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Physical therapy billing is the process of submitting claims, invoices, and bills to receive reimbursement for the healthcare services provided. Billing makes use of specific codes to identify the diagnosis, treatment, and procedure performed during the physical therapy session.Bills may be sent to insurance companies, government programs, or private payers, depending on the situation. This, combined with the range of codes required, can make billing quite an involved process.
What Is Involved In PT Billing?
Pre-authorization
The billing process for physical therapy treatment begins with clinics verifying any patient information relating to insurance or program eligibility. This step is a functional way to determine how any treatment will be paid for. Clinics also collect relevant demographic information about the patient at this stage, which may be useful for selecting appropriate treatment.
Treatment & Capturing Charges
As treatments are provided or assigned to a patient, charges for the treatment are “captured” based on the codes matching the treatments. The codes define treatment based on a standardized guideline, and if treatment customization is needed, code modifiers are available to help indicate changes. Code reporting will form a type of treatment record, useful both for determining the cost of services but also for tracking progress.
Claims
A completed list of codes for a patient’s treatments is submitted in the form of a claim. Claims are reviewed for accuracy and then either approved for reimbursement or denied. Denied claims can be corrected and resubmitted. Minimizing denied claims can help clinics to reduce lost revenue. Approved claims result in payment for the clinic.
What Makes Physical Therapy Billing Important?
Ongoing Care Availability
The main reason that physical therapy billing is necessary is that it helps healthcare providers to get paid for the services they render to their patients. In order to keep clinics open, update equipment, and support staff, physical therapists need to be paid. Physical therapy billing processes exist to facilitate those needs as simply as possible.
Treatment Plan Accuracy
The billing process also helps to reinforce the accuracy of the services provided, which is necessary for patient safety and care. The system of codes employed in the billing process is often referred to by clinics over the course of treatment. Simplifying treatments and procedures into codes instead of descriptions helps unify the treatment process if patients go from one physician to another or even to a different clinic. Billing codes make it easier for healthcare practitioners to maintain their records, track patient progress, and confirm the therapy plan’s success.
Accountability
The coded nature of the billing system also serves to establish accountability for both practitioners and patients. If problems arise following treatment as a result of incorrect care or improper recovery activity, the billing code history may help indicate what was done in error. Accurate billing can help clinics to avoid problems like regulatory compliance fines or malpractice claims.
Getting Help With Billing
Physical therapy billing can be a complicated and challenging process, especially for providers who do not have the necessary expertise or system to handle their billing. Administrators have to consider proper billing codes, understand insurance policies, and navigate different payer systems. To mitigate this challenge, it may be useful for clinics to outsource their billing tasks to independent billing services.
Outsourcing offers a variety of benefits to clinics and practitioners. It frees up in-house staff to focus efforts on providing care. Outsourced billing also allows clinics to benefit from the knowledge and skill of specialists with extensive experience in the field. The expertise of billing services can help their clients maximize their healthcare reimbursements and potentially reduce expenses.
The physical therapy billing process is, in some ways, the lifeblood of clinics, keeping them functioning correctly. It can be complicated to navigate, requiring that healthcare providers be cautious that their reports are accurate and timely or risk losing reimbursement. Incorrect billing can also negatively impact a clinic’s relationship with insurers.
With the assistance of physical therapy billing services, clinics can mitigate or avoid these risks. PT billing services provide accuracy and efficiency, making them useful partners. Explore the independent billing services available to your clinic to see if there is an option that can help your clinic reach its full potential.
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