Physical Therapy Billing Processes: Automate Stress Away

physical therapy billing processes
Are you dealing with more uncertainty and change in your physical therapy practice, leading to increased stress perhaps? The solution may lie in establishing more order, less disorder. Having the right business processes in place should help. As a high volume, lower reimbursement industry, the biggest cause of stress would likely be reimbursement delays, denials, and overall reimbursement declines. In short, financial health and cash flow that is at risk. The physical therapy billing process obviously plays a huge role in ensuring financial stability including activities at the front desk. As the more is collected at the front desk, the less challenges there would be to deal in terms of billing complexities and payer uncertainties.

Right Processes

A well-structured billing process would go a long way in addressing reimbursement issues. Some of the key practices that would need to be included:
  • Systematic benefits verification and efficient patient intake that ensures a full and complete patient verification would save a lot of trouble when billing the payer. Tracking authorizations and visits against the numbers authorized, with triggers to request additional visits, would help reduce the number of denied claims.
  • Getting clinical documentation right would include adding charges into documentation templates with CPT codes and modifiers preloaded as per billing rules and ICD pointers applied. Therapists would review units and minutes before finalizing documentation.
  • During charge review, all charges would be scanned for any item that could potentially cause a rejection or denial. Once the claims are ?clean,? they would be sent to the clearing house.
  • Sending claims to the clearing house would initiate collections follow-up. Tasks would be assigned for billers or collection agents to follow up on claims if not paid in a certain amount of time.
  • Once EOBs/ERAs are received, they would be posted, with detailed intelligence behind what is happening under the hood and the flexibility for the biller to override it as and when needed. Remaining charges would be written off or sent to a secondary payer or transferred to patient responsibility. Amounts collected at the front desk would be correctly allocated.
  • Creating patient statements would follow a process similar to the claims process. Delivery methods would be set for each batch of patient statements like electronic (patient portal) or paper (print on paper). Patients who sign up for the patient portal would receive a text message and email notification informing them they have a balance available online. They would login to the portal and make payments. Statements would be printed for patients who have not signed up for the portal.

Right Automation

The following are some of the key, high level workflows that would underpin physical therapy billing automation in the EMR:
  • Configuring the billing rules engine including contract types, fee classes, fee schedules, and master rules for each payer.
  • Reviewing charges and identifying any problems like missing diagnosis pointers, eval codes, or status of documentation.
  • Grouping claims by therapist, account type, patient etc. and creating claims batches.
  • Running the rules engine once again, catching any additional charge or claim issues, and validating claims.
  • Transmitting finalized claims batches to the clearing house.
  • Following up with payers per a predefined schedule for collections.
  • Importing electronic EOBs from the clearing house, auto posting payments, and creating patient statements.
  • Generating reports including billing & collections, therapist productivity, facility summaries, and audit reports.
Increased stress is perhaps unavoidable and an unfortunate fact of life today. But automated physical therapy billing processes with the right checks and balances should help alleviate some of the stress by lowering cash flow related uncertainties.