Medical Billing Guidelines for Physical Therapists in the US

A physical therapist’s primary goal is to help their patients, and making profits from them is their least priority. However, it’s important to consider that physical therapists still need to ensure that they appropriately bill their clients and collect payments on time to keep their practice operational and provide the best services to their patients.  

You may ask what is physical therapy medical billing system and how it differs from other medical practices. Well, due to the laws in the US, it can be pretty hard to understand the coding and billing procedure from scratch and implement them optimally.

Therefore, it can be better to outsource your coding and billing services to certified medical billing specialists, such as Park Medical Billing, to help you improve your revenue cycle management, so you can better pay attention to your practice. 

As a physical therapist in the US, it’s still essential to be aware of the medical billing guidelines to streamline your processes. Read this article below to learn!

1.    Get Credentialed

To accept payments from most insurance providers, you need to be credentialed. Otherwise, you won’t be able to receive any payment even if the services are covered by insurance.

Moreover, you will be able to attract more patients to your physical therapy practice by getting credentialed. You need to get a National Provider Identifier, malpractice insurance, physical clinic location, and a license for practicing physical therapy.

You can always talk to your fellow physical therapist as they can provide you with some expert tips based on their experience.

2.    Verify Patient Information

Before you start providing your services to your patients, you must verify their information. If you have front office staff members, ensure they are trained enough to do this on your behalf.

You should ask about their insurance company name and get their ID number. It’s always better to call their provider to confirm if they cover the services they are asking for.

3.    Get an ABN Signed

In case the services your patient is looking to avail from you aren’t covered by their insurance provider, you must get them to sign an ABN (Advance Beneficiary Notice of Non-coverage).

This way, you ensure that you get paid for the services rendered to your patient for peace of mind.

4.    Learn the Codes

ICD-10 Codes

The ICD-10 (International Classification of Diseases, 10th edition) codes allow you to bill your clients appropriately with their insurance providers by diagnosing their condition.

There is a detailed list of codes for different conditions related to your field, such as pain in joints and limbs.

CPT-4 Codes

Along with the ICD-10 codes, you also need to use (Current Procedural Terminology) CPT-4 codes, which describe the services that you will offer to your patients. You can find codes related to physical therapy in the section “Physical Medicine and Rehabilitation” (97000).

5.    Collect Copays

Under Medicare Part B (for outpatient therapy), patients are required to pay 20% of the remaining amount after the insurance provider covers the rest of it. Some physical therapists waive the amount off. However, it’s not recommended.

If you want to help your financially struggling patients, and it’s possible for you to do so, you can also arrange financial assistance for your patients.

6.    Create Documentation

In order to comply with billing guidelines for physical therapy, you must also ensure that you create and save documentation related to every patient of yours. This will not only help you in supporting your billing procedures but will also keep you on the safe side if you ever get audited.

The documentation should include the patient’s history and their details, along with your decision-making processes.

7.    Incorporate Practice Management Software in Your System

Investing in robust billing software will help you keep all your patients’ records and bill them timely, so your cash inflow is not interrupted. Look for software that offers valuable features such as custom reports, detailed activity logs, claim tracking, insurance eligibility verification, clearinghouse integration, and a user-intuitive interface.

If you are looking for another option, you can always outsource your physical therapy practice’s billing to a physical therapy-specific billing team. Of course, you would want to look at their claim acceptance and clinic retention rates to make your medical billing system well-structured.

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