Physical therapy billing is becoming a very lucrative business as the physical therapy industry grows. The skills required to bill for physical therapy services is quite basic but it’s the correct coding, appealing denials, and the actual collecting that’s becoming more and more challenging.
Many physical therapists in private practice are losing a lot of money. They do not enjoy the billing aspects of their business and all they want to do is treat patients. Little do they know, if you don’t get paid for your services you won’t enjoy know even the treating part.
More and more physical therapy practices are outsourcing their billing to those who specialize in it and can do it better. Often times, outsourcing can be a more cost-effective way for them to manage their billing avoiding the cost of software, hardware, and additional employees. The downside is many of the billing companies out there are not very organized and not very good with collections, or staying up to date with the coding and regulation changes. If you find one that is, the service is well worth the money.
The purpose of this site is to help billers and physical therapists understand how to be more successful at physical therapy billing.
Effective physical therapy billing includes strategic use of CPT codes, modifiers, and collection letters. A common denominator among the most successful practices in the country is they are good at billing and collecting for their services. Those who do not have a sound understanding of how to code, bill, collect, strategize and audit-proof are less successful but also more vulnerable to scrutiny, request for refunds, and violations.
A successful billing “system” looks like this…
You get short-listed by insurance companies avoiding the usual games they play such as frivolous denials and constant stalling tactics because they know you know your rights.
Reimbursements and profits are maximized by using best paying codes, and justifying them correctly in your documentation, and modifiers are applied appropriately, and staff are trained well.
Insurance companies pay you on time with little hassle.
- Patient pay their co-pays without complaint, even if it’s as high as $70!
- Your entire organization understands their role in a healthy billing system.
Physical therapy practices are only collecting 40-60% of their facility rates. This is causing a big problem in the physical therapy industry. The most recent economic census data reports that physical therapists have the poorest collection rates of all healthcare providers. -James Ko, PT, Advisor
If you want to be successful, you have to get the right tools.
You can’t use old intake forms that were borrowed or stolen from past employers and copy someone doing the wrong things. You absolutely can’t use inadequate software like MediSoft, Lytec, TurboPT, PTOS, Clinicient, Theraoffice, and Kareo.
The most successful private practices have…
State of the art software that’s simple to use with few bells and whistles but strong rules and alerts.
Legally sound registration and intake forms.
Legally sound Assignment of Benefits (AOB) form that contains the correct items allowing for legal leverage in case of insurance company denials and/or patient unwillingness to pay. A sound AOB allows a practice to deposit checks made directly to the patient, file a complaint with the insurance commissioner. You must have legal tools that allow you to get paid when insurance company or the patient ever try to evade payment.
A simple fee slip that makes it easy for the practice to collect patient portions at the time of service.
Successful private practices present a bill and collect patient portions at the time of service.
It is illegal to waive or discount patient deductibles or co-pays absent financial hardship. Many physical therapy practices are breaking federal and state laws unknowingly. There was never a police force but now there is…the FBI. “Take what insurance pays (TWIPs)” and “Professional Courtesy” is against the law unless certain criteria are met. Follow these steps to make sure you maximize success…
Have a “Patient Advocate” intake the patient and make sure the patient properly understands their financial obligations. Financial ambiguity can lead to quick no-shows and cancellations.
Place strategic signage on counter and wall to educate patients of their legal obligations.
Learn more by getting on our waiting list for the next course being scheduled as we speak, and we will send you free secrets and resources while you wait!
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