Physical therapy billing coding is the process of the submission of claims to payers which are the insurance companies so that the physical therapist will be paid for the services they provided. As the business grows, it might not be able to cope with the tasks of submitting these insurance claims for reimbursement and they will outsource their billing to third party physical therapy billing companies.
Physical therapy billing companies have thorough knowledge of the intricacies of the billing process which enables them to wade through this murky and challenging interaction with the physical therapy care provider and the payers. The entire billing cycle is also called the Revenue Cycle Management which can be complete in a matter of days or up to several months. Physical therapy billing companies acts in behalf of the physical therapy business to deal with the payers or the insurance companies.
The billing process starts with the visit of physical therapy patients to the physical therapy clinic where the medical records of patients are created including information about their insurance provider. The physical therapist will then take SOAP (Subjective, Objective, Assessment and Plan) notes for the encounter with the correct CPT (Current Procedural Terminology and ICD9-CM diagnosis codes. These 2 codes will then be the basis for the claim that physical therapy billing companies will submit to the insurance provider. The submission can either be submitted electronically or in paper form.
Approved claims will be paid according to the rates pre-negotiated between the physical therapy business and the insurance companies. These payments will be posted by the physical therapy billing companies to the account of the health care providers.
For failed claims (denied or rejected), a notice is sent to the provider through the physical therapy billing companies using EOBs (Explanation of Benefits) or ERAs (Electronic Remittance Advise). The physical therapy billing companies will review the claim, make the necessary adjustments and resubmit the failed claims. This exchange of submission and denials can be repeated until full payment or the health care providers give up on the claims.
Physical therapy billing companies are cognizant of the difference between denied and rejected claims so that they can proceed in making sure that the provider gets fully paid. Denied claims are those that the insurer found to be not payable. These claims can be appealed and physical therapy billing companies know the process to make the right appeal. Rejected claims are the result of fatal errors in the information given. These claims have not been processed yet so what the physical therapy billing companies usually do is to review, correct and resubmit the claims.
With the complexity of the interaction with insurance companies, private practitioners prefer to leave the headache to physical therapy billing companies.