The skills required to offer physical therapy billing services is quite basic but it’s the correct coding, appealing denials, and the actual collecting that’s becoming more and more challenging.
Most physical therapists 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 the treating part very much.
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.
If you find one that is, the service is well worth the money.
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Successful 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.
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.
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
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 that makes you vulnerable if ever audited, nor should you use complicated software that takes too long for your staff (it costs you more money than you know).
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 and more. 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. Patients like being presented a bill before paying.
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.
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