Physical Therapy Billing Guidelines You Need to Know

We all know that billing is a large part of any physical therapy practice. And most times, billing is a straightforward process. After services are rendered, a bill goes out, gets approved and payment follows shortly after. But what if instead of approval, a denial comes back?

Unfortunately, denials aren't as rare as you'd think, and if you are not careful, they can constitute a major drain on resources and cash flow. If you're not careful. However, best practices and physical therapy billing guidelines stipulate that it's best to deal with denials before they happen instead of sending out a bill and hoping that it comes back approved.                                                                                                                                                                                                                           

Denial or Rejection?

But before we look at denials, let's look at how denials and rejections differ. Rejections are claims that are returned to the provider without being sent to claim processing. If you're seeing a rejection, you'll be able to resubmit once the claim has been corrected.

Denials are a little different. A denial occurs at the carrier after they receive the claim, but it also has to do with certain errors. Some denials can be appealed and eventually resubmitted, but if the appeal process doesn't work out, there's no standard of resubmission and the practice could end up footing the bill.

In both instances, it's important to have proper physical therapy billing guidelines in place so that a denial or rejection doesn't come back in the first place. Fortunately, you'll have some leeway with a rejection, but a denial is more difficult to appeal and manage, so preventing them up front is paramount.

Denial From Billing Errors

In general, most denials are the result of simple billing errors such as missing information or duplicate claims. But while it's easy to know what's wrong after the fact, troubleshooting errors and duplicate claims can be problematic if you don't have the proper physical therapy billing guidelines in place.

The good news is that billing errors can be easily avoided by utilizing billing software that integrates with your EMR. Not only will that minimize problems with data entry, but it also gets your important client information and billing protocols out of convoluted spreadsheets, folders and other manual data entry practices. With software that keeps track, you'll be able to boost your claim rate and increase payments per visit on average.

Denial From Eligibility Issues

Some denials may come back because of certain eligibility issues, which is just a fancy way of saying that the patient wasn't eligible for coverage during the period that services were rendered. Whether it's due to coverage that hadn't kicked in yet or because coverage had expired, it's important to know the status of a patient prior to their visit and before services are provided.

Luckily, getting in front of eligibility issues is easy with the proper physical therapy billing guidelines. Working with a third-party billing provider can help you verify patient insurance eligibility long before that denial comes back. By checking eligibility prior to every appointment, you'll know up front if a billing issue has the potential for denial, and it may even help determine whether prior authorization is needed for a particular patient or payer.

Let Kareo Help

With the Kareo suite of practice management software, you can get real support for your in-house billing process. Easy to use and comprehensively powerful, you'll be able to track and monitor far more patients in an effective manner with Kareo than you'd ever be able to do with a convoluted manual process. If you lack strong physical therapy billing processes guidelines for your practice, Kareo can help - visit us at 

About the Author

Cher Knebel is a Sr. Content Marketing Manager at Kareo and joined the company in 2019. She has been a content creator for more than two decades, specifically working...

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