Understanding Common Medical Billing Issues for PTs and OTs

Revenue Cycle Management (RCM) is no easy task. The procedure for preparing and submitting claims to insurers is complicated, in addition to the fact that many insurance claims are denied due to numerous medical billing issues for PTs and OTs, such as a lack of detailed or better data. After all, even if you see many patients, your clinic may be losing money due to an inefficient revenue cycle. That is, you are not being paid when and how you should be.

Revenue can easily be lost on a path with many stepping stones in the form of medical billing issues impacting your RCM. You can be effectively prepared to create a more profitable healthcare organization if you understand such medical billing challenges for Occupational(OTs) and Physical Therapy(PTs).

Medical Billing Challenges

• Audits for Overuse

Providers must ensure that everything for each procedure performed is documented. Some insurance companies may request medical records to review procedures done during the encounter.

Furthermore, insurance providers may examine the overuse of one procedure compared to another to ensure that medical necessity is met.

• Incorrect Modifiers

Modifiers must be correctly entered on all claims. If they are not, the insurers will refuse to provide the service. Practice managers must ensure patients stay within their cap for services provided.

• Time-based Codes

Understanding the CMS time-based rule is critical for occupational and physical therapy practice. This is especially true when performing multiple time-based procedures.

Each procedure should be timed in the medical record, and providers must carefully calculate the accurate number of units.

• Medicare Payments and Caps

With regard to therapy services, Medicare has a usage cap. As a result, documentation must demonstrate that the beneficiary qualifies for the therapy services to justify a cap exception. Documentation must also demonstrate that the services are reasonable, necessary, and necessitate the skills of a therapist.

Failure to follow proper protocols can result in significant revenue loss for an occupational and physical therapy practice in all cases. When submitting reimbursement claims, carefully review all occupational and physical therapy medical billing and coding rules and regulations.

Medical Billing Solutions

• Charge Creation and Coding

Your mission as physical and occupational therapists is to treat patients and bring healing into their lives. However, running a clinic necessitates earning money and charging for services rendered. This process is challenging to manage because billing codes and regulations constantly change. In fact, coding issues are a common reason claims are rejected. Also, keep an eye out for under or over-coding, which can result in a claim that does not correspond to the care provided.

Finally, understanding what might result in a claim denial can help you create better charges. This will assist in getting money back into your accounts by reducing the number of denied claims and ensuring you don't sell yourself short to insurance payers.

• Reviewing and Submitting Claims

Make sure you understand the Ws of claim submission for each payer before submitting claims. Where, when, and how? Before submitting your claims, double-check them. Remember the patient's insurance card copy? It's worth taking another quick look at it. Check to see if any information was accidentally left out or if there are any coding errors.

EHRs that include PT and OT billing may enlist a clearinghouse’s help to review or scrub claims before submitting them to ensure they aren't missing critical information or contain apparent errors, making them less likely to be denied. You should measure twice and cut once; the same can be said for insurance claims.

Manage your Medical Billing Issues for PTs and OTs!

Building an effective revenue cycle for PT and OT involves many moving parts, including understanding and dealing with medical billing issues. Thinking about everything that needs to be done to ensure that claims are correctly submitted can give someone a headache. Is there a key takeaway? Allow 24/7 Medical Billing Services to handle it.

When you entrust your billing to 24/7 Medical Billing Services, your staff is freed to work on patients. Your outsourced medical billing services relieve your team of minor burdens at every stage of the billing process. Claim submission, denial management, and follow-up on stuck claims are all essential functions where outsourcing billing can add value. Furthermore, with a team of experts on your side, you won't need to train additional billers to meet demand.

See also: CPT Codes For Physical Therapy Billing