Out of all the sub-categories in healthcare practices, Physical therapy is becoming one of the busiest. It includes categories like sports, geriatrics, trauma rehabilitation, women’s health, neurology, wound management, and many more. When it comes to Physical Therapy, the most physical therapists have their own clinics because therapy takes time. The sessions are much longer than other medical sessions. One of the biggest challenges that every physical therapy practice faces is handling administrative burden, which includes tasks like billing and coding.
One undeniable and shocking fact is that the U.S. healthcare industry spends about one-third of its overall costs on its administrative needs. The final reimbursements that a healthcare provider will get depend on accurate medical billing and coding. That is why it becomes so important to prioritize revenue cycle management. The complexities in medical billing for physical therapy make it difficult. Only a few medical billing and coding companies like Unify Healthcare Services can handle the needed expertise.
In this blog, we will focus on the types of challenges and their solutions for standard physical therapy billing.
Let’s Begin with the Challenges that Arise in Physical Therapy Billing
Every healthcare organization and even their patients face a lot of challenges while handling the physical therapy billing. The primary causes of these challenges are its constantly updating framework and complexity. And the physicians have to manage several processes which further contribute to them simultaneously. These challenges are primarily encountered in claim denials, regulatory compliance, reimbursements, and AR management.
Following are the challenges of physical therapy billing -
Knowing the difference between therapy sessions
As a physical therapist, you handle two types of therapy sessions – one-on-one and group sessions. There may be cases where mistakenly the billers start billing group sessions like the individual ones. This may put your healthcare practice at risk. Most of the claims that you file like this may also be sent back and denied. And in case, medical billing and coding companies bill individual sessions like group ones, you will not be able to get paid for the services you rendered.
It is important that your coder use the one-on-one CPT codes, when the documents mention direct patient contact. The number of units of therapy they can bill is also proportional to how many minutes of direct contact service was offered.
There might arise a case when the therapist may be able to charge for one-on-one rates even in group sessions. This is when individual attention is given. If there is any such chance, there is a possibility the biller can improve the total revenue generated at the end of the month.
When you choose the right medical billing company like Unify Healthcare Services, you will get the best strategies to tackle medical billing complexities.
Understanding the complexity of service rendered
Another unique challenge that you need to understand is the complexity of every service rendered. Remember the fact that code groups here vary based on the complexity of the services provided to the patients.
Depending on the level of complexity, there are following categories of codes for Physical Therapy:
Code for PT Complexity level
- 97161 - low
- 97162 - moderate
- 97163 - high
In the same manner, Occupational Therapy (OT) also has such categories of codes that needs to be taken care of:
Code for OT Complexity level
- 97165 - low
- 97166 - moderate
- 97167 - high
Confusions due to changing payer regulations
There are different insurance payers. These include - Medicare, Medicaid, and other payers. They regularly change their terms and conditions. And as there is any change in the procedures and systems, it is important for your billers and coders to keep up.
Unify Healthcare Services is different from other medical billing and coding companies as we have a team of professionals who is well-versed with all the codes and changing guidelines in the medical billing world. This brings a positive difference in the medical billing services we provide to healthcare practices.
On the other hand, if you have an in-house billing and coding team, you must ensure enough resources to train them on a regular basis. And you hire third-party service providers, talk to them to understand how adept they are at updating their skills.
Handling complex coding challenges
In physical therapy, medical billing and coding companies need to specifically focus on coding. This is because it is quite challenging. This particular segment of healthcare needs to use both ICD and CPT codes. ICD is used for the treated problems, on the other hand CPT is used for the different treatments administered.
Therefore, the coders have to be comfortable in handling different codes. More than that he must know how to use them in the right places. Most of the times, simple coding mistakes are common reasons why claims get denied in the first place.
Handling your coding and billing process might not be your forte as patient care. But you don’t have to worry because you have certain billing guidelines that will help you avoid mistakes. These mistakes could be holding up your payments from insurance companies. But not any longer.
Just follow the guidelines mentioned below and you will have your revenue cycle in good shape now and for the future while you focus on providing the same level of excellent care.
Ensure Clean Claims Submission
One way to maximize the revenue from insurance claims is to ensure that the claims you submit are accurate. The claim can be directly denied by insurance providers due to any coding errors, missing information, and so much more. If you want your revenue cycle to move forward, it is a must to submit clean claims as per every list of physical therapy billing guidelines.
Do Thorough Documentation
Maintaining proper documents for everything that happens in your physical therapy clinic is not just important to ensure accurate claim submission. It also helps to prevent an insurance audit, which can truly slow down your entire healthcare business. A proper documentation begins with detailed intake forms and making copies of insurance cards.
The Importance of Physical Therapy Billing Experts
While there are many billing challenges that you undergo in your physical therapy practice. It includes insurance pitfalls, customer communication issues and internal structure breakdowns, and many others. But with proper guidance from PT-specific billers, they can be avoided.
Physical therapy billing experts of Unify Healthcare Services can ease the strain on your limited resources while maximizing your potential revenue.
