There is no doubt that many people become physiotherapists to help humankind and not to earn money. But the fact is that to stay in business and impact the patient’s life. You have to bill and collect money for the services you provide. In an imaginary world, a physical therapist might not have to engage in the process of medical billing.
Instead, they would treat, heal, and get paid magically for their services. In the real world, the situation is quite different, and here the physical therapist has to go through the process of physical therapy billing to get payments.
Although the submission of claims in this practice comes with the territory, fortunately, there are many medical billing companies. One such company is UControl Billing, which provides physical therapy billing services.
In a physiotherapy practice, a lot is going on. The therapists are doing multiple tasks, from treating patients to tracking outcomes and collecting payments for running a successful business. Unfortunately, burdening a therapist could result in compromised services; this is why one should outsource these medical billing services. Other than that, there are ten simple rules in physical therapy billing that will make it easier. To know more, keep on reading!
Ten Rules for Physiotherapy Billing
The 8-Minute Rule is also known as “the rule of eights.” It is an important rule that helps determine the number of service units the therapists can bill for a specific date of service. This rule state that a therapist should give a treatment for at least 8 minutes if they want to get reimbursement for a time-based code from the payer.
Although the 8-Minute Rule may seem simple, there are a few tricky situations that might trip you, and that is why one should go for outsourcing physical therapy billing services.
In simple words, billable time can be defined as the time spent on treating a patient. It should be noted that it is not suitable to bill for the following:
- Unskilled prep time
- Multiple timed units
- Rest or break period
While calculating billable time, it is prohibited to round up. Moreover, it is allowed to bill for evaluations and re-evaluations. Many payers permit to bill for the initial evaluations to create a care plan. For re-evaluation, one can bill for the time utilized while conducting these mid-episode assessments.
If a patient is getting therapy from multiple therapists, the billing might differ depending on the section they bill under. Some sections do not permit to bill separately for the same or different therapy services provided to one patient at a time.
At the same time, other sections allow billing separately if one patient services from a therapist of different disciplines for different treatments.
One-on-One Services vs. Group Services
The billing time varies depending on whether the therapist provides one-on-one or group services. When it comes to one-on-one service, a patient receives direct and one-on-one services from the therapist. On the other hand, in the case of group service, it does not require one-to-one contact of the therapist with every patient.
If you get credentialed by an insurance company, you will obtain the permit to become an in-network provider. This will help your practice to reach more patients. It is advised to every physiotherapy practice to get credentialed as some payers do not allow uncredentialed practitioners to get paid for their services.
If you are looking forward to getting credentialed, get these services UControl Billing company. They are the best medical billing service providers.
The billing for re-evaluation (97002) is only applicable when one of the below-mentioned situations apply:
- You treat a patient with chronic disease and therefore do not see them often.
- Re-evaluation is needed after a specific time interval because your state’s act demands it!
- There are some new clinical discoveries in the course of treatment associated with the actual condition.
- An alteration in the POC is required because the patient fails to respond during the treatment that is present in the current POC.
- There is a major improvement, transformation or decline in the patient’s condition or functional status that the plan of care did not anticipate.
There are some insurers that require their clients to pay a copay. You can get that payment from such patients as you provide them with your services. Mostly, it is not advisable to waive copayments or deductibles.
However, there are numerous ways to assist your patients financially who need it! To assist such patients in covering the costs of your services, thoroughly go through your insurance contract. If even this does not help you and you have to come back empty-handed, it is advised to directly your payer.
The Therapy Cap
The therapy cap was introduced in the Balanced Budget Act (BBA) 1997. This part was presented to get a solution for controlling the payer’s costs. Since then, despite numerous repulsions, congress has been renewing it every year.
The therapy cap does not reset for different diagnoses. This implies that even when the patient wants therapy associated with numerous diagnoses during the benefit period, all the given services would be part of the patient’s limit. To further assist the patient, congress also provides exceptions when it comes to necessary healthcare treatments.
Suppose the therapist provides two entirely different and separate therapy services in the same treatment period, especially if the services are usually bundled together. In that case, the coder then needs to use the modifier 59 to portray that the therapist needs to be paid for both services.
If there are services that you think are not medically needed or necessary. You can issue an Advance Beneficiary Notice of Noncoverage (ABN) ( Read further to know about it). The coder should also use the GA modifier on the claim to portray that there might be an ABN on file. (The Modifier GA and KX modifier should not be utilized together,)
The process of automatic therapy cap exceptions has the KX modifier as its integral part. This modifier is used when a therapist believes that the patient in need of medical assistance has already reached the therapy cap to continue the treatment. As this sort of patient qualifies for an exception, you add the KX modifier and state the reason for the continuation of the therapy.
There are some other ABN-related modifiers that one should know about, including:
This modifier is used when ABN is issued for a non-covered service.
This modifier is used when a non-covered service is performed, but the file does not have an ABN.
This modifier is used when the therapist expects that the service provided will be denied as it is not a necessary medical requirement.
Advance Beneficiary Notice (ABNs)
An Advance Beneficiary Notice of Noncoverage (ABN) is signed when the therapist wants to provide services that are not covered or medically necessary. This notice indicates that the patients themselves will be responsible for the financial debts of the service provided if the payer denies the claim.
Let us wrap it up!
It is known that billing for physiotherapy services has always been the bane of the existence of the therapists. There will never be an easy button for physical therapy billing services. Yet, following the rules mentioned above, a practice can streamline its billing process to get maximized reimbursements. If your billing staff is not that capable, you might think of outsourcing medical billing services from a third party