WINNIPEG, MANITOBA, CANADA — Physical therapy practices (A.K.A Physiotherapy exercises) already using Mavenlive physiotherapy software may be pleased to learn that we are using our unique, expert software to automate the process of bill coding.

This is presently in development and alpha testing, says Dr. Jay Winburn, president of Prognition Corp., the parent company of Mavenlive.

“At present, bill coding and the payment process is a major stumbling block and irritant for just about every health care provider,” Dr. Winburn says. “It is one of the top reasons cited for leaving private practice and working for large institutions with a specialized staff that handles this process.”

Medical billing and coding is the process health care providers use to submit insurance claims so they can be paid by insurance companies and governments for services they provide patients. Most private and government-owned insurance companies use the same process.

In the past, Mavenlive- used by therapists throughout the world to perform physical therapy assessments and other tasks- has been integrated with existing billing systems. The process of assigning codes, however, is done by hand.  The person doing this has to review the chart to see what was done and then make judgments about what bill codes are appropriate.

When physical therapy clinics submit bills:

• * Medical claims examiners/adjusters at the insurance company process claims.
• * For more costly claims, medical directors review and evaluate their validity for payment by considering factors such as patient eligibility, provider credentials and medical necessity.
• * Approved claims get reimbursed for a certain percentage of the billed services, based on pre-negotiated rates between providers and insurance companies.
• * Claims that are denied/rejected are sent back to providers.
• * Most commonly, denied or rejected claims are returned to providers in an explanation of benefits or other similar document.
• * Providers must decipher the message, reconcile it with the original claim, make any necessary corrections and submit the claim once more.

“It’s not unusual for this to go back and forth several times before the provider actually gets paid,” Dr. Winburn says. The Medicare rejection rate of claims submitted by physical therapists and occupational therapists is the highest of any health care field – 79 percent.

By adding bill coding capabilities to the Mavenlive exercise prescription physiotherapy software, we believe the logic of bill coding can be programmed and mistakes can be eliminated, which should enable clinicians to get paid quicker and more consistently by insurance companies.

Having bill coding under the same software umbrella as the assessment notes and prescription of physiotherapy exercises removes the need to re-enter information, which commonly is an error source.

“Ultimately, Mavenlive will be able to determine when information is missing and the physiotherapist can be made aware of this before the patient leaves,” he says.

If the claim doesn’t qualify, the health care provider will be notified before the patient leaves and can make any appropriate changes to what is recorded or done so the claim does qualify.

“Mavenlive will of course document everything so the health care worker doesn’t have to worry about audits,” Dr. Winburn says. “The bill coding will be derived from what actually occurred during the patient’s visit.”

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