Episode 4

Surviving Medicare Cuts

Revenue Cycle Expert Tricia Morgan-Putt joins Allison to talk about the current Medicare landscape and how to navigate the latest cuts. Some of what we talk about: Lessening the impact of Medicare cuts The role of your front office staff in collecting payments The impact of bedside manner on your revenue
Published on 05/04/23
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Episode Transcript

Episode 5 – Tricia

 

Allison

Good morning, Good afternoon and good evening and welcome to the Therapy Matters Podcast. Your one stop resource for expert insights and advice on everything, therapy and rehab. I’m your host, Alison Jones. And today I’m joined by Tricia Morgan-Putt, a 35 year veteran specializing in revenue cycle management services for the therapy and rehab industry. Tricia, thank you for joining me today.

 

Tricia

Yeah, thanks for having me.

 

Allison

Excellent. So today we focus on a very important topic, surviving Medicare cuts. As we know, the Centers for Medicare and Medicaid Services, CMS, adjusts the Medicare physician fee schedule annually as part of a broader strategy. This is to facilitate an equitable health care system for quality, affordable, innovative and accessible service delivery. However, over the years, we’ve seen a downward trend in payment rates for health care professionals.

 

Allison

This includes physical therapists. And unfortunately, the ruling for 2023 again included another cut. And at the same time, practices are also dealing with rising operating costs. So we’re seeing more expenses for equipment to bring into therapy practices. Supply costs are higher. And probably the most impactful is staff costs. And that’s even if they can find the appropriate staff to bring into their practices.

 

Allison

It’s much higher price right now. So all of this is squeezing profits. So the question is my question to you, Tricia, is what are the three things that therapy businesses can do to lessen the impact of Medicare cuts?

 

Tricia

Well, yeah. So absolutely, what you can do is make sure that you have verified insurance benefits. That’s extremely important that you get the right benefit for the right patient that’s coming in and you treat appropriately. Secondly, obviously, authorizations. If you need an authorization, you can’t really skip that process. A lot of times insurance companies will not go back and make a retro authorization for you.

 

Tricia

So if you miss that opportunity, you’re missing out on that revenue. And again, what you said was what the climate is right now, you cannot miss out on any revenue because of the cuts that are being implemented as well as the price of, you know, Labor costs. And the third thing is, is make sure you stay within the insurance parameters that have been set.

 

Tricia

So if you have even if you don’t have to get an authorization but you have insurance that says, okay, you can only treat 12 visits, then treat your 12 visits, or if you have to treat six visits and send notes, make sure you do that. Make sure you keep up with the insurance regulations that they have by payer.

 

Allison

Excellent. Okay. So, I mean, let’s dig into those three areas a little bit further. Let’s start with let’s start with verifying benefits. So, you know, tell me why it’s crucial to verify your benefits correctly.

 

Tricia

Yeah. So what happens is, is when you call an insurance company and some some of your providers, you’re going to know that you have to get authorization and and verify the benefits. But when you call in to verify the benefits or you look online and it’s just one step, typically therapy services are another level down. Like you can verify that.

 

Tricia

Yes, the patient does have this insurance. Yes, they’ve met their deductible, but do they really have therapy benefits? And a lot of times those will have different co-pays, different co-insurance, different rules. And you need to really know what those are in order to make sure you maximize your reimbursement by following the guideline. Once you verify the benefit.

 

Allison

And how frequently should practices be verifying benefits.

 

Tricia

You need to verify your benefit every time a patient, every time you have a new patient. Right. So the patient comes in for the first time. You need to verify their benefits and make sure that you know what the patient has and talk to the patient about it the next time you verify the benefit. If the patient comes back in, say, six months later, eight months later, you need to re verify those benefits because they two things could happen.

 

One, they could be out of therapy benefits and now they have to be a cash patient or two, they’ve changed insurances because they’ve changed jobs.

 

Allison

Now, are there are there sort of any tools that can help practices automate this process or is this largely a manual effort?

 

Tricia

Well, yes. So there’s tools that you can use. So if your software has a way to reach out to a provider being a clearinghouse of some sort, or if you have portal access, you can check through portals and websites or your if your system is allowed to do it, they can go out directly to a clearinghouse and check those benefits through a clearinghouse and get those that information back into your system.

 

Tricia

Sometimes you have to go ahead and call the insurance companies to get the correct, but typically that is not something you have to do every time. But as you have staff that knows how to verify insurance, they’ll know which payers they have to call to get more information.

 

Allison

Now, what happens if you don’t have staff that knows that information.

 

Tricia

That there is your challenge. So you need to make sure that, you know, you’ve trained yourself well. You keep either within your system, you have cues that say, Hey, you need to call this. So you have a brand new patient, a brand new staff member. They’re using your system for the first time. You should be able to get a cue that says this needs to be verified through a phone call.

 

Tricia

It’s by insurance. It should be a pop up. Now, there’s some type of note that tells you, I need you to do X. If you don’t have that, you’re going to be down to paper and pencil and, you know, stickies on the desk. So either way, you need to have staff that kind of knows the rules, either by your system prompting or somebody has what we used to call the bible of each pair of exactly how to verify those benefits.

 

Allison

So really, looking at your system to do a little bit of that work for you to help streamline that process and make it a little bit easier.

 

Tricia

Absolutely.

 

Allison

Okay. So how does this process help a practice collect revenue?

 

Tricia

The process of verifying benefits? Well, the the best way to collect your revenue is to know what you’re going to get. Right. So if you don’t if you don’t know what the insurance is going to pay, what they’re going to allow, then you’re in the dark just treating the patient, hoping that, number one, you’re in network. Number two, if you’re out of network, you’re collecting the money at the time of service from the patient, because typically the patient gets that check.

 

Tricia

So if you’re not proactively checking your benefits, then you have the risk of losing revenue due to either patients getting the revenue or is completely denied.

 

Allison

All right. Let’s shift gears to collecting co-pays. Why is it important that practices collect co-pays at the time of service?

 

Tricia

It’s important to collect co-pays at the time of service because once the patient leaves the treatment, they typically lose about 50 to 60% of revenue. As soon as that happens, because patients will pay as they come in, because they’re right there in front of you and they’ll pay their bill. If they’re on, they walk out the door.

 

Tricia

Right. They leave the the office and now they have other bills that they have to pay. And now their medical bill is not as important. Typically, medical bills are never as important because really bad things don’t happen to you if you don’t pay your medical bills because especially in therapy services where therapists tend to be more lenient and will adjust off a bill.

 

Tricia

So now the therapist is going to be losing money because they literally cannot collect it from the patient. And they they typically do not send patients to collections. They just don’t. So to collect it at the time of service means that you are collecting full amount for them. The sorry start again, You’re collecting the full amount for that treatment for that day by insurance company and by the patient’s portion.

 

Allison

Well, 50 to 60%, that is a massive amount of money to literally just let walk out the door.

 

Tricia

Literally. Yes. Yeah. So, yeah. So what happens is, is that the patients leave, right? And then they wait till the end of the treatment to pay. And now you’re trying to get retroactive payment for something, a service that you’ve already rendered. And now they come back and they say, well, I’ll pay you $20 a month. Well, it might be a $500 bill.

 

Tricia

So at $20 in two years is not going to make as much money for you as it did right now when you needed it, because you’re paying yourself.

 

Allison

Right. Right. So what can practices do to make it easier to collect payments from patients at the time of service?

 

Tricia

Well, what I suggest you do is make a payment plan for the patient and make it so you’re not asking for the patient to pay every single time they come in. Put a credit card on file and charge that credit card as it has been agreed to have a payment plan written out, discuss what the treatment is going to cost, and then make it easy for the patient just to not have to think about their bill that goes on, their credit card and so on and make payment kind of like a gym membership.

 

Tricia

You don’t think about it. It just gets paid. And your services, you’re not asking at the time of service every single time the patient comes in because you know, sometimes you have cash, sometimes you don’t. Sometimes your credit cards in the car, whatever it is, it’s very best practice is to get it at the time of service and get that payment plan set up for the patient.

 

Allison

Now, is there any special training that you have to do for your front office staff to help with delivering that message to patients?

 

Tricia

Yeah, your front office staff has to be very they they have to be kind of balanced, right? They have to be the cheerleader for the practice. And they also have to be the person that says, well, we do need payment. And that that’s hard to get a person to do because either they’re very a cheerleader for the practice, really happy to see you.

 

Tricia

And they kind of feel bad about taking your money. You need the balance of the person that says, hey, you know, this is our practice and we need to get this revenue in order to keep the practice up and help other people. So you need to have a person that is balanced to not be afraid of asking for money.

 

Tricia

So it’s an interview process. Honestly, you’re interviewing for a specific type of person that can do this process because it is hard sometimes because you’re looking at, you know, working through payment plans with people and making sure they make that payment.

 

Allison

What about posting payment policies in in the front office or having that as part of like the your paperwork when you’re onboarding a patient?

 

Tricia

Right. You can do that if you post your payment policy in the office. That’s great, you know, because you can always refer back to it. But as a patient, when I walk in and I look at that payment policy, it’s like, okay, now you just want money. Like, you’re not you know, it’s like a it’s kind of a double edged sword.

 

Tricia

So if you have your payment policy and it’s super strict, then it seems like you’re not going to accommodate where the person is. If you don’t have your payment policy, then it comes back in the person. This is why I didn’t see the payment policy. So definitely have something that’s signed. I don’t necessarily think you have to post it because it’s kind of it’s a little forceful when you’re coming into therapy for the first time to see all the rules.

 

Tricia

You have to sign enough documents, you know, for HIPA, for all these things. You’re signing documents. It’s just nice to have a person talk you through what this benefit looks like, what your insurance benefit looks like, and what’s going to be expected of you to pay in a one on one type of situation. And then they’ll sign that policy instead of just posting it.

 

Allison

More of a personalized 1 to 1 experience, for sure. Okay. So any other tips? So if you if you do run into the situation where you’re not able to collect that payment upfront, you do have a patient that has an outstanding balance. Any other tips that you can offer for dealing with those patients that are late with payments and how to, you know, go about collecting those balances?

 

Tricia

Well, yeah, you can start sending out notices, right? You can send out a notice saying, hey, you know, you probably just forgot to pay this bill or, you know, kind of a gentle nudge if they’re still in treatment. Right. If they’re still in treatment at the time and they’re not paying their bill and you cannot get any, then the front office person really needs to talk to the therapist or the coordinator at the clinic, whoever it is, that is a level above that can say, hey, you know, this patient is not paying.

 

Tricia

I’ve asked several times, I need someone else to get involved. And a lot of times if you get the therapist involved because the therapist has a relationship with that patient, by that time they can say, hey, you know, my front office is kind of stating that you haven’t made any payments. I really need you to get caught up on this, you know, because this helps you get, you know, all the way through your treatment.

 

Tricia

You don’t have to because patients know when they don’t pay. So they’re coming in and they’re not paying. So they always know they’re not paying. It’s not they’re surprised. So there’s always this underlying tension when they go in as, oh my gosh, are they going to ask? And if a therapist just kind of soft sells it to them, that we really do need to collect your co-pay?

 

Tricia

It’s part of your treatment plan, then a lot of times the patient will go ahead and pay the bill.

 

Allison

Do you ever get to the point where you’re more of a hard line and and you say, we’re going to have to withhold treatment if we don’t receive payment? Or is that is that sort of pushing it too far?

 

Tricia

Yeah, Typically, of all the years that I’ve done this therapy office is very seldom do that because therapists always care about their patient, always patient will always come first. So typically owners will say, okay, you know, treat the patient and we’ll just put them on a longer treatment plan. As far as getting our payment plan, as far as getting paid.

 

Tricia

But they typically don’t stop treatment because they want that patient to be better. That’s the core of who a therapist is.

 

Allison

All right. All right. So last but not least here, what about ensuring you’re working within the parameters of what insurance will pay for? Tell me a little bit more about that.

 

Tricia

So that goes all the way back to verify your benefits. So when you go back and you verify your benefits and say the insurance company says this patient gets 12 visits. Right. So you’re you need to make sure that you’re counting those 12 visits and the therapist is working within those parameters, that this patient only gets 12 visits a year.

 

Tricia

The insurance company will no longer pay. What you want to do is you want to make sure that the patient knows it’s 12 visits so that, you know, they’re doing a lot of home treatment anyway. They might accelerate even more home treatment so the patient can get their injury resolved within their 12 visits. But at the end of those 12 visits, if the patient is not better than it needs to be a discussion with the patient, Do you want to continue treatment?

 

Tricia

Do you want to come in once we can be self-pay, right? Yeah, but we’re out of the parameters. So it does really go back to what did you verify? What is the insurance company paying and will they allow more treatment? Sometimes with certain insurance companies, you just have to send documentation that the patient is progressing along with the treatment.

 

Tricia

But they need further treatment because they haven’t met, you know, their goals. So and they haven’t met their goals due to maybe they had a subsequent injury during the time of their treatment or they’re just not progressing because they have other issues that are causing them to to take a little longer. And sometimes you can go back to an insurance company and poof, with medical necessities as this patient needs more treatment.

 

Tricia

That doesn’t happen very often anymore. It used to happen, but not as down as much.

 

Allison

So we’ve talked a lot about tactical strategies to, you know, help mitigate Medicare cuts and keep your revenue cycle moving along. But it’s not all about tactical items, is it? So when we were chatting before we were talking a little bit about the human element that can have a pretty dramatic impact on your revenue cycle too. So I think it’s this is worthy of a a discussion.

 

Allison

So I wanted to leave some time for us to talk about it today and really talk about the impact of really it’s bedside manner on your revenue. So you had said something the other day. You said physical therapy hurts, which, you know, I thought was pretty profound. And, you know, reflecting back on my journey with physical therapy, I’m like, you’re right, it does hurt.

 

Allison

And you had said that, you know, as a therapist, you have to make this as easy a process on patients to make sure that they can continue to come back because that has an impact on your bottom line. So I wanted you to talk a little bit more about that and talk about your experience. You had an experience with some physical therapy in your past and how you you found that to impact the bottom line of that therapy practice.

 

Allison

So I wanted to turn it over to you and just have you tell your story.

 

Tricia

Okay. Yeah, sure. So I’ve had a lot of physical therapy in my lifetime, you know, playing sports too long or, you know, doing things probably outside my limit that I should do. But one of them was, is that I, I ride horses and I had a horse that was a little bit better than me. So he decided one day he he was going to buck me off in this dry riverbed.

 

Tricia

Right. So I get backed off in this dry riverbed and I break my neck, my back, multiple ribs, blow out my clavicle. I’m. I’m a train wreck, right? I’m laying in and I’m broken. So anyway, three months later, you know, after you have a neck brace on for three months and finally I get the neck brace off and I and I tell the neurologist I said, Hey, you know, I want to go to physical therapy account.

 

Tricia

I can’t move my neck. And he’s like, No, you’ll be fine. You have a headache. I’m like, No, I’m want a physical therapy. I need to I need to get range of motion back. So I go to physical therapy. I fight for it. I go and I have this therapist, and you go through this whole process of saying what has happened and you’re nervous, right?

 

Tricia

As a patient, you’re nervous because I haven’t moved my neck in three months and I know it was broken. Like, is it going to is my neck going to break again? Is it going to work? Am ever going to turn my head? You have all these things that every patient has that I know It doesn’t matter what injury it is, They’re still nervous to go in and have somebody touch them and move them and try and get motion when you know it’s going to hurt.

 

Tricia

Right. So you’re apprehensive. So I went into my therapist. They talked through the whole story. She did a treatment on me, which probably was super limited because I was very guarded. The next time I go back, I’m still guarded, I still hurt. And now she’s she says to me, Sugar, So what are you here for? So at this moment I’m freaking out because, number one, she didn’t read the chart to even find out what was wrong with me, too.

 

Tricia

She didn’t you know, she didn’t take the time to even look to associate herself with me before I came in. So we started all over. So I started my story all over. And now I’m even more nervous because I know that she is starting from ground Zero again because she didn’t read her notes. Third time I go back, it happens again.

 

Tricia

And I happened to be at a a rehab facility where I actually know the CEO. So the CEO comes in, he’s like, hey, where’s Tricia? And nobody answers. And I’m waiting for her to say, Oh, she’s right here. She doesn’t even know I’m right there because she doesn’t even know who I am. And so, you know, here I go, I’m right here.

 

Tricia

He walks up and of course, you know, now the therapist is in panic mode because I know the CEO, which shouldn’t change anything. Right. But my point is, is that this person didn’t take the time to read the chart. I don’t think that they need to know everybody. You don’t need to know everybody that comes in every day.

 

Tricia

But read the chart, do your homework before the patient comes in so they can feel better. And like I told you, therapy hurts, right? So for providers to be engaged with their person for hour, 45 minutes, as long as it is right to make sure when that person leaves. Hey, you doing okay? Can I get you an ice pack?

 

Tricia

Can I do anything for you? I know we had a tough session today. You did really great. You know, give them give patients a pep talk when they walk out the door in your front office person say, hey, you know, have a great day, you know, great session, whatever it is, just keep motivating that patient to want to come back because when you leave, you don’t feel any better either.

 

Tricia

Like it still hurts. Right? And just about the time that you feel better, you got to go back and get hurt again. So you just in therapy, it’s super important to make the patient feel comfortable and known and feel like you care. And you do care because you’re therapist and that’s what you do. But you need to project that.

 

Tricia

When I actually talked to the director about this therapist, I walked up, I said, Hey, you know, I bet this therapist has the most no shows, the most cancellations, and the most drop offs of anybody in the therapy, your group. And he said to me, how did you know that? And I said, Because they’re not personable and they don’t make you feel like you matter.

 

Tricia

So that is a huge revenue loss to that for that provider. The director knew it but didn’t know what it was that was causing it. He told me, because she’s an amazing therapist, I go, I’m sure she is. But, you know, you don’t you don’t feel good about coming to therapy, so you stop. So my point here is, is that make sure the patient feels known.

 

Tricia

Make sure that you have a tracking mechanism. And if you do track your therapist and see who’s got the most know shows, who’s got the most cancellations, who’s got the most drop offs on their schedule, and they just might need to be trained on customer service. You know, we live in an age now where everybody talks, nobody really talks.

 

Tricia

You know, it’s it’s an art form that people have to really work at and try to overcome.

 

Allison

That’s I mean, that’s such a such a great such a great story. Thank you for sharing that. And it’s so true. It’s so true that we have to connect as people when we’re going in for health care services. So I think I shared with you a my story of my favorite provider ever, and it was sort of the opposite experience that you had every time I went to her and she came into the room, she was like, Hey, Allison, how you’re doing?

 

Allison

How are you feeling? What’s going on? What’s new? And I knew she had no idea who I was. I mean, she probably saw, you know, 40, 45 patients a day, but she did exactly what you were talking about before she came into the room. And I know this because I watch I like to observe people, you know, when I’m, you know, sitting in like the the waiting area, I like to watch.

 

Allison

And I would see her do this before she went in to see patients, before she went into the room, she would take a minute. She would look at the chart and I saw her for a year. So I saw her when it was like paper charts. And then I saw, you know, look at it when she was looking at the computer, she would take a minute, look at my chart or her patient’s chart, get the basic information, and then go into the room.

 

Allison

And she would do that with every one of her patients. But it made me feel special. I’m sure it made all of her other patients feel special and made me feel connected and made me feel relaxed immediately. And it made me feel seen. And she had a lifelong she had a lifelong customer. And I was so upset when she retired.

 

Allison

I was so devastated. And I’m not I’ll tell you now her replacement. I am not connected to I do not feel the same way about. But I’m sure she had a very thriving practice because of that behavior. So it it’s it’s really important to have that human element as well as, you know, your tactical strategies to improve and maintain your revenue cycle and your business growth.

 

Tricia

So right. If you think of the tactical, the tactical is great, but if you lose your patient because they they don’t feel seen or cared about, it doesn’t matter all the front end stuff you did, you’ve lost that patient. You’ve either lost that patient for life for everybody, like they’ll never go back to therapy or you lost that patient for your practice.

 

Tricia

Either way, it’s a loss. So, yeah, therapy therapy is an interesting profession because of how much good they do for everybody. They get people back to living their life normally to the best possible way that they can. And it it sometimes it’s discounted because people think, well, just fix it at home. Or even physicians are like, well, you know, just work it out.

 

Tricia

It’ll be fine. Well, no, there’s keys to we need more help than just trying to work it out on ourselves. We just can’t. And then when we have that human intervention where somebody cares, it just means so much more.

 

Allison

It does. It does. Absolutely. All right. So let’s bring this to a conclusion. What are what are the main takeaways for our listeners? What do you want them to take away from today’s episode?

 

Tricia

Well, I do want to take away that they do the tactical right. That’s super important. But also, I think the thing that’s going to make every practice thrive is your customer service and knowing that your patients are coming in, knowing that it’s going to be rough, but it’s worth it. And that’s for every provider, every person in the practice to actually own and really want to be a part of is that win for the patient to get better and to have a quality of life that they expect Excellent.

 

Allison

Well, Tricia, we are out of time for today, but I want to thank you for joining us.

 

Tricia

Sure. Thanks.

 

Allison

And I want to thank thank our audience for tuning in today to the Therapy Matters podcast, your one stop resource for expert insights and advice on everything, therapy and rehab. We look forward to seeing you on the next episode. Thank you. Thanks for listening to Therapy Matters. Do you like the podcast? Give us a five star rating. Subscribe and tell all your friends about the show.

 

Allison

Want to be a guest or know someone? Contact me at allison.jones@raintreeinc.com. That’s allison.jones@raintreeinc.com Therapy Matters is brought to you by Raintree, therapy and rehab’s favorite EMR. Raintree is the only all-in-one therapy. EMR delivering a complete and seamless end-to-end patient journey from first contact to payment to patient retention.

 

Allison

To learn more about Raintree, visit us online at raintreeinc.com.

 

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