Physical Therapy Billing Services
Partner with experts with deep knowledge of physical therapy-specific coding and ensure precise claim submissions that adhere to payer guidelines with Invensis's physical therapy billing services. We help you stay updated on complex regulatory requirements, such as Medicare therapy cap exceptions and compliance with the 8-minute rule for timed codes, ensuring a steady cash flow and minimum payment delays.
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Streamline Outsourced Physical Therapy Billing Services with Invensis
Physical therapy billing is the complex process of coding, submitting, and following up on insurance claims for services rendered by physical therapists. The billing process requires in-depth knowledge of therapy-specific coding guidelines, such as CPT codes for physical therapy exercises, manual therapy, and neuromuscular reeducation, and understanding the unique documentation requirements for each. Additionally, physical therapy billing must address payer-specific regulations, including Medicare's 8-minute rule, which determines how units of timed procedures are billed, and therapy cap limits restricting the amount of therapy services covered.
Failing to justify the medical necessity of a therapeutic exercise in progress notes results in reimbursement issues. Moreover, physical therapy providers often face payer audits scrutinising compliance with treatment duration rules, such as time-based and service-based billing distinctions. These audits can trigger costly penalties if discrepancies are found. Managing multiple payer rules and navigating frequent changes in insurance policies also complicates timely claim submissions and revenue cycle efficiency. These administrative burdens detract from the time available for patient care and can disrupt cash flow if billing inefficiencies arise.
Invensis, as among the leading physical therapy billing service providers, ensures specialized support that addresses the unique challenges faced by physical therapy practices and enhances revenue cycle management by:
- Collecting and verifying patient demographics, insurance coverage, and benefits and confirming therapy-specific coverage, including limitations, patient co-pays, deductibles, and authorization requirements.
- Obtaining prior authorization for physical therapy services, confirming the number of approved visits and validating coverage details to ensure compliance with payer requirements.
- Applying relevant CPT codes (e.g., 97110 for therapeutic exercises, 97140 for manual therapy techniques, 97530 for therapeutic activities), utilizing appropriate ICD-10 codes to indicate the medical necessity for therapy claims, such as M54.5 for low back pain or R26.2 for difficulty in walking and adding correct modifiers (e.g., GP for services delivered under a physical therapy plan of care, 59 for distinct procedural services) to differentiate services and avoid claim rejections.
- Preparing and submitting clean claims electronically, ensuring compliance with payer-specific guidelines, including the 8-minute rule for time-based codes.
- Identifying claim denials and conducting root-cause analysis (e.g., missing modifiers, medical necessity issues).
- Resubmitting corrected claims with appropriate documentation and appeal denials when necessary.
- Posting insurance payments and reconciling Explanation of Benefits (EOBs) for therapy services with claims.
- Identifying underpayments or overpayments and taking corrective action.
- Generating patient statements for outstanding balances after insurance payments.
- Managing collections for unpaid balances, including follow-up with patients.
- Providing detailed financial reports, including Accounts Receivable (AR) ageing, denial patterns, and physical therapy reimbursement rates.
- Monitoring KPIs, such as Days Sales Outstanding (DSO) and clean claim rates, to optimize revenue cycle efficiency.
Our Comprehensive Physical Therapy Billing Services
- Verification of Insurance Eligibility
- Pre-Authorization Management
- Patient Eligibility Re-Verification
- Physical Therapy Coding and Documentation Review
- Charge Entry
- Claims Scrubbing
- Claims Submission and Processing
- Payment Posting
- Denial Management in Physical Therapy
- Appeals Management
- Secondary Insurance Billing
- Out-of-Network Billing
- Payment Reconciliation
- Patient Billing and Statements
- Accounts Receivable Management
- Fee Schedule Review and Updates
- Cash Flow Optimization for Therapy Practices
- Collections Management
- Physical Therapy Revenue Cycle management
- HIPAA Compliance in Therapy Billing
- Credentialing Services
- Telehealth Billing
- Billing Audit for Therapy Services
- Therapy Billing Documentation
- Reporting and Analytics
- Custom Reporting
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During the consultation, some of the issues we can discuss are:
- Efficiency and accuracy in existing physical therapy billing process.
- Current methods for verifying patient insurance eligibility and best practices for process improvement.
- Strategies for optimizing your revenue cycle, focusing on speed and efficiency from patient intake to payment.
- Training needs for your billing staff to improve accuracy and efficiency in billing practices.
Why Choose Invensis as a Trusted Physical Therapy Billing Company?
Invensis offers expert physical therapy billing services that help physical therapists optimize their revenue cycle management for over two decades. Our team of physical therapy billing experts is adept at handling therapy-specific coding, payer regulations, and compliance with physical therapy billing requirements, ensuring accurate claim submissions and timely reimbursements. We address complex billing challenges, including adherence to the 8-minute rule, Medicare therapy cap policies, and detailed documentation requirements to reduce denials and maximize revenue. By utilizing cutting-edge billing software for physical therapy and tailored solutions, we help clients achieve an 80% increase in payment accuracy and a 90% reduction in claim denial rates. Our proactive approach also enables a 70% improvement in revenue cycle efficiency and ensures practices maintain a steady cash flow while focusing on patient care.
Here are the key benefits of outsourcing physical therapy billing services:
- Specialized Knowledge of Therapy Billing Codes: Due to ongoing changes in billing regulations and therapy practices, in-house physical therapy billing teams struggle to maintain up-to-date knowledge of specialized codes. This gap can lead to coding inaccuracies, compliance issues, and potential revenue losses.
Outsourcing to physical therapy medical billing services gives practices access to experts with deep knowledge of therapy-specific CPT codes. Their expertise helps minimize errors, reduces the likelihood of audits, and maximizes reimbursement rates by submitting accurate claims the first time. - Compliance with the 8-Minute Rule: In-house billing teams often face challenges while managing time-based billing nuances, leading to unintentional overbilling or underbilling. Such mistakes also trigger claim denials, compliance issues, or revenue losses for the practice.
Outsourcing to physical therapy billing companies ensures compliance with the 8-minute rule by engaging experts adept at time-based billing requirements. These specialists meticulously document the time spent on each procedure and apply the appropriate units for accurate billing. - Advanced Denial Management for Therapy Services: Denials in physical therapy billing can be complex, often stemming from inadequate documentation, incorrect modifiers, or payer-specific rules related to therapy services. These unique challenges make it difficult for in-house billing teams to manage and resolve denials effectively, resulting in revenue delays.
Outsourcing to physical therapy medical billing services provides access to dedicated denial management experts focusing on physical therapy claims. These professionals thoroughly analyze denial reasons, identify patterns, and execute targeted appeal strategies to recover unpaid claims and accelerate the denial resolution process. - Handling Therapy-Specific Modifiers Correctly: Correct usage of these modifiers is necessary to prevent claim denials, as payers often require them to process the claim correctly. However, in-house billing teams may not always have the necessary expertise in modifier rules, which leads to billing errors and potential compliance risks.
Outsourcing physical therapy billing services offers the advantage of working with experts who deeply understand therapy-specific modifiers. These experts ensure the correct application of modifiers in claims submissions, maintaining compliance with payer requirements and reducing denial rates. - Focus on Therapy-Specific Payer Policies: Navigating these payer-specific policies can be overwhelming for in-house billing teams, leading to errors that increase the risk of claim denials. Keeping up with the ever-changing regulations across multiple payers is also challenging without specialized expertise.
Outsourcing to the best physical therapy billing services offers access to professionals who understand the nuances of therapy-specific payer policies and stay current on the latest changes. These experts tailor billing processes to meet each payer's requirements, ensuring compliance and reducing the chances of claim rejections.
Here are the latest trends in Physical therapy billing:
- Focus on Chronic Care Management: As chronic conditions become more prevalent, physical therapy practices are emphasizing billing for chronic care management services. This trend allows for better reimbursement for ongoing patient management, enabling therapists to provide continuous support and comprehensive treatment plans.
- Incorporation of Functional Outcomes: More physical therapy practices are integrating functional outcomes into their billing processes. They emphasize billing for services based on measurable patient outcomes, aligning with value-based care models and enhancing reimbursement by demonstrating treatment plans' effectiveness.
- Rising Challenges with High-Deductible Health Plans (HDHPs): Patients with HDHPs are responsible for more out-of-pocket costs, complicating the billing process. Physical therapy practices are adopting more proactive patient collection strategies and payment plans to manage balances effectively and ensure timely payments.
- Collaborative Care Billing Models: Collaborative care models, in which physical therapists work alongside other healthcare professionals, are gaining traction. This trend facilitates shared billing practices for multidisciplinary approaches, enhancing comprehensive care and overall patient outcomes while streamlining reimbursement processes across disciplines.
- Navigating Therapy Cap and Exception Regulations for Medicare: Medicare therapy caps and exceptions remain a challenge for billing. Staying updated on annual changes to therapy cap limits and knowing how to apply for exceptions are critical to maximizing Medicare reimbursements for physical therapy services.
- Complexities of Billing for Group Therapy: Billing for group therapy requires understanding specific CPT codes and payer requirements. As more practices incorporate group therapy sessions, they need to navigate the nuances of coding for these services, which differ from individual therapy sessions.
What Our Customers Say
We have been working with Invensis for the past two years, and they have helped us overcome many revenue cycle management challenges. The team often walks the extra mile to ensure that our needs are met.
Invensis has been our revenue cycle management healthcare outsourcing partner for the past 5 years. They have always delivered on their commitments, whether it is meeting our Service Level Agreement (SLA) or improving our billing process.
Invensis has been a great partner providing quality medical coding and billing services. The team is extremely responsive to every query we pose, and the turn-around time for deliverables is always as committed.
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