Physical therapy billing is a crucial issue for all physical therapists in private practice. Practices pay anywhere from 6 to 9 % of their gross revenue towards billing. It is thus crucial to have a billing professional who understands both state laws and ethical billing practices.
Accurate can make all the difference towards a successful practice. As a practitioner, you want to be reimbursed quickly and appropriately.
The biggest mistake physical therapists make regarding their physical therapy billing is allowing the process to take too long and becoming a ‘victim’ of insurance companies, who try stalling tactics to delay payments. To be successful at physical therapy billing, you must follow up diligently with payors and make sure you get paid!
Most physical therapists want to treat patients and allow the billing to be dictated by a third party. They think physical therapy billing can take care of itself or at the most assign an employee to take care of it. There is more to physical therapy billing than generating a claim with diagnosis codes and CPT codes.
Start by using a good physical therapy billing system that is constantly updating to adhere to the latest changes in medicare and reimbursement laws. Ensure that all of your documents like registration forms, new patient interview forms, and fee slips etc. are clear, well-structured and easy to understand. Present bills to your patients and collect patient portions at the time of service. Keep in mind that waiving and discounting co-pays and deductibles is illegal without documented financial hardship.
All relevant personal and insurance information must be gathered from patients during the initial interview or first appointment.
To keep your physical therapy billing system running smoothly, ensure that the physical therapy billing person processes the claims and reimbursement paperwork for the patient charges daily. Most professional billing services handle this for you, so your claim is not denied by insurance companies. Medicare guidelines are constantly changing, therefore physical therapy software and medical billing services should always stay updated.
Bills should be generated and submitted electronically to insurance companies as quickly as possible to facilitate physical therapy billing.
In most cases, electronic claims are paid within 14 days but paper claims can take as long as 60-90 days.
Try to collect 90-100% of the billed charges. Do not accept excuses from the insurance companies such as, “Untimely submission”, “Not UCR”, “Not Medically Necessary”, “No Benefits” etc. Send out appeal letters to the insurance company if they send out denials of any sort. Send a copy of the same letter to the patient and the insurance commissioner.
When an insurance company asks for more information in order to delay the payment, send strong letters complaining about their stalling tactics.
Optimize the fees that you receive by charging according to the amount of time spent on a patient. Use modifiers like -59 and -22 to get paid extra for those patients who require more time and energy to treat.
Each time insurance companies provide adverse comments about you, send out letters to the insurance company refuting the allegation using the Explanation of Benefits statement as a basis.
Finally, try to find an in-house billing person instead of outsourcing your physical therapy billing to a professional firm. This increases the chances that you’ll have more control over billing procedures and get paid in a more timely manner.
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