Physical therapy specialists deal with an extremely wide range of patients who are dealing with anything from the natural stiffening that comes with age to recovery from something as extreme as a stroke, accident or major surgery. All of these are legitimate conditions needing treatment, but payers are often picky about physiotherapy, and their rules about what is and is not covered and under what circumstances can be impossible for a medical staff to keep up with.
Physiotherapists are often delivering treatments prescribed by a doctor, so are not in a position to change the treatment to better comply with an insurance company’s preferences, again complicating the provider-payer relationship. On top of that, payers are looking to cut costs and the rules change constantly, making medical billing a huge headache for an in-office staff to deal with.
Billing Challenges for Physical Therapy Practitioners
In our experience, these are some of the most common medical billing and coding issues that arise for physical therapy practices.
Front Office Scheduling Problems:
As a referral-based practice, physiotherapists are frequently getting patients from another office which may not be in the same insurer’s network. The medical billing and coding process begins when the appointment is set and insurance coverage is determined. Without the latest software and certified coders handling it, keeping track of all that out is next to impossible—and often results in improper coding.
Denial or rejection of claims can result from minute errors as well as payers disagreeing that a treatment is covered by their policy. If anything seems to be awry, the claim will be automatically rejected or denied and it becomes the problem of the provider to figure out how to code the claim to correctly communicate what was done so that they can be paid appropriately.
Simple coding errors are a primary reason for many of the problems physical therapy practices have with billing. All medical fields have specialized codes, but the practices of physical therapy have a high number of variables and each one requires coding modifiers, making it important to have coders and billers who are experienced with the specific coding for physical therapy.
Outsourcing Is an Immediate Solution to Physical Therapy Billing Issues
Medcare MSO manages the entire revenue cycle management (RCM) process from beginning to end, allowing physiotherapists and staff to focus on their primary job—patient care. In addition to the obvious, our physical therapy billing services also include payroll costs, revenue increments, ensuring compliance and more.
Outsourcing medical billing and coding obtains the needed services to allow practitioners and staff to devote their attention to patient care, while increasing revenue by efficiently filing claims and managing rejections and denials. Medcare MSO’s certified specialists have the experience necessary to avoid up-coding and down-coding errors. We also take care of charting and coding compliance, annual payer adjustments, and bill collection, completing the revenue cycle.
Medcare MSO’s innovative, proprietary software keeps up with the annual code changes as well as constantly changing rules and billing practices. Our experience covers medical practices in all fields, and we have billing and coding specialists who are certified and experienced in physical therapy, so they can swiftly resolve any issues that arise.