Exciting changes are underway! Our website is currently undergoing upgrades to enhance the user experience.
Contact Us
  • Eligibility and VerificationEligibility and VerificationComprehensive EHR Services For Upto 4x Revenue Making Medical Billing Accessible and Effortless for All.
  • Patient CoveragePatient CoverageAre you facing troubles while verifying patient coverages before appointments?
  • Appointment SettingAppointment SettingAppointment setting has a pivotal role in the healthcare system and its errors can be serious for patients and healthcare providers.
  • Customer SupportCustomer SupportAre you looking for top-notch customer support for your EHR-related queries?
  • Real-Time Patient Data AccessReal-Time Patient Data AccessReal-time patient data has a pivotal role in managing Electronic Health Records.
  • Patient Data CentralizationPatient Data CentralizationPatient data centralization is more than just data. It is about keeping it in a secure and accessible location.
  • Daily ReportsDaily ReportsAre you facing reporting discrepancies from your financial end?
  • KPI Metric ReportKPI Metric ReportDo you want to get the most out of your key performance indicators?
  • Monthly ReportMonthly ReportDo you feel the discrepancies in your healthcare practice are not getting reported sufficiently?
  • Trends ReportTrends ReportDo you also want to jump on the healthcare bandwagon of going with the tide?

Did you know that you can now make physical therapy billing hassle-free with the implementation of certain key billing practices? These billing practices and more can be easily covered, and you can come across a range of different challenges.

This blog will focus on the types of challenges and their solutions for standard physical therapy services. We will also cover how these challenges negatively impact your physical therapy billing. Continue reading further to learn how to avoid common mistakes in physical therapy billing and maximize your revenue.

Physical Therapy Billing

Overview Of Physical Therapy Billing

Physical therapy billing manages reimbursement claims of physical therapy services and their payments. You have to regularly follow up with insurance companies to receive those payments. This billing practice involves a variety of tasks like assigning codes.

You also have to verify the insurance eligibility of your patients. There are specific guidelines set by regulatory authorities that have to be followed. Physical therapists use a set of standardized Current Procedural Terminology (CPT) codes.

These codes are used to document the treatment provided to their patients. Those codes enable insurance companies to understand the services provided. The insurers also have to assess the insurance coverage of patients before releasing payments.

Common Challenges in Physical Therapy Billing

Healthcare organizations and their patients face a lot of challenges with physical therapy billing. Its constantly updating framework and complexity are the primary causes of these challenges. You have to manage several processes which further contribute to them simultaneously. Let’s cover the common challenges in physical therapy billing:

1. Insurance Claim Denials

Insurance eligibility verification can become an issue with physical therapy billing practices. Insurance providers have complex policies and regularly make changes to their information regulations and coverage plans. Healthcare organizations have to verify whether the insurance coverage of their physical therapy patients is eligible to receive their services.

Any discrepancies or errors in this process can result in claim denials. You may enter inaccurate information, like the physical therapy CPT codes and types of service. This inaccuracy can lead to claim denials as insurers cannot match the details of their clients.

Some physical therapy ailments require authorizations from insurance providers before they are implemented. Such ailments mainly comprise speech, occupational, and physical therapy. Specific procedures, like penile prosthesis surgery, have to be run through the insurers.

Your staff may become so occupied with other organizational processes that they may need help to obtain the required authorizations. This lack of pre-authorizations can also be a challenge since the therapists and insurers need to be on the same page.

2. Regulatory Compliance

Specific compliance requirements are set to maintain safety standards for physical therapy patients. You must adhere to them, as overlooking compliance policies can land you in challenging legal scenarios.

Particular regulatory compliance challenges can cause these scenarios, so you must swiftly address them. New physical therapy codes are regularly being assigned today and undergo regular changes. These changes are in terms of specificity, coding structure, and documentation requirements. 

Staying updated with the CPT code for physical therapy also can take a lot of work, mainly due to its sheer number. There are also constant concerns about complying with the HIPAA regulations as they are strict about the security of patient data. The problem arises when that information is disclosed in a public medium.

There can be various reasons for insurance providers to reduce the reimbursement rates of certain physical therapy services. They can also implement restrictions for the same reasons. You will have to constantly face these restrictions if you do not update with the changes.

3. Slow Reimbursements

Accuracy is probably the most important aspect of filing and submitting reimbursement claims. Physical therapy services can be time-consuming and complicated. Therefore, you may have to rush your practices, which may result in errors and challenges.

You may also have to cross-check some of your claims due to their complexity, which eventually slows down the reimbursement operation. An ideal scenario would involve patients availing of their physical therapy procedure and you submitting their claim to the insurer for reimbursement.

The challenges arise when you encounter an unexpected delay from that insurance provider. They delay the release of your reimbursements since your claims miss some of the documents required. These documents usually comprise orthopedic surgery reports and itemized bills.

Many procedures and treatments require sophisticated devices like prosthetic limbs. The physical therapy billing of such services is complex as insurance companies have unique reimbursement procedures for them.

4. Accounts Receivable Management

Delayed reimbursements also impact the accounts receivable management process of healthcare organizations. It hinders your financial performance due to a lack of smooth reimbursements, which subsequently affects your cash flow. You may also be simultaneously dealing with multiple insurers who have different rules and regulations.

This may also impact your ability to provide quality care to your physical therapy patients. The waiting time for hospitals and clinics to receive their reimbursements can extend a lot. This delay results from many reasons, like a large number of claims ready for submission.

Insurance providers may also take a huge amount of time to process them. There can also be some administrative inefficiencies within your physical therapy billing process. These reasons have a combined effect on the cash flow of healthcare organizations as they have to deal with high accounts receivables.

Strategies for Overcoming Billing Challenges

The challenges are primarily encountered in claim denials, regulatory compliance, reimbursements, and accounts receivable management. The following is an analysis of the strategies that you can implement to overcome them:

1. Insurance Claim Denials

You have to collect several aspects of patient data accurately. Physical therapy procedures and treatments can vary based on the complexity of the relevant injury or disease. This variance is how insurance verification can result in challenges.

Hospitals can verify those details to overcome the challenge of physical therapy modifiers. They can implement it as a first level of verification. This way, they can ensure that their staff recorded accurate patient details right at their initial stage of registration.

Healthcare organizations can devise a policy to contact the relevant insurance companies and inquire them about their latest treatment guidelines. As a result, you can document their prior approval and go ahead with your ailments and procedures.

You can conduct comprehensive reviews of your reimbursement claims as well. Healthcare organizations can also audit their medicare physical therapy billing to identify discrepancies before submitting their relevant claims.

2. Regulatory Compliance

You can implement a compartmentalization procedure for your physical therapy billing staff. The staff can be divided into different categories, and one of them should be particularly assigned to monitor regulatory changes. Hospitals can invest in their training and use the relevant technology for this.

Healthcare organizations can also invest in staff training to maintain the data security of their physical therapy billing unit. Furthermore, you can clearly establish your own policies to manage patient data securely. The solution involves effective communication with the insurers, with which you can keep yourself informed of their changes.

You can designate some of your staff members for this as well. This way, they can efficiently execute claim denial management. These communication instances serve as your points of contact to discuss insurance-related matters. You can also dial them up to confirm the fine details of your physical therapy billing services.

3. Slow Reimbursements

You can overcome reimbursement delays by keeping the insurers in the loop. You should constantly communicate with them about the patient data involved in your claims. This way, they are aware of the various aspects that you have covered.

Simultaneously, you must enhance vigilance while filing your claims to ensure that you enter complete details. As a result, you must carefully navigate through those intricate procedures while covering all bases. Hospitals and clinics should also fulfill their complicated guidelines and requirements.

You can overcome this challenge by comprehensively documenting these policies beforehand. This way, you can ensure that there are no uncertainties in your reimbursement. You can receive all your payments with a close study of the insurers’ procedures.

4. Accounts Receivable Management

Hospitals and clinics can overcome these challenges by implementing EHR systems to replace manual processing. Apart from this, you can use some other tools to streamline your physical therapy billing. You must also regularly resolve your disputes and follow up on pending claims.

How HQB Helps You To Overcome These Challenges

Health Quest Billing offers comprehensive solutions to overcome challenges in physical therapy billing. You can utilize our specialized services to reduce your insurance claim denials. We can make that possible through our eligibility verification and accurate claim preparation. Our team of experts stays updated on the latest insurance policies and coding changes.

They ensure that your claims follow the most current regulations and requirements. We also manage regulatory compliance with precision. We can protect you against potential legal issues through strict compliance. Our proactive approach can help you manage authorizations and ensure accurate documentation.

This way, it streamlines your reimbursement process and increases cash flow. Health Quest Billing also provides tracking and follow-up services. Our services can swiftly process your claims and decrease the number of your AR days. This comprehensive management reduces the administrative burden on your healthcare staff.

The Bottom Line

This blog focused on the common challenges in physical therapy billing and primarily covered effective ways to overcome them. We analyzed how those challenges can negatively impact your procedures and treatments and which steps you can take to counter them.

Health Quest Billing is here to assist you in improving the revenue cycle management of your physical therapy billing practices. Contact us today to learn how you can solve the problems of your therapeutic services. Our solutions are bound to generate accurate physical therapy bills.

Contact Us For Physical Therapy Billing

Ready to upscale your Physical Therapy Billing and Boost your Revenue? Schedule an appointment with Health Quest Billing today and let our experts guide you towards a more efficient and profitable billing future.

Schedule An Appointment

Frequently Asked Questions (FAQs)

The 8 minute rule states that a unit cannot be billed unless the one-on-one treatment lasted at least 8 minutes.

The main issue currently being dealt by physical therapists is accessibility. It has a direct impact on patient adherence, which determines the success of their treatment plans.

The biggest issue in physical therapy is staff management. It can negatively affect your physical therapy clinic's performance.

Physical therapists are currently struggling to successfully manage their employees. This is typically divided into the recruitment and staffing process and unmotivated employees.

Two or more patients can be simultaneously treated under group therapy who may or may not be doing the same activities.