Physical Therapy Billing Strategies to Maximize Reimbursement

As a physical therapy expert, like any other healthcare professional, your top priority is to relieve the suffering of your patients. No doubt, the job is challenging and intensive in nature, but it is equally important that your healthcare facility is properly compensated for the services rendered. 

Claim denials, the burden of paperwork, and slow reimbursement are the hidden battles you must fight to optimize the revenue cycle for your healthcare practice. As a dedicated physical therapist, this guide equips you with the most effective strategies that can help you handle the complexities of physical therapy billing and enable you to maximize payment collection. 

Understanding Physical Therapy and Billing

Physical therapy is a branch of rehabilitative healthcare whose basic role is to help manage movement and relieve pain in people suffering from various conditions, such as neurological diseases and traumatic injuries. Physical therapists are trained, licensed healthcare professionals who improve mobility through massage, heat treatments, and exercise.

The specialists plan customized treatments based on the conditions of the patients. The approaches include manual therapy, prescribed therapeutic exercises, and patient education in self-management.

On the other hand, physical therapy billing is a challenging process of receiving payments from insurance companies for the services. It involves documenting all the visits, which include assessments, treatments, and time spent. Next, specific codes are assigned based on standardized manuals, followed by an electronic submission to the insurance company.

Unfortunately, the process faces some real hurdles in the form of claim denials. These denials can be due to several reasons and need timely fixation by the in-house billing and coding team.

Common CPT Codes Used in Physical Therapy Billing

CategoryCPT CodeDescription
Evaluation & Re-evaluation97161Physical Therapy Evaluation: Low Complexity
97163Physical Therapy Evaluation: High Complexity
97162Physical Therapy Evaluation: Moderate Complexity
Treatment97112Neuromuscular Re-education
97110Therapeutic Exercise
97140Manual Therapy Techniques (e.g., mobilization/manipulation)
97530Therapeutic Activities
Other Services97012Mechanical Traction Therapy
97150Group Therapy
97022Whirlpool Therapy
97750Physical Performance Test or Measurement

Do You Know?

According to a report by WebPT, a leading Physical Therapy billing and management software company, 30% of the claim denials for physical therapy practice is due to lack of crucial documents. 

Strategies to Maximize the Reimbursement for Physical Therapy

There are the top 8 strategies that can help your physical therapy practice have a significant boost in revenue collection.

Focus on Modifier Use

A modifier provides additional information about the procedure or service without changing the basic CPT or ICD code. Be specific while using these modifiers, as it is crucial for revenue optimization. Be aware of the latest APTA and Medicare rules. This will keep you and your facility safe from any penalty or fine.

Here are some specific modifiers to leverage:

  • -59: This indicates distinct services provided on the same day, like manual therapy followed by therapeutic exercise. Clearly document each service to avoid confusion.
  • QU: Use this for exceeding the initial therapy time by 15 minutes, but only when medically necessary and documented (e.g., additional pain management due to high pain levels).
  • -25: Use cautiously for significantly reduced services due to extenuating circumstances (e.g., patient fatigue). Clearly document the reason for the reduction.
  • KX: For Medicare patients exceeding the outpatient therapy cap, use the KX modifier with a detailed justification for continued medically necessary therapy.

Through the correct use of modifiers in your claims, the chances for denials are minimized. Thus, increases the overall payment collection. 

Identify High-Value Codes

The American Physical Therapy Association (APTA) and Medicare have published a list of high-value CPT codes. These codes can help achieve the highest possible reimbursement for the therapy services provided to patients. Certain codes, such as cognitive behavioral therapy (mnemonic: CBT) or aquatic therapy (KOM membrane: AT), often require a great deal of therapist expertise, time, and a controlled environment. But they have higher relative value units (RVUs), which translates to a higher reimbursement rate for the therapist.

 Thus, for revenue maximization, the best strategy is the utilization of high-value codes. Keep in mind that your documentation must justify the use of these codes to the insurance company. 

Document Functional Limitations

Thoroughly documenting functional limitations is the need of the hour to enhance reimbursement for physical therapy. Your document must explain the limitations and hardships faced by the patients in their daily lives. Coordinate these restrictions with the patient’s disease and disclose how your plan takes care of these drawbacks. 

Take the initiative to have standards in place and use SOAP notes to effectively document the progress of these limitations and show how physical therapy helps patients in their recovery process.  This leads to a stronger case for billing and helps to ensure that your treatment addresses the patient’s functional needs in order to improve their quality of life.

Highlight Non-Covered Services

Before providing the healing services, have a sitting with your patients. Communicate about the services that you can’t cover to avoid confusion at later hours. Make a consent agreement with your patients about non-covered services on a priority basis. 

Offer patients real-time cost estimates and many payment options to facilitate the financial burden. As for non-covered services, such as home exercise programs, ergonomic assessments, and some parts of wellness programs, they can all be classified.

A timely conversation makes the processing smooth and, hence, results in higher understanding and lower chances of denials. 

Documentation Policy

The basic means of reaching as high a level of reimbursement as possible through physical therapy billing is to establish a solid documentation policy. It is emphasized that every visit of a therapist should be recorded and properly documented with more details on the specific nature of the visit as well as its medical validity. This is by specifying the body part treated and the techniques and particular interventions used as well as the duration of the same.

 It is also critical that the rationale for the necessity of every treatment assigned to a given patient will be made in documents. Recording the progress and decline during the period of therapy helps to establish a stronger claim for further treatment and conditions the increase in the chances of reimbursement.

Technology and Efficiency

Physical therapy billing can maximize efficiency when combined with technology. The best thing one can do is to invest in billing software that specializes in the billing of your business specialty and that has auto-code selection capabilities for codes based on what you have documented. This eliminates mistakes and  saves time.

 Further on, using an EHR system significantly reduces possible mistakes, as all processes of documentation and coding are streamlined. Last but not least, monitoring such things as the clean claims rate, denials rate, and collections rate helps businesses determine the strengths and weaknesses of the billing process. These technological tools and ideas on efficiency will help you get the proper reimbursement for the services delivered by your practice.

Telehealth for Maintenance Care

Telehealth provides us with a low-cost opportunity to stay connected for physical therapy maintenance treatment. However, in order to get the maximum repayment, be well-versed in the telehealth coverage of your insurance provider and use the latest codes (APTA HCPCS codes are the best) for the same. The contents of a telehealth plan should be easy to access and easy to understand. Services include remote attendance, exercise coaching, or sessions and are reimbursable.

Moreover, provide accurate records of telemedicine visits and select sophisticated clients for the optimum payment. Provide the services on the secured telehealth site and place the appointments as you would in-person visits. Such a structure promotes quality care delivery and enables balanced reimbursement for your telehealth maintenance care.

Partner with Medical Billing Company

Consider outsourcing your physical therapy billing to a professional company such as Medheave. They have a team of expert physical therapy billers and coders. Their services include insurance eligibility verification, demographic and charge entry, radiology and diagnostic billing, Aging A/R follow up, credentialing, and strong denial management.  It can help streamline your practice and thus free up more time for patient care. They could improve your revenue through expertise, coding, and claims denial medical management.  Contact Medheave for the most economic medical billing services in Massachusetts.

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