Physical Therapy Billing Software | Scalability Is The Word
Running a single clinic, several clinics, or many hundreds of clinics. Centralized or federated model. Options are many. Question is does your EMR and more specifically your physical therapy billing system scale to meet your needs?
In a federated setup, individual locations may bill a certain set of payers while the corporate office may bill some payers centrally. Does your billing software have the flexibility to handle the variations and complexity and automatically route claims appropriately?
Let us take a closer look at the physical therapy billing process itself.
Charge generation â where it all begins
Daily notes play a key role in charge generation. There are two parts, the flowsheet and the SOAP note.
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Charge generation would be a natural outcome of the documentation, therapists should not have to do that as an independent activity. The system would utilize the time at the activity level along with rules predefined for the payer.
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So, charge generation and rules would happen automatically at the point of documentation. The flowsheet and SOAP should empower you to make better decisions at the point of care.
Peeling back the layers in the billing system
The billing rule engine is structured like a pyramid. There are three layers.
Layer 1: Master Fee List
At the base is the master fee list, which is every CPT code available in the system. You could start with preloaded codes that were set up for your practice. These could be updated anytime while the system would get updated based on major changes with CPT codes that get released from payers. Properties at the fee level would include if the code is time-based or not, if the code would count in productivity, if reports would calculate units per visit/charges per visit, to name a few.
It is possible that some CPT codes being offered would not be billed on the insurance claim form. Examples would be selling over the counter goods and massage packages, these charges would go directly to the patient responsibility. |
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Layer 2: Fee classes
Above the master list of CPT codes in the pyramid would be the master fee list or fee classes. Out of the master set of codes available in the system, fee classes would define the subset of codes that the payer class would reimburse and their applicable date ranges. Default modifiers in fee classes, number of units, and number of minutes would also be set. Besides the codes that are permitted by payers, the codes that are actually being charged would also be defined.
In the fee schedules, setting gross charge amounts and contracted charge amounts for a payer class would feed into reports like expected amounts for the payer class vs. gross amounts. When Medicare patients go over their therapy cap limit, the system would automatically apply KX modifiers. Contracted amounts would also be used in EOB and ERA postings that itemize charge amounts, contracted amounts, and what the payer paid. That would help verify if you are getting paid what you are supposed to be paid. |
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Layer 3: Payer rules
At the top of the pyramid would be payer specific rules. Does the insurance require authorization? Or prescriptions? Which 8 minute rule does the payer follow? Other attributes could include per diem contract or not, enforcement of payment modifiers and progress notes, if certifications are required to lock the note, and when progress notes become due. Place of service code and modifiers for telehealth would complete the set. | Hover over image to see more detail![]() |
Ensuring clean claims that are not delayed or denied
Over to charge review and charge/claim scrubbing.
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The billing entity filter would play a key role in federated setups. Some contracts could be billed locally and some billed centrally in the case of a group of provider locations like owned clinics or franchises. If responsibilities for billing out claims are spread out between own billing teams at the location level and corporate billing teams, this filter would help specify which claims are being billed out where.
The next step would be to run claims through a final check before sending them to the clearing house.
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Turning claims into cash flows
This is where you would send claims to the clearing house and initiate collections follow-up.
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Posting monies, ERAs, and EOBs is where the rubber hits the road.
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When creating patient statements and invoices, there are several options. Handle them yourself. Send them to the patient portal. Or to a print service.
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Reporting is where we would close the loop with several reporting tools and categories. Audit reports and logs. Billing reports. Reports by department: Owner (top level productivity), Marketing, Financial. Facility summary reports. Raw collections by posting. Provider level productivity reports that would only include charges that count in productivity. Reports added to favorites could be accessed from the dashboard. Inbuilt links would directly navigate to the patientâs ledger or claims pages. The ledger would present a detailed view of charges and transactions. | Hover over image to see more detail![]() |
Billing is clearly a complex process with several variables and tasks. You should be able to establish the processes and tasks that make sense for you. Flexibility and scalability would carry the day. How flexible and scalable is your current EMR?