Top 10 Mistakes to Avoid in Physical Therapy Billing

Physical Therapy Billing
Did you know that you can now completely streamline your patient care through effective physical therapy billing? Like any other process, it involves a range of different tasks and has its own share of mistakes. These mistakes can damage your operations if not swiftly addressed.

This blog will take a look at ten such mistakes and discuss their causes and remedies in detail. We will specifically also discuss how these mistakes can result in denied reimbursement claims. Continue reading further to find out the mistake that has lately been affecting your services.

What Is Physical Therapy Billing?

What Is Physical Therapy Billing
Physical therapy billing is implemented in healthcare organizations in order to generate medical bills and file reimbursement claims. You have to process these bills and claims so that you can justify that specific patients availed of your therapeutic procedures and treatments.

Such patients usually have difficulties with their mobility and strength as a result of certain physical illnesses and injuries. Therefore, they have to avail of your services, and you have to implement the necessary billing practices.

10 Common Mistakes In Physical Therapy Billing

Physical Therapy Billing Mistakes
Physical therapy billing is an extensive process in healthcare organizations that involves a series of various tasks. Its tasks are usually comprehensive and time-consuming, sometimes resulting in certain mistakes.

These mistakes are independent of the organizational scale of hospitals and clinics. They usually comprise omitted modifiers, missing certifications, and misuse of exercise codes. You can also encounter miscounted time, underbilled fixed-rate payers, and some other mistakes.

    1. Overlooking Modifiers

Your billing has specific physical therapy modifiers that you can use to alter some aspects of your services without changing their basics. This way, they specify the details of your therapeutic procedures and treatments to insurance companies.

Moreover, you have to apply the modifiers selected by insurers to all the physical therapy CPT codes on your reimbursement claims. Since this is a detailed task, you can easily overlook some of its steps, especially with Modifier 59. This modifier is a little more complex.

It specifies how two similar physical therapy services are provided separately and independently. You can receive your reimbursements for both services in an edit pair. For this, you have to append modifier 59 to the CPT code for medicare physical therapy.

    2. Misplaced Certificates

Physical therapy certifications can easily get misplaced if they are not comprehensively recorded and documented. It is the only measure with which you can ensure that insurance auditors will approve your physical therapy billing practices.

In addition, you can get reimbursed for providing your services to patients. For this, you must fulfill all requirements of insurance companies before you start treating your patients. This practice is often hindered if you do not timely send the relevant documents to insurers in a timely manner.

It is also possible that you may fail to obtain the certifications from insurance companies. In such a case, you are required to submit additional documentation to provide reasons for the certifications taking longer than 30 days.

    3. Incorrect Patient Identity

Healthcare organizations often mix up their patient identities and turn up with incorrect ones for specific cases. There are two prominent gaps in the medical practice that result in these incorrect patient identities.

Patients are more likely to provide correct information to your front office staff, who may have incorrectly noted some of its characteristics. Their errors can create incorrect patient identities that do not match with their physical therapy services.

Furthermore, you may also have incorrectly entered your patient details into the physical therapy billing software. These errors can lead to claim denials, which you will have to correct and resubmit. Therefore, you must always validate your patients’ insurance eligibility and IDs.

    4. Transposing Patient Digits

Transposing patient digits is another mistake that can significantly impact physical therapy billing services. It involves a simple switch of two or more numbers, which changes the details of those services. It usually results in insurer denials along with delays in payment posting.

You are most likely to transpose any digits while entering your patients’ birth dates into the medical system. Therefore, you must double-check and validate your numerical data before submitting your reimbursement claims to insurance companies.

    5. Invalid Insurer Recipients

One of the most superficial physical therapy billing mistakes is to send your reimbursement claims to invalid insurer recipients. A reason for this mistake is primarily the absence of a copy of the relevant insurance card.

You may also have made a data entry mistake while entering the specific insurance provider’s payor ID or mailing address. In such a case, you may have to deal with delays in getting your reimbursements as you will have to file those claims all over again.

You can rectify this mistake by ensuring that you have copies of the insurer’s credentials on both sides of the board. Your front desk staff should also be directed to comprehensively check your management system and accurately verify the relevant insurance agents.

    6. Incorrect Physical Therapy Codes

You may also have accidentally assigned incorrect codes to your physical therapy procedures and treatments. This is a common scenario as the diagnostic and procedure codes for the physical therapy billing unit are regularly updated.

As a result, hospitals and clinics may not always remain informed about those updates and changes. Your currently billed service codes are likely to be either deleted or changed. As a result, your claims may be denied if you do not incorporate the changes in your medical codes.

You can resolve this mistake by monitoring the changes in your physical therapy codes and revising your coding books accordingly. Healthcare organizations can also set up specific timelines to routinely check up on the coding changes and incorporate them wherever possible.

    7. Absence Of Code Linkage

A code linkage links your diagnostic codes to procedure codes to highlight the medical necessity of your physical therapy services. Therefore, your medical coding must align with your procedures and treatments.

Their alignment fosters the confidence in your patients that your services are medically appropriate and accurately performed. As a result, they are more inclined to accordingly pay against your physical therapy billing.

Many medical practitioners fail to imply the medical need of their codes and face denials. You will not be accurately reimbursed if you are not aware of your set diagnostic and procedure codes. They enable you to effectively assess the code links on your reimbursement claims.

    8. Exercise Code Misuse

The exercise code 97110 is prominent as many therapists assign it to different services. Its definition aligns with all those procedures that require exercise to improve the mobility and strength of patients. It is a generic code that can technically be assigned to many services.

Many hospitals misuse this technicality and constantly use this code as a catch-all. It can be a mistake, and such therapists may be missing out on ample reimbursements. You may be putting your patients on heavy exercise equipment or making them perform large body movements.

These services have a higher physical therapy billing rate and must be billed for their therapeutic activities. By relying heavily on code 97110, you are actually exposing your medical organization to insurer audits. Insurance companies may feel that they are being overused.

    9. Overbilling Procedures And Treatments

This billing mistake can either be intentional or accidental and result from different scenarios. They usually comprise making nonessential appointments, overcharging, and upcoding therapeutic services that are not even provided.

Overbilling usually results from constantly assigning codes to procedures and treatments that are not availed by patients. It can only be resolved through a robust medical system that implements checks. They ensure that your billing practices are accurate and have integrity.

You must take note of the exact compensable injuries for each patient case whenever reviewing the relevant medical bills. In addition, therapists should also accurately verify their diagnoses and justify their medical necessity. This way, you can easily identify your unnecessary charges.

    10. Misbilling Healthcare Services

Misbilling is a multifold mistake and has several aspects, such as timing issues, manual errors, and input oversights. Its reason is your inability to code your therapeutic services to the highest level of specificity. You may also not timely identify the billable codes or create clean claims.

Failure to identify billable codes prompts insurance providers to deny your reimbursement claims. Therefore, you must ensure that your claims include the correct places of services. Healthcare organizations should also validate the details of their claims, like prior authorization.

There can also be typographical errors from your data entry if you have not cleaned up your therapy billing workflows. You can conduct an internal audit of all your therapeutic procedures and treatments. The audit can process documentation and monitor coding.

The Bottom Line

This blog analyzed the top 10 mistakes of physical therapists that can have long-lasting impacts on their billing practices. We particularly highlighted the reasons for these mistakes and potential measures that you can take to counter them.

The medical billing experts at Health Quest Billing themselves have come up with these common mistakes. They can seriously hinder your physical therapy billing if you do not address them. Contact us today to identify your mistakes and how you can solve them.

Frequently Asked Questions

    1. What are therapeutic exercises and how do they relate to physical therapy billing?

Therapeutic exercises are designed to improve mobility and strength, often billed under code 97110 in physical therapy. Misuse of this code can lead to billing errors and reduced reimbursements.

    2. How does the 8-Minute Rule impact billing for physical therapy services?

The 8-Minute Rule is crucial for determining billable units in therapy sessions. If a session crosses the 8-minute threshold, an additional unit can be billed, impacting the revenue cycle management.

    3. What is a plan of care in physical therapy, and who ensures its adherence?

A plan of care outlines the therapy objectives and methods, including therapeutic exercises. Its adherence, overseen by the treating therapist, directly affects billing and reimbursement rates.

    4. Can an occupational therapist bill for manual therapy, and how is it coded?

Yes, an occupational therapist can bill for manual therapy, typically using specific service codes. Accurate coding is essential to ensure proper reimbursement from the insurance plan.

    5. What does ‘additional unit’ mean in the context of physical therapy billing?

In physical therapy billing, ‘additional unit’ refers to extra time or services provided beyond the base session, calculated based on the 8-Minute Rule and impacting the overall billable units.

    6. How does revenue cycle management affect accounts receivable in a physical therapy clinic?

Effective revenue cycle management streamlines billing processes, from service date to claim processing, ensuring timely and accurate accounts receivable for the clinic.

    7. What role does electrical stimulation play in physical therapy, and how is it billed?

Electrical stimulation is used for pain relief and muscle stimulation in physical therapy, billed using specific codes. Accurate billing ensures correct reimbursement rates for such services.

    8. How important are billing policies and claim processing in physical therapy?

Billing policies and claim processing are crucial in physical therapy, as they determine how services like manual therapy and therapeutic exercises are billed and reimbursed by insurance plans.

    9. What is the role of therapy assistants in delivering outpatient services?

Therapy assistants play a key role in providing outpatient services under the supervision of licensed therapists, contributing to the overall therapy plan and affecting the billing for these services.

    10. How does the type of insurance plan affect reimbursement rates for occupational therapy services?

The type of insurance plan can significantly influence reimbursement rates for occupational therapy services, with different plans covering varying services and rates.

    11. What is an Assistive Technology Assessment in occupational therapy, and how is it billed?

An Assistive Technology Assessment evaluates a patient’s need for assistive devices in occupational therapy, and is billed based on the complexity and duration of the assessment.

    12. How do the dates of service affect claim processing in physical therapy?

The dates of service are critical in claim processing, as they need to align with the episode of care and treatment duration. Incorrect dates can lead to claim denials and impact the revenue cycle.