physical therapy cpt codes Archives | Page 2 of 2

Physical Therapy Billing: Real Time, Automatic Claim Submission to Boost Cash Flow Reiterated

by Nitin Chhoda PT, DPT | Aug 1, 2016 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Paper-based physical therapy billing not only consumes a lot of time but is also prone to claim submission errors that will affect the practice’s revenue.

Nitin Chhoda shares how an integrated physical therapy EMR can produced automated claim submissions and boost cash flow for your business.

A steady cash flow is a primary concern for any physical therapy practice and it’s one of the most difficult aspects for clinic owners to predict.

Coding errors, claim denials and time spent exchanging correspondence via the postal service reduce the turnaround time on physical therapy billing reimbursements and can quickly place a clinic in the red.

Billing with EMR

The future for physical therapy practices of all sizes is good physical therapy billing through the utilization of an EMR.

They offer superior coding options to reduce denials and errors, while providing paperless electronic claim submissions that reach their destination almost instantly.

Submissions can be transmitted individually as clients are seen or set for a batch submission at the end of the day.

One of the biggest problems facing practices is the need for proper coding and documentation in the claims process to ensure clinics receive the reimbursements to which they’re entitled. Information management is a hallmark of automatic claim submissions, providing crucial physical therapy billing and documentation to facilitate and accelerate the reimbursement process.

Paper Submissions are Reduced

Electronic submissions reduce the need for paper physical therapy billing and invoicing for significant savings and can reduce associated costs by up to 15 percent over traditional methods. Electronic submissions are environmentally friendly, highly efficient and enable therapists to collect for their services in hours instead of weeks.

Funds are automatically deposited in the practice’s account. Coding errors are the bane of a physical therapy clinic and electronic claim submissions offers a wide variety of options to accommodate physical therapy billing by the session, services rendered or treatment setting.

Electronic claim submissions via EMRs are secure and HIPAA-compliant. Claims can be sent virtually to any agency or payer with which therapists work, from private insurance, Workers’ Compensation and TRICARE for veterans to Medicare, Medicaid and clearinghouses.

Software for Physical Therapy Billing

Physical therapy billing software can virtually eliminate coding errors and drastically reduces the number of denials, post-payment audits and requests for clarification.

When an instance does occur, disputes can be handled quickly and efficiently through electronic methods.

EMR documentation software provides a clear record of the patient’s visit so therapists don’t inadvertently submit claims that contradict coding and billing rules or lack specific billing codes.

Electronic claim submission capabilities allow clinic owners to file for reimbursement from any location with Internet access. The system enables payers to deliver crucial correspondence and responses through the same claim submission system.

Automated Physical Therapy Billing

An automatic physical therapy billing record is created of what was filed and when, along with the current status of the claim. Ceilings on payments and reduced benefits for employee insurance programs are costing practices dearly.

Physical therapy billing software enables clinic staff to verify a patient’s insurance eligibility and range of coverage before they arrive at the office. Therapists can utilize that information to develop a treatment plan that falls within the constraints of the client’s available coverage.

Automatic claim submissions provide enhanced coding options to boost reimbursement levels. Submissions can be set to send individually, or as a batch at the end of the day for added convenience.

Physical therapy billing allows therapists to receive payments in hours or a matter of days instead of weeks for better overall cash flow. Superior speed and documentation significantly reduces errors, denials and audits, while placing more cash in clinic coffers where it can do the most good for the practice and patients.

CPT Codes Defined

by Nitin Chhoda PT, DPT | Feb 8, 2016 | Electronic Medical Records, Physical Therapy Billing

Along with ICD-10 is another term called CPT codes. Nitin Chhoda defines and differentiates these two terms, and explains the impact they will have on the whole physical therapy documentation process.

Practitioners must become familiar with the codes in order to minimize errors upon claim submissions.

While owners of physical therapy practices are contending with the switch to ICD-10 coding, another term with which clinicians must be familiar with is current procedural terminology (CPT) codes.

CPT Codes

Every procedure, task, service, device and surgery a patient receives is associated with a specific numerical code. Insurance companies utilize CPT codes to determine the amount healthcare providers will be paid and CPT codes must be linked by medical necessity.

The American Medical Association (AMA) develops and copyrights CPT codes. They’re responsible for changing, revising, updating and discarding those that become obsolete as new technology and treatments become available. They encompass thousands of individual codes that are updated annually.

CPT codes, even when used in physical therapy documentation purposes, are uniform and apply to all clients except those with Medicare coverage. Medicare utilizes the Healthcare Common Procedure Coding System (HCPCS) that encompasses three levels of coding.

HCPS Levels

HCPCS Level I is maintained by the AMA and Level II consists of alphanumeric codes. Level III codes were abolished in 2003 and were state-developed for Medicaid and Medicare contractors. Therapists should be aware that the reimbursement amount for each code varies widely among insurers and assigning the correct code to the appropriate treatment is a complex endeavor.

An EMR facilitates the process, but clinic owners will want to ensure their coding and billing expert has the best possible training to manage CPT codes and the upcoming ICD-10 changes, along with a thorough knowledge and understanding of medical terminology. Entering the wrong codes will result in denials and delays in reimbursements.

It’s imperative that physical therapists use the code that most accurately reflects the service or treatment that was provided. It should match the current ICD coding and therapists must provide sufficient documentation to support the CPT code that was entered to avoid denials, audits and requests for more information.

CPT Codes Standard

CPT codes allow for two-digit modifiers should they be required, but they must conform to standard definitions. Incorrect coding costs valuable clinical time, interrupts cash flow and can delay essential services to clients.

CPT codes provide the means for healthcare providers to communicate effectively with insurance companies about the services, treatments and procedures rendered to any given patient.

Using correct coding is essential if clinicians are to be adequately reimbursed for their expertise and ensures payments reach the clinic in a timely manner.

There is no uniform payment for specific procedures. Each insurance provider has its own fee schedule and reimburses according to the company’s guidelines. Proper coding ensures therapists are reimbursed at the highest possible level.

An EMR provides clinic owners with tools to monitor and track agencies that provide the best reimbursements, allowing them to make informed decisions about the best payers with which to contract.

The use of CPT codes in conjunction with ICD codes directly affects the profitability of practices. It’s a complex system that requires knowledgeable staff, careful attention to detail, and stringent documentation to support every diagnosis, treatment and procedure. An EMR makes the coding and billing process easier, and provides practice owners with the tools to track the best payers for increased revenues.

The Typical Insurance Claim Cycle

by Nitin Chhoda PT, DPT | Oct 27, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

The demand for medical insurance billers (MIBs) continues to grow and many individuals are eager to launch a career in the field.

The popularity of medical billing has given rise to a multitude of unfounded claims by scam artists who insist it’s a career path with minimal work and quick rewards. In this informative article, Nitin Chhoda explores the claim cycle and the MIB’s responsibilities.

The insurance claim cycle is the process of billing a third party entity that pays for the medical care of one of its subscribers.

The claim cycle begins the moment a patient makes an appointment with a provider and doesn’t end until the full amount has been deposited in the practitioner’s bank account.

Patient Paperwork

Medical histories, questionnaires and other forms impart necessary data about the patient’s past and current ailments, complaints, procedures and treatments.

A release of information is required so MIBs can file a claim and obtain payment from the patient’s healthcare insurance carrier. During the claim cycle, a release is critical, as MIBs can’t share the needed information with an insurance company without the patient’s permission.

Essential paperwork also includes a copy of the patient’s photo identification and their insurance card. Health insurance fraud is a very real crime for which MIBs must be wary. The insurance card contains information on who is eligible for services, along with exclusions, restrictions, limitations and prerequisites that must be met for payments to be dispersed.

Patients may also have coverage under multiple policies. Each insurance plan will have established deductibles and co-pays that constitute the patient’s portion of the final bill. Make sure that these are all reviewed during the claim cycle process. Always attempt to collect these fees before the patient sees the provider, or have the patient make alternative arrangements for paying.

Computing Power

All of the data must be entered into the MIBs billing software program or electronic medical records (EMRs) system where it can be accessed and retrieved for transmitting, tracking and monitoring reimbursement claims. Care must always be exercised in the claim cycle process to ensure the information is entered correctly to avoid delays and denials.

EMR technology is especially helpful, as it can identify users of potential claim problems.

A patient encounter form must be created and the appropriate ICD and CPT codes entered to substantiate the provider’s diagnosis and subsequent treatment. Any referrals, diagnostic tests and pre-authorizations must be documented, along with follow up visits if needed. The claim cycle process contains a full accounting of medical fees which must be entered and a claim form is always created that will be transmitted electronically to a clearinghouse.

Claims and Follow Ups

Once the claim arrives at the clearinghouse, MIBs will receive electronic verification. Clean claims that are free of errors are forwarded to the payer for remittance. Those with problems will be denied and returned. Clearinghouses and insurance companies are experts at finding even the smallest reason to justify delaying payments. So the billers must not end the claim cycle when they submitted the claims but rather when every claim has been reviewed and accounted for.

Once the claim is approved, it’s the task of the MIB to track the payment, see it securely deposited at the clinician’s chosen banking institution and recorded in the patient’s account.

Overdue payments must be investigated and appealed when appropriate. Billers will need to contact patients about any outstanding balance, be prepared to send unpaid accounts to collections, or write it off as a loss at the provider’s discretion.

The insurance claim cycle is completed when each portion of the payment is collected from the insurance carrier and the patient.

With EMR technology, receiving remittance from commercial payers can take as little as 10 days, and 30 days for government operated plans. MIBs are a crucial element in the claim cycle process, working to ensure that the practices of their clients receive the funds to which they’re entitled.

Electronic Medical Records and Its Role in Patient Billing

by Nitin Chhoda PT, DPT | Jul 29, 2013 | Electronic Medical Records, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

Convenience is the keyword for the 21st century clinic. Today’s population is busy and mobile, with little time left after meeting, work, and family obligations. Nitin Chhoda discusses how electronic medical records system (EMRs) simplifies billing for both physical therapists and patients in a variety of ways.

Patient income has long been the lifeblood of medical providers. Effective physical therapy billing is a highly necessary procedure for physical therapists in particular, as some patients may have sessions last over a period of several months.

Versatile Billing

Electronic medical records allow patients to make payments on their own time with a push of a button. Today’s consumers are used to online billing for various services.

However, some medical providers still insist on paper bills. Online billing through an electronic medical records system allows patients to make either one-time payments, ongoing payments, and sometimes participate in automatic billing via credit or debit card.

EMRs make it easier for both patient and physical therapist. If a physical therapist would like to move into online billing, electronic medical records system is a logical step.

Instant Transactions

Prior to online billing, physical therapist billing used to involve mailed checks or credit card payments taken over the phone. Both of these practices took office assistants’ time to manage billing, and involved a lot of upkeep.

However, with electronic medical records, physical therapists can receive their funding in as little as 48 hours. Consumers are also able to pay on a variety of devices, such as phone or tablet, without waiting for a paper bill. Providers can increase their income by 23% by adding the ability to receive credit card payments, and EMRs provides that opportunity.

Electronic medical records represent a new wave in improved patient care and physical therapist billing.

Physical therapists who are looking to streamline their practice in income and medical records should consider using EMRs.

As one of the facets of the changing face of healthcare, electronic medical records are an essential tool for the survival of a physical therapist office.

CPT Codes — from the Medical Coder Perspective

by Nitin Chhoda PT, DPT | Aug 3, 2012 | Physical Therapy

Nitin Chhoda explains how medical billing and coding can be simplified with an integrated electronic medical records and billing system. The importance of communicating with patients and elaborating costs and financial responsibilities is also discussed.

CPT codes are pretty complex to use if you are unfamiliar with the process.

However, because they are so widely used, there have been many improvements in the way that medical coders and billers can access the codes they need.

Especially in an increasingly electronic age, CPT codes are only getting easier to use. Coding speed and accuracy can be increased with special physical therapy software that allows you to search for the right CPT codes quickly.

The most common reasons that insurance claims are rejected or denied have to do with incorrect coding or policy non-compliance. And every claim that has to be re-done makes the medical coding in your office slower and more costly.

With the Internet and software prices going down, these problems are being reduced for medical coding professionals and for the clinics that they work for. The high-end EMR solutions also include coding databases and can help improve efficiency and accuracy.

In order to draw more clients to use EMRs, software developers are learning to provide just what clinics and clinicians need from a complete electronic system.

Not Just CPT Codes – All Medical Coding

And of course, CPT codes are just one aspect of the job of a medical coder. CPT codes for Medicare are the same as certain HCPCS codes. Not every clinic will use all CPT codes, but only a certain sub-set. CPT codes list are only good if they are combined with the appropriate ICD codes when submitted with claims.

These kinds of important requirements keep medical coding staff very busy, which is one reason why many practices prefer to hire certified medical coders.

Communication with Patients

Another important way that CPT codes are used is in communication with patients. After a claim is filed and the insurance company responds with the amount they are covering, if there is any leftover amount it is up to the medical biller to bill the patient.

Patients usually find the medical billing paperwork to be confusing and overwhelming, especially patients who have recently undergone a medical procedure or have been diagnosed with a serious disease or condition.

Medical billing staff have to be able to communicate why certain CPT codes are used, why the insurance company did not cover the entire cost, and what the patient is responsible for paying.

Determining Future Costs

It can also be helpful if patients get an explanation about what future costs to expect due to discrepancies between the amount the insurance company will cover and the amount the patient has to pay.

CPT codes dictate how much a patient will be charged as well as how much the insurance company will pay.

The hope is that with a reasonable agreement between the health care provider and the insurance company, the patient will not be responsible for partial payments all the time. CPT codes can be used to ensure that pricing is consistent with the expected reimbursements from insurance companies as well as programs like Medicare and Medicaid.

CPT Codes: What's In It?

by Nitin Chhoda PT, DPT | Aug 2, 2012 | Physical Therapy

CPT codes and ICD codes are the terms used when discussing medical situations, and are used by the insurance and medical billing companies as guides. Nitin Chhoda describes the categories and roles of these codes as they relate to the physical therapy business.

CPT stands for Current Procedural Teminology. The CPT codes have been set and maintained by the American Medical Association and they are updated every year in October.

One of the easiest ways to understand the CPT codes is to compare them to ICD codes. While ICD-10 codes identify the diagnosis of a patient, CPT codes identify the services rendered.

CPT codes are used by clinicians, medical billing and coding professionals, and patients, as well as accreditation organizations, as a standardized communication tool for talking about medical services.

In fact, the reason that CPT codes are so useful is that everyone uses them when referencing medical services. The most prominent uses are in medical coding and billing, when a clinic needs to bill an insurance provider or government program. Medicare and Medicaid are both billed using CPT codes list along with ICD-10 codes.

Categories and Sections

CPT codes come in three categories, Category I, II, and III. Category I is split into six sections: Codes for Evaluation and Management, such as home services, hospital observation services, or emergency dept services; Codes for Anesthesia, such as obstetric, head, or neck; Codes for Surgery, such as nervous system, digestive system, or general; Codes for Radiology, such as nuclear medicine, diagnostic ultrasound, or mammography; Codes for Pathology & Laboratory, such as drug testing, immunology, or transfusion medicine; and Codes for Medicine, such as dialysis, allergy & clinical immunology, acupuncture, and ophthalmology.

Categories II and III are a little different. Category II are CPT codes that measure performance and are entirely optional. Category III are CPT codes for emerging technology use.

Not Optional

CPT codes are required by health insurance companies, as well as Medicare and Medicaid, in order for medical or physical therapy billing to be successful.

Additionally, HIPAA requires that CPT codes are used as part of a national data standardization and collection effort.

However, the copyright for CPT codes is help by the American Medical Association (AMA). That means that anyone who uses the CPT codes must pay license fees. This usually falls on the shoulders of health care services providers.

Insurance companies and government programs also use CPT codes as a reference for the amount of reimbursement that the clinician or clinic is paid for services. Insurance companies will negotiate with health care service providers in order to determine the precise amount, but once the amount for a service is set, all both parties need to know is which CPT code to use and the payment can be made in the agreed upon amount.

Updates and Improvements

But paying for access to CPT codes isn’t all bad. The AMA maintains the system and ensures that updates are made every year. The resulting system provides all users with a way to share information quickly and in a standardized way. The AMA has workshops to get informed feedback in order to make the system easier to use. The uniformity that CPT codes provide benefits everyone who works in medicine.