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Physical therapy helps rehabilitate individuals affected by injuries, illness, or disabilities. Physical therapists rely on billing and reimbursement to make sure they get paid for their services. If you are a physical therapy practice owner, understanding the basics of physical therapy billing can help you streamline your billing processes and make sure you are receiving the proper reimbursement. Here are some of the basics of physical therapy billing:

File Accurate Claims

The billing process involves submitting claims to insurance companies or patients to get reimbursed. This is how your practice and therapists get paid, and maintaining accuracy during the process helps save time and money. If your claims are inaccurate, the insurance company can deny them, which means you will need to spend time on appeals. When filling out claims, ensure that the patient’s information is accurate and that you are using the correct billing codes and modifiers.

Verify Insurance Coverage 

Before beginning treatment, verify each patient’s insurance coverage. This can help you avoid treating uninsured patients unknowingly. It can also help you understand the coverage limitations, such as copayments and deductibles. Being aware of these conditions can help prevent payment issues by ensuring you and the patient are on the same page about who is responsible for the bills.

Understand Current Procedural Technology (CPT) Codes

Current Procedural Technology (CPT) codes are numerical codes assigned to specific medical procedures and services. To be reimbursed for services, physical therapists use these codes in their claims to describe the treatments and interventions that they provide to the patient. If you own or work for a physical therapy practice, you should familiarize yourself with CPT codes that are relevant to you and make sure you are using the most up-to-date codes. Before writing a claim with a specific code, make sure that the payer covers that service.

Don’t Fall Behind on Documentation

One of the foundations of proper physical therapy billing is thorough documentation. You should document every patient encounter. Document patient evaluations, treatment plans, progress notes, and changes to treatment. The documentation should show medical necessity to prove that the services provided were necessary. When documenting, you should include details about the patient’s condition, limitations, treatment goals, and the interventions provided. This information can help support treatment decisions and may be necessary if there is a dispute.

Evaluations and Re-evaluations are Billable

A patient’s initial evaluation usually involves gathering information about their medical history and performing tests to formulate a diagnosis and develop a treatment plan. This evaluation requires specific documentation and coding, but the time spent doing it is billable. If a change in the patient involves re-evaluation, you can bill for that as well.

Know the Rules Regarding Time

Many physical therapy interventions are timed, meaning they are billed based on the duration of the service. When performing one of these services, you will use time-based codes. Before starting the service:

  1. Make sure you record the time. You will also document when you stopped providing the service.
  2. Record accurately, and avoid rounding. When you bill the service, you will bill it in 15-minute increments.
  3. If you are still determining how many units to charge, divide the number of minutes you worked with the patient by 15.
  4. Charge for that many units, and if there are 8 minutes or more left over, you can bill for an additional unit.

This is the 8-minute rule. You should also adhere to specific guidelines or payer policies when billing time-based services.

Learn How To Use Modifiers Appropriately

Modifiers are two-digit codes that provide additional information about the service mentioned in the claim. They are added to CPT codes if there are exceptions or specific circumstances. They can be used to identify the type of therapy, if the service was provided by multiple therapists, if it was provided in unique settings, and more. Using appropriate and correct modifiers can help make sure that the billing is accurate.

Learning About Physical Therapy Billing Gives You More Time To Focus on Your Patients

Learning about physical therapy billing can free up more time to focus on patient care. It can also create a better patient experience by allowing you to communicate about treatment more cost-effectively. Learning about the billing process can help you save time and money and create a better patient experience.