How Does Physical Therapy Billing Work – 2022 Guide??

Being a physical therapist can make your schedule quite hectic. You must understand and treat the patients, trace outcomes data, and get payments. Thus, you may have less leisure time and a busy schedule. The physical therapy billing depends on fitting services generated with systematic codes.

It allows insurers and various parties to comprehend what type of treatment the patient received and the total money the physical therapist gets for it. It can be a tiresome and time-consuming process, if done manually, but it is ideal for automation and digitization.

What Are Different Physical Therapy CPT Codes

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When billing for physical therapy, there are a number of various codes that can be utilized. Providers must select one of below three codes for first examinations, which shows the level of complexity the patient has:

  • 97161: Physical therapy evaluation as “little complicated.”
  • 97162: Physical therapy evaluation as “reasonably complicated.”
  • 97163: Physical therapy evaluation as “highly complicated.”

Here are the ten most regularly used codes for services generally given by physical therapists. You can click here to know more about the codes and physical therapy guidelines.

  • 97110 (healing exercise)
  • 97112 (neuromuscular re-education)
  • 97116 (gait activity)
  • 97140 (manual treatment)
  • 97150 (group treatment)
  • 97530 (restorative activities)
  • 97535 (self-care or home management activity)
  • 97750 (physical performance test or measurement)
  • 97761 (prosthetic exercise)
  • 97762 (checkout for orthotic or prosthetic use)

Explaining How Physical Therapy Billing Works

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Here we will learn how the payment works after the physical therapist has done the treatment.

Collecting the demographic and insurance information of the patient and confirming any further financial help eligibility is the first step. You can know how the patient will pay for the therapy and services delivered here. You can improve this stage as a service provider by creating transparent pricing rules and using automated insurance confirmation solutions.

Transparent pricing can assist in weeding out patients who do not have sufficient funds for your services, allowing you to focus on what you do best. Patient eligibility technologies that are automated will notify you if the patient’s insurance will pay for their treatment, saving your staff time.

A physical therapist is allowed to watch the patient and provide treatments after finalizing the patient’s input papers and confirming insurance eligibility. It is critical to keep track of all these things using CPT and ICD codes so that you can appropriately catch the charges for payment.

This process is greatly simplified by medical billing software, which lets you discover and apply precise codes promptly and efficiently. A few medical billing software may even cleanse claims to assure that each one is coded correctly. It clears up your personnel for other critical tasks and increases the likelihood that your claim will be processed appropriately.

It is where you have to submit the claims for compensation after they have been correctly coded. It is made simple by an electronic medical billing system, which is frequently incorporated straight into the workflow and can be completed with a simple touch-on button.

It is critical to resubmit a claim as soon as possible if it was denied. The ideal billing solution may assist here by sending out automated reminders, formulating changes, and resubmissions. The payment will be sent once the insurer has examined and authorized the claim. In several situations, the patient will still have to pay for other expenses.

Employing an integrated billing solution that enables online payments via the patient portal is crucial. It is significantly more easy than other payment methods, and it increases the likelihood that a patient will pay a bill promptly. Billing reminders sent automatically will also boost on-time payments.

What Are Some Vital Physical Therapy Billing Guidelines

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Here we have listed the vital guidelines or rules of physical therapy billing.

One-on-One Services vs. Group Services

Depending on whether you provide one-on-one or community services, the total pay for the duration you spent to give proper patients can differ. One-on-one service is a personal counseling program that engages a patient in abrupt and one-on-one connection. Despite the fact that community service frequently necessitates a constant presence, one-on-one engagement with the patient is absent.

Credentialing

Obtaining an insurance payer’s credential allows you to evolve as an in-network physical therapist, allowing you to reach and support a larger number of potential consumers. If you have not previously gotten a credential with a major payer in your area, you should endeavor to do so. A few payers like Medicare will not pay or reimburse anonymous physicians for any service.

The 8-Minute Rule

The “eight rule” establishes the total support unit physicians that will bill Medicare for the provided treatment day based on the 8-minute rule. As per the legislation, the patient needs to get treatment for a minimum of eight minutes to receive compensation from Medicare for a time-based code.

Billable Time

In order to say it in a simple way, the total time a physical therapist spends on treating a patient is chargeable. However, there are a few difficulties to consider. You can not charge for:

  • Papers and documentation
  • Preparation time for unskilled workers
  • Supervision
  • Breaks
  • Various timed units due to numerous therapists
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Copays

You can get a copay from the patient after you deliver the services if the patient’s insurance requires it. Relinquishing copayments or deductibles is almost never a wise decision. On the other hand, there are various ways you can help patients who need financial support.

Browse the insurance contracts carefully to know more about what the payers deem appropriate when it comes to assisting patients with the price of the services. If you are still unable to locate the payers, reach out to them immediately.

ABNs

Patients need to approve an Advance Beneficiary Notice of Noncoverage (ABN), which is essential to provide specific services to the patients that are deemed not medically necessary or those that are not compensated by Medicare. It implies that the patient should pay the expenses if Medicare declines the claims.

Bottom Line

As you can see, physical therapy billing makes the entire payment procedure easy. So, it is best to use a good physical therapy billing software and automate several time-consuming tasks.