Overcoming Common Challenges in Physical Therapy Billing

Challenges in Physical Therapy Billing
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 about the new changes in its workflow.

Physical Therapy Billing Challenges And Their Solutions

Physical Therapy Billing Solutions
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.

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.

    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 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.

    2. Inaccurate Patient Information

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.

    3. Lack Of Pre-Authorizations

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.

    4. Non-Covered Services

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.

    5. 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.

    6. Constantly Changing Regulations

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.

    7. HIPAA Compliance

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.

    8. Staying Updated

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.

    9. 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. The following is a rundown of some of the prominent challenges for reimbursement teams.

    10. Delays In Claims Processing

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.

    11. Complex Reimbursement Process

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.

    12. 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. As a result, you have to deal with the following challenges:

    13. High Accounts Receivables

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.

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.

Frequently Asked Questions

    1. How can healthcare providers ensure high-quality care while managing physical therapy billing?

Healthcare providers can maintain high-quality care by using accurate coding and proper documentation in billing operations, ensuring that treatment plans are well-supported financially.

    2. What role does accurate documentation play in enhancing patient outcomes in physical therapy?

Accurate documentation in patient records is crucial for healthcare practices, as it helps in formulating effective treatment plans and tracking patient outcomes efficiently.

    3 How can private practices use a patient portal to improve patient care in physical therapy?

Private practices can enhance patient care by utilizing a patient portal, which allows easy access to patient records and facilitates better communication about treatment plans.

    4. In what ways can healthcare practices manage patient privacy during billing processes?

Healthcare practices can safeguard patient privacy by ensuring sensitive patient information is handled securely in the billing department, using compliant billing software and practices.

    5. How do treatment plans impact the billing operations of a healthcare professional?

A healthcare professional’s billing operations are directly influenced by treatment plans, as these plans determine the coding and documentation needed for accurate medical billing.

    6. What are the major challenges faced by practice owners in medical billing for physical therapy?

Practice owners often face major challenges in medical billing, such as managing accurate coding, ensuring financial stability, and maintaining compliance with patient privacy regulations.

    7. How can a billing team enhance patient visits in physical therapy through effective billing operations?

An efficient billing team can improve the experience of patient visits by streamlining billing operations, ensuring timely and accurate billing, which contributes to overall patient satisfaction.

    8. Why is medical billing software important for maintaining high-quality care in healthcare practices?

Medical billing software is essential in healthcare practices for ensuring high-quality care, as it aids in accurate billing, reduces errors, and allows more focus on patient care.

    9. What common billing challenges do healthcare providers face in physical therapy?

Healthcare providers in physical therapy often encounter common billing challenges such as managing complex reimbursement processes and ensuring accurate documentation for patient treatments.

    10. How can a medical billing service benefit practice management in physical therapy?

Utilizing a medical billing service can greatly benefit practice management by streamlining billing processes, ensuring accurate claims submissions, and allowing healthcare professionals to focus more on patient care.

    11. Why is accurate coding vital for the financial stability of private practices in physical therapy?

Accurate coding is vital for the financial stability of private practices, as it ensures proper reimbursement for services rendered and minimizes the risk of claim denials and delays.

    12. How does proper documentation in a plan of care impact the billing department in physical therapy?

Proper documentation in a plan of care is crucial for the billing department, as it provides the necessary details for accurate billing and compliance, thereby enhancing the overall efficiency of billing operations.