or filled out inaccurately, then they can be denied by the insurance companies and stymie the reimbursement process. Insurance claim denials are frustrating to any holistic practice; not only is the payment completely denied or delayed, but the time it takes for reimbursements can extend to weeks or longer. For the most timely and full reimbursements, holistic practices must keep denials in medical billing as minimal as possible.
Common Reasons for Claim Denials
The five most common procedures denied for holistic practices are:
- Manual therapy
- Heat/cold therapy
- Office/outpatient established visits
- Injections
- Acupuncture services.
For strong revenue cycle management, holistic practices should aim for a 95% clean claims rate; maintaining a high clean claims rate increases your practice’s efficiency and overall profitability. So, how can your practice avoid insurance claim denials and maintain a strong clean claims rate? Here are some of the top reasons for denials in medical billing:
Lack of Coding Specificity
Especially in the ICD-10-only landscape, claims that aren’t coded to the fullest level of specificity possible are ripe for denial by both public and private payers. That means that all identifiers and modifiers must be included on every claim, every time, covering concerns as granular as possible.
Billing Duplicate Claims
Even in well-organized operations, it’s surprisingly easy for practices to submit claims relating to the same encounter more than once. It may happen when a team member resubmits a claim before hearing back from the insurance company on the initial submission or fails to check on existing documentation as to whether the claim was submitted from the start. Either way, it’s an easy ticket to an unnecessary denial.
Timely Filing
Organizations often see unnecessary denials for failing to submit claims within the payer’s filing window. Why do practices wait? While reasons vary, the issue usually comes down to bandwidth and time: If your staff is stretched too thin, it’s impossible to address all of your front-office and back-office responsibilities in a timely manner. Contracting with a medical billing company is a smart way to keep filing deadlines from slipping past you.
Unverified Insurance
Insurance claim denials can be the byproduct of established patients updating their insurance without letting your practice know. Staff members may assume that regular patients have not had any changes to their insurance. However, if there have been changes to their insurance and no one checks their eligibility, then you might be headed straight for denials. Verifying your patient’s insurance at every visit can ensure there are no insurance-related issues during the billing process.
Best Practices for Avoiding Insurance Claim Denials
After learning the common reasons for insurance claim denial, try the following denial management tactics!
Track Every Claim
No claims should ever get “lost” in your practice management system. If that’s happening to you, it’s imperative to implement a more comprehensive process for tracking where claims stand throughout the entire revenue cycle. In many cases, claims slip through the cracks because they’re not handled fast enough by the team at your practice. Make sure your coders are coding every encounter on the same day as the date of service, then upgrade your technology to a system that scrubs, submits, and monitors claims with minimal employee effort.
Identify the “Why” In Your Insurance Claim Denials
Simply put, you can’t lower your denial rate if you lack an understanding of why your claims are being denied! Review all of your denial notices from a set period – for example, three or six months – and log the associated reasons for the denial. Look for patterns, then talk it out with pertinent staff members to get back on track.
Follow Up In Time
Most denials can be corrected and resubmitted within a given time frame, which varies from payer to payer. Find out what the window is for each of your major players, and make sure it never slips past you. Better yet, create a window of your own, like five to ten days, during which it is your billing team’s top priority to follow up on every denial and correct or appeal when appropriate.
Automate Eligibility Checking
Unfortunately, many holistic practices handle eligibility checks in an unstructured, unsophisticated way – heavy on last-minute calls to payers in advance of a patient appointment, or sometimes even after services have been rendered. Neglecting eligibility checks – or managing them in an outdated way – is a disservice to your patients and practice!
Reduce Your Claim Denial Rate with Holistic Billing Services!
By using these tips to reduce your holistic practice’s claim denial rate, you’re sure to make the most of your practice’s revenue in the future. However, these tips definitely require time and effort to do it successfully. If you’re in need of expert medical billing services, let Holistic Billing Services be your go-to source for an error-free billing solution.
With decades of experience dealing with a broad range of medical billing issues for all kinds of holistic practices, the team at HBS has seen just about every kind of medical billing error an organization can make. That’s why our clients trust us to help them manage their insurance claims to ensure they’ll be accepted as clean claims on the first attempt, avoiding lengthy back and forth negotiations with the insurance company. And best of all, you’ll avoid the scrutiny of federal and state auditors.
Contact us today to learn about Holistic Billing Services medical insurance billing services and find out how we can help you increase your clean claims rate!
Unfortunately, many holistic practices simply let their accounts receivable (A/R) metric to be a black box of misunderstanding, when in reality, it’s one of the most important numbers to know when gaining an overview of your practice’s financial standing.
This figure indicates the financial health of your practice, which is essential to know when making budgeting decisions and planning for the future. Keep reading to learn more about this important figure and how to track it!
What Are Accounts Receivable Metrics?
Accounts receivable is the money owed to your practice for services rendered and billed, which is a high-touch area of every holistic practice. So if you aren’t sure what your practice’s A/R figure is, it can be hard to gain a holistic understanding of how long it’s taking you to get paid.
Essentially, your holistic practice’s accounts receivable metric rises when you provide your holistic services on credit terms. The continuous tracking of your accounts receivable facilitates the timely payment of your debts.
Your holistic practice risks accumulating bad debts if you fail to monitor your accounts receivable. As such, the decision to offer your health care services on credit terms comes with the additional responsibility of managing accounts receivable.
Why Should Your Holistic Practice Track Accounts Receivable Turnover?
If patient visits are stable, incoming cash should be too – which is why it’s vital for holistic practices to
understand how many days pass between the bills going out and the payments coming in.
A practice’s accounts receivable (A/R) indicates how many payments have not yet been collected, whether for insurance reimbursements or out-of-pocket services. In a healthy holistic practice, the goal is to streamline your operations to get your practice paid faster, which could involve eliminating billing and coding errors or doing a better job of following up on claims. Tracking the amount of time claims spend in A/R can help practices identify which payers are behind and build rapport to understand why.
With knowledge of the average time that passes between patient visit and payment collection, you can easily spot whether your team is slow to submit claims to payers. Plus, you’ll understand just how much funding you need to keep in the bank – and for how long – in order to sustain your operating expenses prior to reimbursements.
How to Calculate Accounts Receivable
To get a sense of your starting point, calculate your current “Days A/R” by looking back at your billings:
- Compute the average daily charges for a set number of months by adding up the charges posted for that period, and dividing by the total number of days in those months.
- Divide the total accounts receivable by the average daily charges.
The result is the average days in accounts receivable. For example, if you look back at the last three months, you can consider that a starting point for ongoing measurement on a quarterly basis. If you compare those three months to the three or six months that precede them, you can understand if that baseline is consistent with your performance over time.
A/R within 30 days is the golden standard. If you’re averaging over 60 days in accounts receivable, investigate immediately. Is there a payer stalling on payments? Are denials spiking around particular procedures? Have there been errors in your claims requiring resubmissions?
If you’re in the zone of ~45 days – or ideally, less – you can start monitoring and understanding your billings better by bucketing and aging your receivables.
As you know, every payer operates on their own schedule. You can correlate payments coming out with bills coming in to gain an understanding of when an insurer reimburses you. This could be within a 30- or 60-day window – providing your team with more knowledge on when a given bill has reached its “late payment” threshold and it’s time to contact the payer.
Best Practices for Lowering Days in Accounts Receivable
Conduct Timely Invoicing
Prepare and dispatch your invoices immediately after rendering holistic services on credit. Each invoice should
have the client’s name, account number, date of transaction, description of the holistic services rendered, any discounts offered, and total payable amount.
These details are crucial in tracking your accounts receivable after transferring them to your sales journals and general ledger accounts. Invoices are also useful in case of errors or disputes, such as overcharges and undercharges, that may arise in the future. Make follow-up calls to confirm your clients received their invoices.
Track Every Claim
No claims should ever get “lost” in your practice management system. If that’s happening to you, it’s imperative to implement a more comprehensive process for tracking where claims stand throughout the entire revenue cycle.
In many cases, claims slip through the cracks because they’re not handled fast enough by the team at your practice. Make sure your coders are coding every encounter on the same day as the date-of-service, then upgrade your technology to a system that scrubs, submits, and monitors claims with minimal employee effort.
Educate Patients
Most patients have only a vague understanding of how holistic practices collect payments from insurance providers and may not have a clear sense of their financial obligations when they consume holistic services.
Providing a brochure or reference sheet to all patients that outlines their role and responsibilities in the payment process can clear up a lot of confusion. It’s also important to have someone on staff who has the financial expertise to answer any questions patients may have about how the claims and payment process works.
Outsource Your Medical Billing
Whatever the cause is behind your accounts receivable metrics, partnering with a reputable medical billing service is one of the fastest and easiest ways to turn this key revenue metric around. Experienced medical billing services can overhaul the way a practice codes its services and how it submits claims to payers to minimize the rate of denials.
Outsourcing your medical billing process to a third party also frees up time for office staff to focus on providing the best service and care possible. Instead of spending hours on the phones trying to collect outstanding payments, a specialty practice can focus on expanding its patient base and improving its healthcare experience to better retain the patients it already has.
The experts at Holistic Billing Services believe that our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house.
With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.
Holistic Billing Services’ expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.
More Americans than ever before are embracing holistic healthcare over conventional medicine with nearly 40% of adults using some form of alternative patient care to date. Whether it’s to alleviate chronic pain, reduce stress, or for other benefits, there are countless holistic patient care approaches to prevent, treat, and manage almost every condition or illness.
What is Holistic Care?
Holistic patient care refers to the provision of care based on a mutual understanding of the patient’s physical, psychological, emotional, and spiritual dimensions. In addition, holistic care emphasizes the partnership between nurse and patient and the negotiation of healthcare needs that lead to recovery.
Holistic healthcare is a form of medicine that treats the “whole person,” treating not the physical self, but also the emotional, spiritual, and mental facets as well. Whereas conventional medicine seeks to provide treatment for pain or the ailment, holistic healthcare focuses on both treatment and prevention. For example, if a patient has an ailment and turns to holistic therapy for help, the holistic practitioner will seek any underlying causes, including the patient’s stress levels and diet.
Conventional vs Holistic Patient Care
Conventional healthcare is an approach to medicine that’s based on modern science, and which evaluates the human body, its disorders, and medical treatments in purely biophysical or biochemical terms. Common treatment methods include drugs, radiation, and surgery, for example. Additionally, conventional medicine often utilizes the most statistically likely diagnosis and treatments that work on larger populations through scientific studies, over individualized or specialized methods.
Conventional medicine and holistic healthcare differ in three primary ways:
- Treatment of Illness: Holistic treatments often incorporate medication, natural solutions or supplements, or diet and exercise regimens, like yoga. On the other hand, conventional medicine often includes formal tests and standardized treatments for every patient based on the illness. Treatments often include medication, with brief suggestions for lifestyle changes rather than concrete emphasis or direction to make those changes.
- Cause of Ailment: While conventional medicine looks at physical components, such as corporeal symptoms and genetics, for the causes of illnesses, holistic healthcare looks at the overall wellness of the patient. This includes any possible imbalances, such as issues with mental health and diet, and discussion on how to level out imbalances.
- Insurance Coverage: Until recently, many holistic practitioners were not covered by insurance or were out of network. One survey by the National Center for Complementary and Integrative Health found that Americans pay more than $30 billion per year on alternative medicines out of pocket. With trends like these, insurance companies are taking note and are moving to be more inclusive of holistic healthcare.
5 Benefits of Holistic Medicine
There are numerous benefits to utilizing holistic healthcare in your wellness journey, ranging from the practitioner’s approach to their overall goal of treating you as a whole person rather than the symptoms of an illness.
Such advantages include:
- Practitioners who offer safe, natural, and effective medicinal treatment options that include lifestyle and self-care, and who use alternatives to traditional prescription drugs and invasive procedures whenever possible
- Aiming to treat the underlying cause of disease or condition, instead of just managing the symptoms; holistic providers will take time to understand their patients as a whole and treat them as such as opposed to just treating individual components
- Prevention is the primary goal, as well as helping the patient unlock their innate healing abilities; patients are seen when they’re well and when they’re sick, which helps the patient and practitioner form a plan for continued well-being and disease prevention
- In part due to the growing popularity of holistic medicine, more Western medical practices are adding supplemental holistic care – making it more accessible for patients. Hundreds of healthcare centers, including hospitals affiliated with Duke, Yale, Johns Hopkins, and other top medical research centers, are also offering holistic therapies, including acupuncture, massage therapy, meditation, Chinese herbal therapy, and more.
- For patients increasingly dissatisfied with the minimal time they receive with doctors and with physicians who seem to prescribe a pill for every woe, integrating their conventional treatments with holistic therapies or completely choosing a holistic approach to medicine offers a refreshing new take on care.
What to Look for When Choosing a Holistic Practice
When seeking to incorporate holistic medicine into your overall wellness plan, there are a number of qualities to consider. Here’s where to start: 
Understand Which Specialty – If Any – You Need
First, determine if you’re trying to address a particular ailment or if you want a generalized holistic approach. For example, searching for an acupuncturist might take you down a different path than an Osteopath who can treat all the same ailments as traditional docs (coughs, UTIs, you name it), but they are especially helpful for migraines, back and neck pain, period aches, arthritis, and digestive woes.
Ask Them About Their Approach to Holistic Medicine
This is inherent to whatever your goal is with exploring the many benefits of holistic medicine but essential to know how the particular practitioner approaches treatment. Do they lean more on herbal remedies or energy healing? What’s their background in this type of holistic healthcare? Learning more about the practice and holistic provider can help inform your options when moving forward.
Be Sure They’re Open to Integrative Care With a General Practitioner
While holistic healthcare can offer tremendous benefits and alternatives to conventional medicine, you’ll probably still want to utilize your conventional medicine provider for some situations. This is why it’s important to know if your holistic practitioner can coordinate care with your general practitioner for an overall holistic plan.
How Can Holistic Billing Support Holistic Practices?
No matter what type of holistic practice you’re running, your medical insurance billing processes could use some help. Medical billing is especially complicated for holistic practices and can possibly overwhelm your business as you focus on growing your practice and provide care for your patients. By outsourcing your medical billing, you can leave the responsibility of insurance enrollments, credentialing, and medical billing and coding to the experts – saving you time!
As an experienced billing provider for holistic practices, Holistic Billing Services can help your practice navigate the intricacies of insurance billing claims to minimize denials, increase your revenue, and grow your practice. We understand the unique needs of holistic practices, as well as the common obstacles you face when it comes to medical billing and coding. With a knowledgeable partner by your side, you can streamline your billing and increase your revenue cycle management! To learn more about our services, talk to one of our billing and coding experts today.
Did you know that 86% of medical providers utilize an EMR/EHR system? Utilizing an electronic health record system can greatly benefit your holistic practice, too! From protecting patient information to reducing the time it takes to perform daily tasks, an EHR system can streamline your overall practice management and empower you to spend more time taking care of your patients.
What is an Electronic Health Record System?
An electronic health record (EHR) is essentially a digital version of a patient’s paper chart. EHRs are updated in real-time so information is available instantly and securely to authorized users. While an EHR does contain patients’ medical and treatment histories, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.
EHRs are a vital part of healthcare IT software and can:
- Contain a patient’s medical history, diagnoses, medications, treatment plans, allergies, and laboratory and test results
- Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
- Automate and streamline provider workflow
7 Benefits of Delivering Holistic Patient Care Through an EHR
EHR systems can drastically improve your holistic practice’s overall operations by:
Reducing Errors
Digital records allow for better tracking and more standardized documentation of patient interactions, which has a greater potential to reduce error compared to mountains of paperwork. With digital paper trails, illegible handwriting in practitioners’ notes or prescriptions is no longer a problem, plus coding for procedures or billing is easier. Integrated systems can also be set to flag indicators of potential harm. Incorporating a standardized digital record for your patients can further reduce miscommunications, too!
Improving Cost Savings
Using an electronic health record system and integrated communications methods can significantly cut administrative costs, including reducing the need for physical chart storage, redundant data entry, and insurance claims management. This, in turn, helps with facilitating care coordination and reducing the time it takes for hard-copy communications among patients, providers and insurance companies. Overall, EHR systems help your holistic practice get more out of your staff and their time.
Increasing Efficiency
With an EHR system, your staff won’t have to ask practitioners to clarify their handwriting nor will they risk important information slipping through the cracks or getting buried in mountains of paperwork, so their time is better spent handling more important matters that impact your holistic practice. By having everything – and everyone – on the same page, your holistic practice’s operations get optimized to function at peak efficiency.
Coordinating Patient Care
In a 2018 survey, 66% of people want access to other healthcare professionals to help coordinate their care. With digital records, practitioners can more easily coordinate and track patient care across practices and modalities. Your holistic practice can smoothly integrate with your patient’s other providers across specialties and disciplines. This ensures comprehensive care and communication in order to collaborate on patient outcomes as a team.
Streamlining Workflows
EHRs increase productivity and efficiency by significantly cutting down on paperwork. Patients and staff have fewer forms to fill out, leaving providers with more time to see patients. Referrals and prescriptions can be sent almost immediately, which reduces wait times for appointments and pickups. Plus, automatic reminders can tell patients when it’s time for follow-up appointments. Furthermore, with integrated patient tracking, billing and insurance claims can be filed in a timely manner.
Collecting Data Efficiently
Holistic practice providers should strive to have dynamic patient-centered records that track the care continuum over the person’s lifetime, in sickness and health, across all pertinent disciplines. Having a single, continuous record for a patient provides a holistic view of overall health for better diagnosis and lifetime treatment that considers the patient as a whole in addition to your holistic practice’s involvement.
Another element of this is that the digital nature of information ensures that healthcare providers anywhere have access to a patient’s information. A physician traveling on business or vacation, for example, can log on to an EHR system and access patient files or submit prescriptions remotely. Or, a healthcare provider in another state can view a patient’s health records to provide effective, quality care and treatment in times of emergency.
Enhanced Patient Privacy
In a recent study, 80% of those surveyed rated patient privacy as very important; implementing an electronic health record system for your holistic practice can address this! In today’s world, data security and patient privacy are incredibly important both financially and in terms of your reputation.
Improve Your Holistic Patient Care With Holistic Billing Services
Our experts here at Holistic Billing Services believe that our success is your success. Our team is dedicated to making it feel like we’re in-house, from handling medical billing and coding to offering consulting services and much more. With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. Contact us today to learn more about how outsourced medical billing with Holistic Billing Services can empower your practice. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.
How committed is your team to make your acupuncture practice the best it can be? From your medical billing department to your clinical staff to your front desk reps, everyone involved in day-to-day business around your holistic practice should be motivated to help you become a top-of-the-line medical establishment.
In order to understand how well your acupuncture practice is financially operating, you need to understand which metrics to track. Knowing which key performance indicators to monitor will empower your staff to optimize their work and streamline your acupuncture practice’s overall operations.
Why Does Efficient Acupuncture Billing Matter?
If your holistic practice’s billing staff isn’t diligent with billing practices, mistakes such as upcoding, downcoding, and inaccurate information can go undetected until it’s too late. This can lead to a high number of rejected claims and ultimately impact your practice’s financial future. Ensuring accurate billing and coding can protect your holistic practice from fines and inefficient billing practices that puts your practice at risk.
Every claim that is not paid on the first submission wastes your holistic practice’s valuable time and money. The Medical Group Management Association (MGMA) estimates that the average cost to re-work a claim that has been rejected or denied is $25 for each claim. If your integrative healthcare practice has to rework 100 claims per month, then it costs your practice an average of $2,500 a month to work on unclean claims; that’s an estimated $30,000 a year! 
Additionally, inaccurately submitted claims can result in legal trouble. If your holistic practice submits too many improperly filled out claims, you can be flagged for potential fraud and abuse. The U.S. Department of Justice (DOJ) enforces laws, such as the False Claims Act and Anti-Kickback Statute, to crack down on coding abuse like improperly used modifiers, overcharged services, and more. In fact, fraudulent claims can cost your holistic practice thousands of dollars in fines!
Essential Metrics to Watch for Acupuncture Billing
As the saying goes, knowledge is power. In order to know how well your acupuncture practice is performing, you should investigate the following key performance indicators:
Net Collection Rate
When thinking about your revenue, you may be inclined to focus on gross collection rate – the total of your initial charges before adjustments. But your net collection rate is a better measurement of financial performance and collections effectiveness since it factors in the percentage (after negotiated contract write-offs) of collectible funds that are actually collected by your practice.
A 96% net collection rate is considered ideal across the industry. Anything lower than a 95% clean claims ratio means your holistic practice is losing revenue, which also indicates your holistic practice is wasting further money and time reworking rejected claims. In reality, most holistic practices have a rate that varies between 75% and 85%, which means that somewhere around 15–25% of claims submitted each month have to be worked on twice, at minimum.
Clean Claims Rate
Your holistic practice’s clean claim ratio is the average number of claims paid upon the first submission. Every provider would love to reach a percentage above 95, but it’s about more than just reaching that number – it’s about streamlining your practice!
Holistic practice budgets are tight, and your staff’s time is the most precious resource you have. So if your clean claims rate is less than 85%, it means your staff is likely having to spend extra time on identifying denial reasons, coordinating with payers, and re-submitting claims. Overall, the clean claims rate directly affects your holistic practice’s overall revenue cycle.
Holistic practices should strive for a 95% clean claims rate, however, few practices actually reach that target goal. Most practices receive reimbursements the first time a claim is submitted for approximately 75% to 85% of claims they bill, which means about one-quarter of claims are denied or delayed due to errors or incomplete documentation.
Accounts Receivable (A/R)
Accounts receivable (AR) is the balance of money due to a firm for goods or services delivered or used but not yet paid for by customers. Accounts receivables are listed on the balance sheet as a current asset. AR is any amount of money owed by customers for purchases made on credit.
Days Sales Outstanding (DSO)
This is probably one of the most critical pieces of information you need to obtain in order to run your acupuncture practice; this metric helps you budget your inflow and expenses. This is calculated by taking your A/R at the end of the closed month and dividing it by the charges at the end of the same closed month. You then take that number and multiply it by the calendar days in the same month.
Patient Balance
As with your entire payer mix, like insurance contracts, there should never be a high accounts receivable balance in any given class or insurance type. It’s really a good idea to not carry patient balances on your books for more than 90 days. If you have patient balances over this timeframe, find out why and work to resolve them as soon as possible.
Average Charge Per Visit & Pay Per Visit
Monitoring this self-explanatory metric also helps you keep track of underperformers at your practice. The average charge per visit and pay per visit are great pieces of information to have to set a standard; then, if you fall below this average on any given visit, it’s a good idea to investigate why.
Boost Your Acupuncture Billing Cycle with HBS!
By using these tips to boost your acupuncture practice’s revenue cycle, you’re sure to make the most of your practice’s revenue in the future. However, these tips definitely require time and effort to do it successfully. If you’re in need of expert medical billing services, let Holistic Billing Services be your go-to source for an error-free billing solution.
With decades of experience dealing with a broad range of medical billing issues for all kinds of holistic practices, the team at HBS has seen just about every kind of medical billing error an organization can make. That’s why our clients trust us to help them manage their insurance claims to ensure they’ll be accepted as clean claims on the first attempt, avoiding lengthy back and forth negotiations with the insurance company. And best of all, you’ll avoid the scrutiny of federal and state auditors.
Contact us today to learn about Holistic Billing Services medical insurance billing services and find out how we can help you increase your clean claims rate!
Running a successful holistic practice involves managing people, administrative responsibilities, and more. But how can you be sure your practice is on the right track to long-lasting success? Utilizing medical billing KPIs to understand your practice’s current performance and set goals for the future can help you realize the status of your holistic practice.
What Are Key Performance Indicators?
A key performance indicator (KPI) is a measurable value that indicates how well you’re achieving key business objectives. They provide a way to monitor an aspect of the holistic practice on a consistent schedule to determine whether or not you’re on target to achieve your established goals.
While a KPI can track many different things, the most important feature of a good KPI is that it must be measurable. Some aspects of a holistic practice are easier to quantify than others, but for a KPI to be effective, you need to be able to compare performance data over time to identify trends and recognize potential problems.
How to Choose the Right Medical Billing KPIs for your Holistic Practice
When selecting a KPI, you first need to know what’s important to your practice. Revenue is usually an easy choice, but there are a number of specific practice activities you may value above others. The best place to start is by doing a thorough assessment of the present state of the practice. This provides a snapshot of where you’re at in terms of financial status, operational efficiency, and patient management. 
Not every holistic practice values the same areas. A wellness care provider may have a different perspective on tracking how many new patients they treat than a more specialized acupuncture practice. At the same time, monitoring too many KPIs can be overwhelming and counterproductive. By focusing on KPIs directly related to revenue, steps taken to address problems that become apparent will improve other areas of your practice along the way.
Top Key Performance Indicators that Holistic Practices Should Be Tracking
There are numerous medical billing KPIs to track for your holistic practice; these are good, foundational metrics to monitor:
Days in Accounts Receivable (A/R)
A practice’s accounts receivable (A/R) indicates how many payments have not yet been collected, whether for insurance reimbursements or out-of-pocket services. For a healthy practice, the average time a bill spends be in A/R should be about 30-40 days. The goal here is to streamline your operations to get your practice paid faster, which could involve eliminating billing and coding errors or doing a better job of following up on claims. Tracking the amount of time claims spend in A/R can help holistic practices identify which payers are behind and understand why.
Percentage of A/R Over 90 Days
After 90 days, outstanding bills and claims become much more difficult to collect while anything over 120 days is likely never going to be collected. If more than 15% of claims are spending over 90 days in A/R, there are likely some serious inefficiencies in your processes that need to be addressed. Tracking this KPI closely will also allow you to “sound the alarm” for your holistic billing team whenever a claim is in A/R for longer than 65 days to greatly reduce the risk of it never being paid.
Net Collection Ratio
Your holistic practice’s net collection ratio is an indication of how much potential revenue you collect after insurance adjustments have been applied. This number will vary a bit by specialty, but the average healthy practice collects around 95% of potential revenue for services, either by collecting from patients themselves or by submitting successful insurance claims. An outstanding practice with the right systems in place – or support from a medical billing provider – typically has a net collection ratio of 98% or greater. Tracking this KPI helps you to measure the overall health of your billing and collections process. If it ever falls below 90% over a period of time, you’ll know that something is out of alignment and should be addressed immediately.
Non-Contractual Write-Off Percentage
A write-off is any bill that goes uncollected; your holistic practice may classify it as “bad debt.” In many cases, it results from denied insurance claims and could indicate an inability of your office staff to follow up on denials. For specialty practices, there is a higher risk of patients allowing bills to go unpaid as they may not need to seek medical services again. In any case, your total percentage of uncollected payments should not exceed 5%.
New Patient Ratio
This KPI tracks what percentage of your patients are first-time visits to your holistic practice. Measured over time, the ratio can help you determine whether your practice offers a good balance of services. For general wellness practices, new patients make up about 25% of visits, while specialty care practices could see up to 50% new patients each month.
Referral Mix
The referral mix segmentation shows you what type of patients you’re receiving and who is referring them to your holistic practice. It can help provide a better picture of where patients are coming from and whether they are a good fit for your practice. 
Payer Mix
Your holistic practice’s payer mix tracks your overall balance of payers. It indicates how much revenue you’re taking in from each payer source, such as individual insurance providers or self-pay patients. As a general rule, no more than 30% of your revenue should be coming from one payer unless you’re working with an underserved population funded by a single source such as Medicaid/Medicare.
Transform Your Medical Billing with Holistic Billing Services
By creating a monthly summary sheet to track KPIs, you can begin to identify and resolve problem areas in your practice that are holding back growth and revenue. Dashboard tools are also incredibly valuable for monitoring KPIs as they allow you to gather and present data in a variety of ways that make it easier to visualize what’s actually happening in your practice. This allows practice administrators to communicate data to physicians and stakeholders more effectively and set benchmarks to evaluate future performance.
Our experts here at Holistic Billing Services believe that our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house. With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.
While there are many factors involved with running a successful holistic practice, one of the cornerstones of success is having a streamlined medical billing operation. Insurance companies, both public and private, have numerous requirements and legal regulations by which your holistic practice needs to comply – including patient copays. Read on to learn the differences between copays and deductibles, and what to consider before waiving a patient’s copayment!
What are Co-Pays?
A co-payment, or co-pay, is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. For example, if you hurt your back and go see your doctor, or you need a refill of your child’s asthma medicine, the amount you pay for that visit or medicine is your co-pay. Co-pays cover the patient’s portion of the cost of a doctor’s visit or medication; the remaining balance is then covered by the patient’s insurance company.
Co-pays typically vary for different services within the same plans, particularly when they involve services that are considered essential or routine and others that are considered to be less routine or in the domain of a specialist. For example, co-pays for standard doctor visits are typically lower than those for specialists, while co-pays for emergency room visits tend to be the highest.
What are Patient Deductibles?
On the other hand, a deductible is an amount a patient pays for most eligible medical services or medications before their health plan begins to contribute to the cost of covered services. If the patient’s plan includes co-pays, they pay that flat fee at the time of service – at the pharmacy or doctor’s office, for example – and, depending on how their plan works, what they pay in co-pays may count towards their deductible.
After meeting a deductible, patients typically pay co-insurance—a certain percentage of costs—for any services that are covered by the plan and continue to pay the co-insurance until they meet their out-of-pocket maximum for the year. Co-insurance is a portion of the medical cost the patient pays after their deductible has been met. Basically, it ensures that the patient and their insurance carrier each pay a share of eligible costs that add up to 100%.
Issues With Waiving Patient Copays
What seems compassionate and helpful for your patients might get your holistic practice into hot water. Consider the following issues to consider when deciding whether or not to waive a patient’s copay.
Is It Illegal to Waive Insurance Copays?
It is a felony to routinely waive co-pays, coinsurance, and deductibles for patients. Waiving the collection of this portion is illegal and considered health insurance fraud because your office is claiming the wrong charge for services when insurance claims are created. To explain this further, we will use the following example: If your patient has a $10 co-pay, then the insurance company will pay $90 on a $100 bill. However, if the co-pay was waived, the patient’s bill is only $90 total, not $100.
The same laws apply to Medicare, Medicaid, and Tricare patients, but the risk is greater if your office does not comply—healthcare providers may be charged with fraud against a government agency. Waiver of coinsurance raises potential Federal Anti-Kickback Statute, Federal False Claims Act, and state law liability issues.
Waiving Co-pays for Some, But Not All, is Unfair
Your holistic practice must offer hardship programs to all patients – not just those with public health insurance. You cannot forgive a patient’s insurance debt for patients with public health insurance during times of crisis, yet require patients with private insurance to pay full co-pays regardless of their financial circumstances. Your practice’s medical billing operations need to be fair and equitable to all of your patients.
When Should You Waive Patient Co-Pays?
There are different scenarios in which healthcare providers may feel it’s appropriate to waive the patient’s insurance responsibility; scenarios may include patients who would like to extend professional courtesy to colleagues or their families, when patients are in severe financial distress, or when collection efforts have negligible results. Each example involves regulatory and legal issues that healthcare providers must consider, and should be given great consideration without just casually waiving the co-pay.
If a patient is in financial distress, healthcare providers may choose not to collect debts without risking allegations of insurance fraud. For example, if the physician doesn’t collect the patient’s insurance responsibility during a period of extreme financial hardship, the physician can choose not to pursue collection activity against the patient for the co-pay that’s owed.
Transform Your Revenue Cycle Management With Holistic Billing!
Our experts here at Holistic Billing Services believe that our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house. With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your holistic practice to focus on what it does best: treat patients.
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.