For a private practice, the world of insurance companies and payers (Medicare and private payers) is a complex and intimidating one.

Nitin Chhoda explains the differences between government and non-government payers to help you better understand the ‘insurance scenario’ so you can make a better decision about the payers you’d like to get enrolled with.

The list of payers of a physical therapy billing in a practice can be long and complex.

Government programs, private insurance companies, auto liability insurance, and workers’ compensation programs all pay for physical therapy services and rehabilitation.

Even within private health insurance companies, physical therapy billing is incredibly complex.

Insurance companies have the power to impose very specific limitations on services provided. Each type of insurance provider will have specific requirements for enrollment and treatment.

Private Insurance Companies

Private insurance companies that cover the costs of physical therapy billing and treatment include automobile liability insurance, workers’ compensation insurance providers, and health insurance companies. Workers’ compensation systems are usually tied into the public system, and there are public providers of workers’ compensation insurance.

However, there are also private companies that work similarly to private health and liability insurance companies.

For physical therapy billing purposes, these companies will expect Current Procedural Terminology (CPT) codes in the Physical Medicine section. These codes help to standardize physical therapy billing as well as other health care services billing for particular procedures and treatments.

Payment policies can be different from company to company. Most physical therapy billing staff will already know that the only way to get claims approved is to follow the policy of each company to the letter.

Any minor mistake can be cause for rejection or denial of a claim. In particular, physical therapy treatments are often limited in number of visits or to a maximum dollar amount each year.

Other Physical Therapy Services

Physical therapy may also be lumped together with other rehabilitative services, making the pool of covered treatment even smaller if the patient is seeing other specialists, including speech-language pathology, occupational therapy, and even chiropractic work.

Physical therapy billing and practices must contract with individual health care insurance companies to determine the payment levels for service. For liability and workers’ compensation payment levels, there are often legal requirements set by each individual state.

Medicare and Other Government Programs 

Medicare, Medicaid, and other government programs, such as county health coverage programs, operate separately and differently than private insurance, and each program has specific rules to follow for physical therapy billing.

In fact, for Medicare, the type and amount of payment is determined by where the physical therapy services are provided.

Different billing procedures are used for in-home physical therapy and treatment within a clinic. The services that apply to most physical therapy private practices are outpatient services. Medicare has an annual cap for physical therapy billing and services that is increased each year.

More Government Programs

Under Medicaid, physical therapy is considered an option service, but one that is still covered by most states. 39 states cover physical therapy even as an optional service, and in all states there are exceptions for “medically necessary” physical therapy and for inpatient hospital physical therapy.

Other governmental programs include services through the US Dept of Veterans Affairs and under the Individuals with Disabilities Act.

Physical therapy billing for all of these services can be overwhelming and confusing. There are many problems with the system, but physical therapy documentation software is making it a bit easier to handle the specifics of each program.

Physical therapy billing involves insurance claim submission and balance billing patients for outstanding dues.

Since patients are the most difficult payers, it’s critical for a practice to gather payment information during the patient intake process, and also to communicate with them about their insurance and balance billing possibilities.

This makes the patient aware of his / her responsibilities and helps the practice increase cash flow.

In an ideal world, every visit that patients made to the physical therapists would be seamless and payments would happen virtually, in the background.

Each time your physical therapy billing staff submits a claim, the hope is that it will be accepted.

Sadly, half the time, those claims are denied or rejected. And for many patients, this can mean that the onus of payment is on them.

Collecting payment is the hard part. When someone needs medical care, the last thing you want to do is demand they pay up for the services they’re getting. But the physical therapy billing system is set up the way it is and the best we can do is adjust and come up with smart ways to make the process less painful.

Pre-Visit Intake and Insurance Reviews

One way that some physical therapy billing departments are doing to make things easier is to work with patients up-front and determine what is covered before the patient has any bills due.

This process is not fool-proof, and it requires a lot of proactive work and planning on the part of the physical therapy billing department. But if a patient knows what to expect, payment is not as stressful and onerous.

With an integrated physical therapy billing EMR, as soon as the patient has entered their insurance and medical information, the staff can get to work finding out what the patient can expect to receive in terms of care.

Any co-payments or deductibles can be discussed up front. This means that the patient will be informed about their obligations and will not balk every time a payment is due.

Be Ready

Naturally, no system is flawless and there will still be situations where a patients insurance company rejects claims based on previous care that was not mentioned or other provisions that were not identified.

But by taking the steps to avoid surprises, both the staff of physical therapy billing and the patients will find it easier to handle the payment process.

Payments from patients are more likely to be paid on time, and you can even collect payment up-front when the patient arrives rather than sending them a surprise bill in the mail at a later date.

Integrated EMR Solutions for Payment Processes

The only way that physical therapy billing staff can streamline the process in this way is if they have access to all the most relevant information. As soon as a patient has made a payment at reception, the billing staff should be able to pull up that information.

If a new appointment is made, information about who will pay should be calculated automatically.

On-site credit card processing should also be an option, for both one-time and recurring payments. Payments can be initiated from within an integrated physical therapy billing EMR.

On-site credit card processing is one of the best ways to collect payments from patients. With a credit card on file and signed permission from the patient, your practice can balance bill a patient without having to turn into a ‘payment collector’.

In this article, Nitin Chhoda reveals key insights to help improve payments from patients and convince them to give you permission for automated, credit card billing.

The most modern and advanced physical therapy EMRs combine everything from patient intake to physical therapy billing in one system.

The benefits seem endless when you look at it from a physical therapy management perspective, but filling in the gaps for the rest of the staff is also very important.

There are many ways that patient interactions can be improved, including in the delicate arena of payment.

Benefits of On-Site Credit Card Processing

Although most physical therapy services are covered by insurance companies or government programs, a significant enough proportion of physical therapy billing payments will come directly from patients.

In fact, a good physical therapy billing and marketing strategy is to encourage patients who will be paying up-front for preventative services.

If you have at least some patients who are paying for their own services, you can predict certain levels of revenue that doesn’t come with the same delays and claims submissions.

These days, it is important to have on-site credit card processing as one payment option for physical therapy billing patients. Even if you are simply collecting credit card information in case of future incidental costs, the value of including integrated credit card payment processing into your EMR will be significant.

For co-payments or initial deductible payments, having recurring credit card processing capabilities will take a lot of time-consuming work out of collecting payment.

And for practices that incorporate up-front payment into their physical therapy billing practice, being able to charge the fees simply and efficiently with a stored credit card can make the entire process smoother and more comfortable for patients as well as staff.

Additionally, physical therapy billing staff should be able to see real-time updates to the payment status of patients, each time the credit card is charged.

Other Payment Precautions and Solutions

Accepting credit and debit cards on-site is just one part of the payment routines. Hopefully you are also equipped to accept cash and even checks.

Even though many people do not use checks anymore, there are still a surprising number of patients who will come through your practice hoping to pay by check.

Checks are a difficult form of payment for physical therapy billing to accept. The cost of a bounced check is not insignificant and the time it takes to re-bill is frustratingly slow.

But there are ways to accept checks safely. Now, you can integrate the Automated Clearinghouse (ACH) process into your EMR. You will be able to instantly determine whether or not a check is good.

Accepting checks may help you to increase the amount of up-front payments you can accept, making your practice more efficient at collecting physical therapy billing payments. Anything that improves your cash intake is a good investment.

Decreasing the Work of Physical Therapy Billing Staff

Another great investment is made each time you reduce the amount of work that physical therapy billing staff needs to manage. Up-front payments and on-site credit card processing make it possible for billers to be taken out of the equation for certain patients. This means they can spend more time and energy focusing on billing and collecting from insurance companies.

There are times when it appears that insurance companies are in the business of denying claims, not paying them.

As a private practice owner, the solution is simple – minimize errors in claim submissions. Nitin Chhoda reveals how to minimize such errors so your practice can get paid faster.

Submitting insurance claims for physical therapy billing and services can be a frustrating and challenging job, no matter how much experience your physical therapy billing staff has.

Insurance companies are so quick to reject or deny a claim, and since they have all the power and a lot of money, it feels like physical therapy practices can do very little to influence the outcome of each claim.

Fortunately, EMRs and physical therapy documentation software have been designed with these challenges in mind. As physical therapy billing professionals have struggled to find solutions, some key aspects of the billing process have been identified as problematic when it comes to claims acceptance.

Errors in Submission

One of the top reasons for rejected or denied claims is an error in the submission. The error can be as simple as a typo in the code or in the name of the patient, or a less-than-perfectly legible claim form.

Usually, these errors result when the physical therapy billing staff doesn’t have the time to carefully fill out and review the claim. These kinds of errors are avoidable, but it usually takes a change of workflow and priorities before errors can be reduced significantly.

The other kind of error that is highly common are errors due to an incorrect or insufficient understanding of the insurance plan. If a patient believes they are covered for physical therapy, the physical therapy billing staff will submit a claim for the entire amount.

But if it turns out that the particular procedures are not covered, or if the patient has yet to pay the entire deductible on their plan, the claim will not be filled as requested. This often leads to partial payment, too, which is not a terrible outcome. However, because the biller did not know that the partial payment would come, research must be done to review what the patient owes and then a bill must be sent to the patient.

An additional problem that plagues physical therapy management is the timing of physical therapy billing. If a claim submission is accepted and paid, that is good news.

Timing of Submission

But if the claim is paid three weeks after the patient visit, the practice is losing money. Many claims are not submitted in a timely manner, either because all of the details about treatment of the patient are not available to the biller, or because making time for physical therapy billing each week is hard for a biller who is somewhat overwhelmed.

Many of the solutions to these problems may seem automatic or intuitive at this point. If the problem is insufficient patient information or clinician notes, a better system of physical therapy billing and documentation is needed.

Solutions

If partial payments due to incorrect billing are slowing down the entire process, learning what each patient owes in advance would help speed things up and ensure that the patient is not surprised by a bill. Of course, EMRs offer many of these benefits for physical therapy billing.

There was a time when claim submission was an ardous, manual process. With the emergence of electronic claim submission, a claim can be submitted in seconds.

Nitin Chhoda describes the technology of real-time, automatic claim submissions and why it’s here to stay. More importantly, Nitin advises you how to find an EMR that integrates this critical feature to help you streamline and automate your practice.

Ideally, every claim sent to an insurance company would be submitted as soon as the practice knew it was time to send a claim.

In reality, claims are delayed by many factors, including problems with clinician notes or weighted procedures, insufficient patient information, and mediocre time management and physical therapy billing.

With a physical therapy EMR, claims for regular patients to consistent insurance companies can be generated in real time. They also take much less time to prepare and send, something that will help improve overall efficiency of physical therapy billing.

Cash Flow Stumbling Blocks

Insurance claims are one of the biggest stumbling blocks for generating consistent cash flow at a physical therapy practice. Health care providers are at the mercy of insurance companies when it comes to getting paid, and insurance companies certainly don’t try to make it easier.

But if you can identify where your problems with physical therapy billing cash flow are, you can start to work on solutions to solve those problems.

The goal of a physical therapy billing solution using an EMR is to make the majority of claims automatic and instantly submitted. The majority of visits from patients are recurring. The initial visit involves some extra steps for collection of patient history and insurance information.

However, after that first visit, the physical therapy billing plan should be somewhat predictable. And yet, without an EMR, each time a claim must be filed for each patient, the biller must fill out new paperwork and submit the claim as if it was the first time.

Real Time Claim Submission

With an integrated EMR, the possibilities for efficiency improvement in physical therapy billing are quite stunning.

To even imagine that insurance claims could be submitted in real time seems like a bit of a fantasy. But for the majority of claims, this kind of streamlined process is quickly becoming a reality.

The trick to submitting claims automatically is preparation and planning. With a detailed treatment plan for each patient, it should be possible for physical therapy billing professionals to know what they will bill after each visit for each patient.

The clinician must follow the treatment plan closely and record each visit according to the agreed-upon plan. The biller can then review an automatically generated claim based on the treatment plan and submit claims in real time.

Big Changes Take Big Work

The hardest part of implementing a physical therapy billing change to workflow like the one described above is getting everyone to do things differently.

We get into routines and then we stay in them – humans are very good at that. But we are also very good at adjusting when something outside of our control changes.

To bring about serious cash flow improvements will take some serious changes. Implementation of an EMR will help to shift the thinking of all staff so they can work from a new perspective. Physical therapy billing staff can begin to benefit from these changes immediately, and the practice as a whole will see greater cash flow efficiency.