Physical Therapy Billing Services

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.