5 EMR Tools Providers Need To Maximize Therapy Payments

With the hands-off experience that automation provides, how can you be sure that your processes are giving you the most bang for your buck? Join us as we explore five unique revenue cycle management (RCM) solutions Raintree offers to not only maximize reimbursements for therapy and rehab organizations but to streamline billing processes and promote clinic growth.

  1. Auto-coding and claim scrubbing 
  2. Automated authorizations
  3. Underpayment detection
  4. Regulatory healthcare integrations
  5. Claim correction tools

Accurate Payments Slipping Through the Cracks

Automating processes such as coding and claim scrubbing can increase the efficiency of administrative tasks. Still, there’s also the real possibility that little things here and there slip through the cracks that can result in underpayments for services that were rendered but weren’t accurately described during medical coding.

To address this pain point, Raintree’s healthcare automated billing system has auto-coding functionality capable of creating extremely accurate claims based on the actual documentation from the patient encounter. From automatically applying modifiers to calculating the appropriate number of units based on insurance billing rules, this tool not only ensures that you’re getting fairly paid for all of the work that you do but it also plays a massive part in preventing underbilling in other scenarios, reducing claim rejections and denials, as well as facilitating patient payments!

Automatic Authorization Tracking 

Most front office staff agree that automation is the best way to go with regular tasks, such as checking for insurance authorization and eligibility. However, despite the convenience that automation affords your workflows, this vital step in the revenue cycle can still leave you coming up short on payments if there’s missing information, a failure to obtain authorization, or even a simple erroneous keystroke. 

But don’t worry – you can easily rectify this leak in your revenue stream by preventing authorization denials and avoiding situations that result in non-payment. In fact, Raintree’s authorization tracking software will hard stop a patient appointment during the scheduling process if there’s no authorization on file, it’s expired, or it has run out, allowing your practice to truly automate processes that previously needed manual checks in place.

But what about the potential revenue loss when established patients no longer have valid authorization? Raintree can tackle these issues with real-time alerts that notify users of upcoming authorization expirations. What’s more, our software can automatically generate a pending task for any insurance that requires authorization validation as well as automatically fax out payor-specific authorization request forms to expedite the verification process with minimal manual input.

Can Your EMR Detect Underpayment?

Setting up a simple billing rule that applies to a batch of similar claims may seem like a great idea, but it’s actually a quick way to invite underpayment for your services. Every therapy and rehab practice deals with multiple payors and each payor comes with a myriad of unique claim requirements. This means that setting up a one-size-fits-all billing rule primes your automated system to miss payor-specific modifiers or even omit codes that could beef up your payment.

With Raintree, you don’t have to worry about missing out on those additional reimbursements. Our highly customizable billing rules can be configured to update the required claim information according to the payor that is being billed, ensuring that your claims are properly formatted no matter which insurance company it’s submitted to and that your revenue isn’t lost due to inaccurate modifiers.

To take it a step further, our billing tools also allow users to set a defined bill amount and expected amount according to what payor is being billed as well as the financial class they fall under. For example, if your therapy and rehab practice has an established contract with an insurance company that states that a particular service will always receive the same flat rate reimbursement, that contract can be defined in our billing rule software and will flag any claims that are not paid the agreed upon amount.

Integrated Healthcare Rules, Codes, and Definitions

If your system isn’t keeping up with updated schedules, rules, and regulations, your reimbursement levels are vulnerable. Each year, medical billing rules, codes, and relevant definitions are reviewed and updated to meet the needs of patients and providers. This means that payors, such as Medicare, make regular changes to their claim submission requirements to enforce practice compliance as well as fair payments. Keeping up with those changes can mean hours of work for your billing department, not to mention the potential for error that can severely impact your revenue!

For example, Medicare requires that providers break their billing times into 15-minute units of service. While some appointments can’t easily be divided into 15-minute segments, there are official modifiers and processes in place to deal with those in-between units of service time. Raintree offers built-in rules that cater to these official processes, ensuring that your Medicare claims are accurate before submission and reducing the risk of claim rejections or denials. Plus, our billing tools don’t stop with just Medicare compliance. With our configurable documentation, your organization can customize the built-in rules to adhere to any payor requirements!

Automate Your Payment Experience with Claim Correction Tools

Did you know that rejected or denied claims are not automatically lost revenue? While there’s no doubt that rejected claims are easier to manage since they can be corrected and resubmitted without penalty, with the right claim correction tools in place, even appealing a denied claim doesn’t have to be a chore. But that doesn’t mean denial appeals aren’t a high priority – in fact, appealed claims often have the same deadline for submission as the original claim, giving your billing department less time to figure out how to recover lost reimbursements!

While time is of the essence, Raintree has the digital billing solutions you need to handle denial management or rebilling, both efficiently and quickly. By taking advantage of our pre-populated, payor-specific forms that streamline your appeals, you can be certain that you’re submitting complete and correct claims to the payor for determination, getting you one step closer to recovering payments.

Raintree = More Reimbursements and Less RCM Inefficiencies

Raintree takes immense pride in providing therapy and rehab practices with the automated tools they need to optimize their administrative and financial operations, including their medical billing processes. With our robust RCM tools on your side, you can simplify your claim management, look forward to accurate payment posting, and take advantage of effortless cash flow!

For more information on how our outsourced medical billing services or automated RCM can benefit your practice, schedule a discovery call with one of our experts today!