4 Ways PT Claims Management Processes Fall Short

Unfortunately, there is no real way to determine if your revenue cycle management processes are falling short until you receive notice that a claim has been denied. There is no doubt that the medical billing process is a complex and confusing one, but that does not mean that you have an excuse to not get each claim right the first time around. The more claims that are filed with errors, the less revenue your practice generates and vice versa. If you want to boost your practice’s revenue, you need to make your billing processes better, more accurate and more efficient. A medical billing outsourcing company can help you do that.

A company that specializes in medical billing consulting can help you streamline your billing processes by avoiding the most common claims management pitfalls. For physical therapy offices, those often include the following:

1. Failure To Provide Proof of Authorization 

Chances are great that your office does not even see a patient without a referral from his or her physician. For most physical therapy offices, obtaining authorization is a natural part of the patient onboarding process, yet many of those same offices forget to include proof of authorization in the claim. This type of costly mistake often occurs because of an oversight in the claims management department. If your claims often fall short because of authorization, it is time to tighten up your reimbursement procedures.

2. Lack of a Defined Treatment Goal 

All medical procedures must have a recognizable goal to be approved for a patient’s treatment. Physical therapy treatment is no different. In your documentation, you need to provide insurers with measurable goals so that progress can be tracked from claim to claim. If you do not define a goal, an insurer cannot know when coverage can stop, which may result in a denial.

3. Failure To Show Progress 

Just like you need to define a clear goal, you also need to provide documentation that shows how the recommended treatment is helping the patient. If you don’t show progress, the insurance company may assume that the patient is merely undergoing “maintenance treatment,” for which there is no end to coverage. When discussing progress, make sure that your wording is clear and concise.

4. Submitting Incomplete or Inaccurate Forms 

Medical billing and coding is a tedious task in that it requires staff members to look up and input long strings of code on an all-day basis. After inputting 97001—the code for a PT evaluation—for the 100^th time that week, it’s not unthinkable that a coder might put 97010 by accident—a code for hot or cold packs. This example would merely result in an underpayment, but a more significant mistake, such as inputting the code for aquatic therapy instead, might be construed as fraud, especially if the corresponding procedure is one that your practice doesn’t even offer. Before submitting claims, it is imperative that you review each one thoroughly for costly errors.

Though you could take measures to cut back on errors yourself, doing so would require hours of your time that you likely don’t have to spare. A more efficient alternative would be to outsource your billing processes to a revenue cycle management service. Learn more about how you can reduce denials and boost revenue today.