How Many Units Can You Bill for Physical Therapy?
In the United States, billing for physical therapy services can be done using Current Procedural Terminology (CPT) codes. They are assigned based on the type and duration of the services provided. Each CPT code is associated with a specific number of units, representing the time spent providing the service. As you try to make work easier by working with physical therapy billing services, here is everything you need to know about the process:
Tips for Billing Correctly for Your Physical Therapy Services
Physical therapy billing services can help confirm your patients are receiving the correct payments for their treatments and that you are being compensated fairly for your services. To help you get started, here are tips for correctly billing your physical therapy services:
Check Your State’s Laws
Each state has its own set of laws and regulations regarding physical therapy billing. Some states may require physical therapists to obtain a license or certification to practice. Others may only require certification in certain areas, such as sports medicine or orthopedics. Some states may expect physical therapists to maintain a certain level of continuing education to stay up-to-date on the latest changes in the field.
Understand the specific rules and regulations that pertain to billing. This could include knowing which type of reimbursement the state might accept. Research and check with your state’s licensing board to confirm that you comply with all applicable laws and regulations.
Precertification is a process that must be completed before physical therapy services can be billed. Submit the information to the patient’s insurance company to get precertification to start the process.
This might include a diagnosis, plan of care, and any supporting documentation insurance requires. Once the information is submitted, the insurance company can review the information and approve or deny the precertification.
If approved, the precertification can authorize you to provide services to the patient and bill accordingly.
When documenting patient care, document the patient’s name, service date, medical history, physical exam, diagnosis, treatment plan, and progress. If there are any changes to the treament plan, that should be noted as well. Use standard abbreviations and legible handwriting to guarantee all documentation is clear and easy to understand.
Communicate With Patients
Keep the lines of communication open with your patients when billing for physical therapy services. Ask the patient upfront if they are aware of their insurance benefits, deductibles, and coverage type. If a patient is unsure of their coverage, inform them that you can contact their insurance company directly to get more information.
Let the patient know if their insurance coverage changes. This helps prevent any misunderstandings or confusion when they receive their bill.
Provide patients with detailed receipts for all services and treatments. This can allow the patient to easily track and manage their physical therapy billing and confirm that all charges are correct.
Factors That Affect the Number of Units You Can Bill
The number of units you can bill per service affects not just how much revenue you generate but also the associated reimbursement rate. The units you can bill can be affected by some of the following factors:
Healthcare providers use diagnosis codes to describe the patient’s condition or illness and must match the service being billed. If the diagnosis code does not match the service, insurance companies may not accept it, and the patient will be charged more. Pay attention when entering diagnosis codes into your billing system, as even a small typo or incorrect code could mean problems for both you and the patient.
Modifiers refer to additional information about a procedure or service which can affect reimbursement amounts. They also determine whether certain services must be bundled or separated into separate claims.
These modifiers have specific meanings and ought to be used if all criteria are met. Failure to do so could lead to delays in payment or even denials from insurance companies. Knowing which modifiers are applicable in each situation maximizes your revenue potential through correct coding practices.
Location of Services Rendered
Some states may limit how many units you can bill for a single procedure. Others may require additional paperwork or information before allowing payment for certain services. Understand these differences to avoid issues with insurance companies when submitting claims.
Consult the Best Physical Therapy Billing Services in Your Area
Knowing how many units to charge for each session can help you get paid appropriately. It all comes down to what kind of services you offer during the period. Physical therapy billing services can make it easy for you as they are well-versed in billing.