These challenges are primarily encountered in claim denials, regulatory compliance, reimbursements, and accounts receivable management. The following is an analysis of how the challenges of physical therapy billing can impact the working of these domains.
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 also 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 the following challenges.
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. You can verify those details to overcome the challenge of physical therapy modifiers.
Hospitals and clinics 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.
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.
You 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.
Due to the complexity of physical therapy practices, you may need to look into some insurance details for specific procedures and treatments. These details may state the payment exclusion of the relevant insurers. Such services are known as non-covered in the healthcare sector.
You can counter them by conducting comprehensive reviews of your reimbursement claims. Healthcare organizations can also audit their medicare physical therapy billing to identify discrepancies before submitting relevant claims.
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.
The ICD 10 coding system was integrated into the US healthcare system in 2015. Physical therapists used ICD-9 systems before it. This change introduced a significant amount of new diagnostic codes. The number went from 13000 to 68000 for all types of healthcare services.
The new physical therapy codes are still 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.
You can counter it with a compartmentalization of your physical therapy billing staff. The staff can be divided into different categories, and one of them should be particularly assigned to monitor only those changes. Hospitals can invest in their training and use the relevant technology for this.
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.
You can make this mistake due to human error, or any other party has exploited their unauthorized access. These practices severely undermine the patient data security of hospitals. For this, you must restrict access controls and implement regular risk assessments.
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.
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.
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 so that 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.
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. The following is a rundown of some of the prominent challenges for reimbursement teams.
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. You can overcome this delay by keeping those 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.
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.
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.
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. As a result, you have to deal with the following challenges:
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.
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.
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.
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