There are many possible reasons for physical therapy and medical claims denial. Using physical therapy billing software, claim denials can be minimized, allowing you to improve cash flow and grow your practice.

Every physical therapy billing precaution can be taken and extensive documentation provided, but at some point, physical therapists will experience a denial for payment.

Claims are denied for any number of reasons, from incorrect physical therapy billing coding and services that aren’t covered to medications that were prescribed.

Patients may have exhausted a lifetime benefit cap on services or received what’s deemed as an experimental treatment by their insurance carrier.

Billing Affects Profitability

Navigating the labyrinth of rules and regulations of physical therapy billing each payer maintains can be extremely confusing, but it can also severely affect the profitability of a practice.

In an effort to cut costs, many insurance providers are requiring preauthorization for treatments and procedures that were never questioned in the past. Each insurer has their own appeal process, complete with deadlines and specific types of documentation that’s required.

EMR Advantage

One of the advantages of an EMR is being able to verify a patient’s insurance coverage long before they come to the office. The availability of time stamping provides documentation of when the treatment was received, who did the therapy, why a particular treatment was used and the patient’s response.

Physical therapy billing software also provides information about the referring physician and the client’s past history, which can play a critical part in contesting a denial.

Those who have implemented physical therapy billing software have an advantage. Therapists utilizing an EMR receive information and updates about denied claims in hours or days instead of weeks.

The same software system allows therapists to quickly submit required documentation, explanations or correct coding errors. EMRs offer billing and coding options and flexibility that actually reduces the number of denials.

Claims Procedure

Claims for reimbursement go through a rigorous physical therapy billing documentation process before payers approve or deny a claim.

In some instances, a particular procedure may be used to treat more than one type of complaint and the payer will automatically deny a request for reimbursement unless the therapist can prove it was medically necessary.

Therapists must be prepared with appropriate physical therapy billing documentation if they’re to receive reimbursement and provide the patient with needed care.

An insurer may also question a curative treatment versus a palliative one. One of the great mysteries in healthcare is why one insurer is willing to pay for months or even years of palliative treatment without a “cure,” while others are more likely to approve curative remedies.

Once treatment has commenced, physical therapy billing insurers expect the therapist to continue, even if a denial has been issued. These expectations raise serious questions about reimbursement for the practice owner.

Therapists can continue to submit claims for the patient during the time the request is being contested, but ultimately, there’s no guarantee that they will be paid.

Physical Therapy Software

Physical therapy billing software offers clear and concise documentation to help therapists reduce and minimize reimbursement denials, and contest them when they occur. While denials can arise for a number of reasons, most can be traced to errors in the manner the claim was submitted or the coding used.

EMRs are a therapist’s best friend, offering extensive documentation, time stamping and copious amounts of information, all of which can be submitted electronically to quickly and efficiently address reimbursement denials.

Discover how real-time software can instantly determine the patients’ insurance coverage and eligibility. This helps you get paid for your services. Discover the importance of eligibility verification function in your EMR.

Revenue cycle management should be a top priority of any physical therapy business. Simply putting it as taking the necessary physical therapy billing steps to ensure therapists are paid for their services and that they’re compensated in a timely manner.

Where Revenue Cycle Starts

A revenue cycle is attached to every client. It begins the moment the patient calls the office for an appointment and ends when their balance is zero.

It’s essential during that initial contact to gather patient data that includes their name, phone number and information about their insurance provider.

Typically, data is provided by the patient when they arrive for their appointment, a time consuming endeavor that involves numerous pages of written documentation that can be streamlined and simplified with physical therapy billing software.

Some clinics gather basic information when a client calls to schedule an appointment, but neglect to ascertain insurance information, an oversight that can cost the practice dearly.

Insurance Coverage and Eligibility Should Be Verified Immediately

Verifying insurance coverage and eligibility for services saves time and physical therapy billing headaches for the clinic in the future. If problems arise, it’s an easy matter to contact the patient or their insurance provider for further details, or reschedule the client if necessary.

Reimbursement denials can be significantly reduced with the use of an EMR that provides electronic billing, coding and submission capabilities. Physical therapy billing software offers flexibility and multiple coding options to reduce rejections and denials significantly.

It’s estimated that it costs approximately $25 per claim to manage each denial. An EMR reduces those costs, while drastically cutting the time needed to provide additional information or challenge denials. The value of an EMR can’t be overstated in the management of revenue cycles.

Patient portals provided by physical therapy billing software allows therapists to capture a wide variety of client data ranging from names, phone numbers and insurance providers to email addresses, mobile device information and complete health histories.

EMR Advantages

The advantages of an EMR doesn’t stop with the initial intake physical therapy billing documentation. They offer powerful tools that can be used to track claims, file disputes and provide additional information when a denial occurs. Claims can be submitted individually or batch filed for greater efficiency and they can be automated.

EMRs allow therapists to clear up questions in hours or days instead of weeks or months.

Therapists that harness the power of an EMR have the needed physical therapy billing tools for patients to make convenient one-time or recurring payments, notify clients when they have an outstanding balance and obtain critical insurance information for verification of eligibility.

EMRs also provide practice owners with multiple ways of contacting patients for any number of reasons using text and voice messaging, phone and email. Using revenue cycle management software provides clinic owners with essential tools to track client accounts for better profitability.

Enhanced  physical therapy billing and coding options, combined with electronic submissions, facilitates the reimbursement process from self-pay patients and claims that go through individual insurance companies and clearinghouses. Physical therapy billing software works for therapists to reduce denials and clear up claim problems when they arise.

If your practice is still using pen and paper, the thought of electronic medical records can be daunting.

Nitin Chhoda explains how to boost productivity using a web-based documentation system to make life easy for the practice owner, the staff and the biller.

Productivity is a key element in all facets of a physical therapy practice, from obtaining vital patient information to receiving reimbursements.

For a struggling clinic, an increase in productivity can mean the difference between eliminating positions to hiring new staff that can help the practice grow.

Physical therapy documentation software provides automation of tasks for increased productivity for every member of a clinic’s team.

As new treatments become available and reimbursement regulations escalate, an EMR provides better and more elaborate coding and physical therapy documentation options to satisfy third-party payer provisions.

Physical Therapy Documentation

Every therapist has experienced the time consuming process of recording, rebilling and providing explanations to insurance companies, Medicare and Medicaid. EMRs offer multiple coding abilities for practices working with an extensive array of providers to ensure therapists are adequately paid and clients receive ongoing care.

Employee wages constitute one of the largest expenses for a physical therapy practice. Clinic owners can utilize their physical therapy documentation software to ascertain where the abilities of staff members can best be allocated. An EMR helps therapists ascertain if they’re overstaffed, identify time wasters, and where positions can be eliminated for greater overall productivity.

Patient Scheduling

A full patient schedule is one of the goals of a productive practice and a physical therapy documentation system provides essential information therapists can use to market their clinic successfully. Referrals can be monitored and marketing efforts tracked to ascertain methods that work best based on a variety of demographics.

An EMR provides improved patient management, eliminating duplication of testing, prescriptions and treatments. Lost charts and missing information is never a problem with physical therapy documentation software.

A secure patient record is created that can be accessed by numerous medical professionals and quickly updated as surgeries, procedures, prescriptions and treatments are implemented.

Patient care can begin immediately instead of waiting for essential records to be transported by the postal service.

The Advantage of a Physical Therapy Documentation Software

Those in the medical professions have notoriously bad handwriting that’s eliminated with an EMR. Personal notes can be added with no loss of legibility.

Therapists work with a wide variety of incidental documents that includes work and school excuses, referral letters and requests for records. Physical therapy documentation software allows therapists to produce and transmit those and a myriad of other documents with just a few clicks.

There’s no need to maintain copious amounts of physical therapy documentation paper-based records, space to house them, or engage staff in the time consuming task of finding them with an EMR.

‘Patient information is available at a moment’s notice anywhere an Internet connection is available, reducing the time needed to implement a course of treatment. EMRs speak for a patient in an emergency, preventing errors or inappropriate treatment.

Clients like the convenience of patient portals with physical therapy documentation software, but patient portals save significant time and effort for therapists. Insurance information can be validated prior to services and a complete health history can be submitted, allowing practice owners to familiarize themselves with the client’s data and formulate possible options.

The highest level of productivity is necessary for clinics to survive and thrive and EMRs provide practices with the tools to achieve that, along with tools to analyze trends and the productivity of their entire business operation.