SPRY has been awarded 9 badges in G2 summer 2024 reports.
Read about it in our press release.
Learn more
Accurate and complete patient records are essential for thorough documentation. These records should include the patient's medical history, treatment plans, progress notes, and all communications with other healthcare providers.
Importance of Comprehensive Patient Records
Justifying Services and Preventing Claim Denials
Detailed patient records allow physical therapists to prove the urgency of their care. PTs can justify the need for specific treatments and interventions, which is crucial in securing approval from insurance companies and other payers.
Complete records reduce the chances of claims being rejected and expedite payments.
Documentation must meet the highest standards for smooth billing. Integrating professional documentation services can save effort and time. With SPRY's documentation services' added support, documentation will be spotless and hassle-free.
Staying current with physical therapy medical billing requires constant awareness of changes in medical coding. Codes such as ICD-10, CPT, and HCPCS are frequently updated to reflect new medical terms and practices.
Keeping up-to-date with these changes reduces billing errors and prevents claims from being rejected, benefiting the practice's finances and demonstrating a commitment to quality care and compliance.
Here are some important billing codes and considerations for physical therapists:
By adhering to best practices in physical therapy billing, practices can achieve better reimbursements, ensure regulatory compliance, and provide optimal patient care.
Checking insurance coverage is another important aspect of physical therapy billing units. It helps set clear patient expectations and prevents billing issues. By checking a patient's insurance before their first visit, offices can know what the patient owes. This usually takes about 20 minutes on the phone. So, best to start this process 72 hours before the first visit.
Setting Realistic Expectations
When checking insurance, offices need to get important details. This includes the policy and group numbers, who the policy is for, and the claims address. They also need to know when the policy ends, how many visits are left, and what the patient will pay. Offices can also check if the therapist is in-network or not.
This information helps set clear expectations with patients about what they'll pay. It helps avoid surprise bills and billing problems.
Avoiding Billing Disputes
Not checking insurance can cause claims to be denied. This happens if information is missing or if services aren't authorized. Therefore, checking insurance before the first visit helps decide if the treatment fits the patient's coverage. This reduces the chance of denied claims and billing issues.
Collecting copayments and deductibles immediately after seeing the patient is key for PT units. This approach helps prevent unpaid bills and simplifies the billing process. For example, if an insurance payment covers $75 of a visit but the patient owes $25, obtaining the full payment at the time of service highlights the importance of this practice.
Reducing Outstanding Balances
By securing payments upfront, physical therapy practices can reduce outstanding balances to a great extent. It improves cash flow and keeps patients happy as there is no stress for follow-up billing or potential disputes over unpaid amounts.
Enhancing Patient Experience
Collecting copayments at the time of service also contributes to a better patient experience. It aids in budget management for both the practice and the patient, preventing the accumulation of unexpected, large bills.
Even after patients meet their deductibles, they may still have copayments, making it essential to clarify these obligations upfront. By addressing payments during the visit, practices can avoid surprising patients with large bills later.
Collecting copayments and deductibles upfront helps PT units with billing, cash flow, and patient satisfaction. This approach matches the trend of insurance companies enforcing patient cost-sharing rules, showing the need for everyone to stick to their financial duties.
Absolute sanitation of processes at the front desk can do wonders for billing mistakes. It’s important that staff accurately collects all patient information, including personal details, insurance, and referrals, during check-in. Incorrect or missing information can lead to billing problems and delays in payment.
Steps to streamline the physical therapy patient check-in process:
Appointment scheduling plays an important part in billing and earnings for PT practitioners. Clinics can use their resources better if time slots are managed well. Low idle time and a steady flow of patients would definitely bring in more money.
Maximizing Billing Capacity
To get the most out of billing, PT units should try these tips:
Increasing Revenue
Improving how appointments are scheduled can also boost a physical therapy practice's earnings. Here's how:
By using these smart scheduling methods, PT units can increase their billing, earn more money, and provide excellent patient care.
Regular audits of physical therapy claims help spot and fix errors early, keeping the practice's finances strong.
Identifying and Addressing Issues
Regular audits catch billing problems early. They check CPT codes, ensure proper documentation, and use modifiers correctly. Fixing these issues quickly cuts down on claim denials, improving cash flow and stability.
Minimizing Claim Denials
Regular billing audits lower the chance of claim denials. They prevent mistakes like duplicate claims, missing services, and wrong codes, keeping the practice's revenue safe and making billing more efficient.
By fixing these audit findings, practices reduce denial risks and keep billing smooth. Regular audits help maintain a strong financial outlook and top-notch patient care.
Staff members well-versed in billing and coding will make less mistakes and manage the billing process better than non-trained ones.
Regular training will help keep the team updated on billing rules, coding, and payer policies and will improve claims submission.
Reducing Errors and Claim Denials
Billing errors can lead to delays and additional work. Regular staff training helps minimize these mistakes.
A trained team understands how to document and code accurately while adhering to payer rules. This results in fewer denied claims, improved cash flow, and a more streamlined billing process for the practice.
Investing in staff training enhances the practice's billing success.
Using physical therapy modifier codes correctly is key for good billing. With over 10,000 CPT codes for billing in rehab therapy, it's vital to know when and how to use the right modifiers. This ensures claims are processed right and payments are maximized.
The Consolidation Appropriations Act (CAA) of 2023 keeps many pandemic-era telehealth waivers for Medicare patients until the end of 2024. Knowing the right modifiers for telehealth services like 95, GQ, GT, and FQ makes billing easier and keeps it in line with payer rules.
Knowing how to use physical therapy modifier codes wisely can make billing easier and increase therapy payments.
Denied claims can really hurt a physical therapy practice's income. It's good to have a strong plan for appealing these claims to get back lost revenue and keep cash flow healthy. The CMS program helps reduce denials and appeals by offering one-on-one help. Also, APTA's efforts led CMS to fix RTM code denials, with changes set for July, requiring claims to be resubmitted.
Recovering Lost Revenue
Many denied claims can be turned around with good documentation and following up. About 20% of health claims get denied, and providers think they should have been covered. By appealing these, physical therapy practices can get back revenue they might have lost.
Maintaining Healthy Cash Flow
Regularly checking and handling denied claims is crucial for a practice's cash flow. APTA's push led to CMS improving coding and reimbursement. By tackling claim denials and getting back owed reimbursements, practices can keep their finances stable.
An important step that cannot be overlooked is to carefully review contracts with each payer to understand their billing requirements, reimbursement rates, and any specific terms related to physical therapy services. Payer policies can change frequently. So, it is good to stay informed about updates or modifications to policies through payer newsletters, websites, or direct communications with payer representatives.
Ensuring Compliance
Keeping updated records of all services given to patients is vital for billing and securing payment. A billing software that integrates with payer policies and helps in compliance can be the best bet.
Avoiding Common Pitfalls
Knowing the right medical billing codes is key to getting paid correctly. Billing teams at PT clinics need to keep up with new codes to avoid mistakes. Good billing includes steps like getting pre-authorization and checking codes to ensure claims go smoothly.
Training staff, using technology, and checking data are good ways to bill correctly.
Staying Updated with Telehealth Billing Practices
Post the pandemic, staying current with telehealth billing requirements is no longer an option. Telehealth billing requirements are dynamic and can vary widely among insurers and governmental bodies. Understanding these nuances helps ensure accurate reimbursement and compliance. For instance, recent updates in codes and modifiers, as well as changes in coverage policies, directly impact how telehealth services are billed and reimbursed. PTs who adapt to these changes can enhance their revenue cycles, improve patient access to care, and continue delivering high-quality services.
Teaching patients about physical therapy billing sets clear expectations and makes sure payments are on time. Practices should explain common CPT codes like 97110 for exercises, 97112 for re-education, and 97116 for training how to walk.
It's also important to tell patients about the CMS 8-Minute Rule. This rule states that a unit of service is 15 minutes and that at least 8 minutes of work must be performed to be billed.
Explaining billing complexity levels, like low, moderate, and high, helps patients get why their care costs what it does. To avoid billing issues, practices should also share details about insurance plans, like copays and deductibles.
Along with knowledge, being clear about billing builds trust with patients. Practices should give detailed Explanation of Benefits (EOB) documents. These explain why payments were made and list the services and payments.
It's also important to know the difference between one-on-one and group billing services. Each has its own rules and payment rates. Modifiers like GP, 59, KX, GA, and CQ make billing clearer and help get the right payment.
By focusing on teaching patients and being open with billing, physical therapy offices can build better relationships. This leads to happier patients and better billing success.
Another important aspect in billing Updated Telehealth Billing Practices
Post the pandemic, staying current with telehealth billing requirements has been indispensable.
Telehealth billing requirements are dynamic and can vary widely among insurers and governmental bodies. Understanding these nuances helps ensure accurate reimbursement and compliance. For instance, recent updates in codes and modifiers, as well as changes in coverage policies, directly impact how telehealth services are billed and reimbursed.
Moreover, as telehealth becomes a permanent fixture in patient care, maintaining up-to-date billing practices is crucial to prevent claim denials, ensure proper payment, and support financial stability. Providers who adapt to these changes effectively can enhance their revenue cycles, improve patient access to care, and continue delivering high-quality services.
As we wrap up our 12 key tips for physical therapy billing, it's vital to note that though the primary motive to chase flawless billing is to ensure a practice's financial wellness the underlying objectives go far beyond revenue. It's about patient satisfaction, longevity of the practice, it's brand image and relationship with payers.
Experience the difference accurate billing can make. Contact SPRY for a personalized consultation and discover how we can help you master the art of physical therapy billing.
Reduce costs and improve your reimbursement rate with a modern, all-in-one clinic management software.
Get a Demo
.png)
