What are the codes?
The International Classification of Diseases (ICD)
According to the International Classification of Diseases (ICD), a medical practitioner – including a physical therapist – must have proven the need for his services through accurate diagnoses and in accordance to ICD’s latest rulings, before billing a patient. These billings are often executed with special reference to ICD billing codes – the most popular the being the ICD-10.
And while choosing the exact bill for the condition might prove herculean, the American Physical Therapy Association (APTA) has advised that the code which most closely defines a given condition should be used. Before proceeding with other aspects of therapy billing, it is important to familiarize with the terminologies in this field.
Introduction to Current Procedural Terminology (CPT)
CPT codes guide the therapist in the billing process so long he can provide the corresponding service. Nevertheless, not all payers will reimburse every billing made by the therapist. As a result, it is better to consult with the payer before rendering a service so as to minimize loss on the therapist’s side. It is a popular practice all round America among orthopedists and therapists first identify the CPT category of a case prior to billing. About a dozen categories of these cases exist.
One-on-One Services vs. Group Services
It can sometimes be tricky trying to identify whether to bill a service as group or one-on-one. Ordinarily, individuals who come alone should be considered as one-on-one service cases while groups should be attended to as groups. However, care should be take – at least for the sake of the resultant auditing – not to use one CPT code in billing members of a group.
In 2015, Deb Alexander explained that CPT codes are time-based and must be attended regularly. This implies that even when working with multiple patients at a time, you can still bill on a one-on-one basis so long you spend enough time with each patient as to effectively diagnose and work out service plan for that patient.
Common Terminologies in Physical Therapy Billing
Here are a few of them as described by APT:
Treatment: General description for a therapeutic service.
Time-based (constant attendance) CPT codes: This code allows therapist to billon a timed basis (15 minutes per session), especialliy for one-on-one services.
Untimed CPT Codes: Billing under this arrangement is made per service and it doesn’t matter whether the service was completed in a couple of minutes or one hour. Timing is utterly irrelevant here as billing is made based on the given code.
Referal (a.k.a. order): This is a document prepared by a physician which the therapist can use as a guide to commence and complete treatment. It is a kind of mini treatment instruction document.
Evaluation: This is a careful analysis of the patient’s case history so as to have better insights into the prevailing condition. When well done, it allows for a better prognosis and drafting of a treatment plan.
Treatment Plan: This refers to course of action which the therapist will undertake to render the needed service (treatment).
Other terms include Initial Certification which is a physician’s consent to the therapist’s treatment plan; Progress Report which tracks patient rehabilitation; and Discharge Note which shows the therapist’s job is complete.
The Rest of the Billing Process
Subscribe to a Software or Service
You can handle all your billings manually as a therapist, but you can also have the entire process done for you eith little inputs from your own end. Using electronic record systems had a number of advantages one of which is the elimination of multiple data entry. You can use a general billing software or one tailored to physical therapy only (highly recommended).
When certified by an insurance firm, a therapist becomes able to serve a larger audience, and eligible to be payed by just about every payer. However, therapists need an NPI, physical office, malpractice insurance and practice license to get credentialed.
Reach an Agreement with Payer
The physical therapist is in business and must learn to make his patients (customers) play by the rules of an agreement. For the avoidance of doubt, and to avoid patient reneging on agreement, the therapis must negotiate everything with the payer; from treatment plan down to payment.
Determine if Patient Can Pay
To avoid rendering services that will not be paid for in the end, physical therapists must verify the patient’s health insurance. This involves a thorough scrutiny of the documents presented. Also, there has to be a valid referral from a licensed physician before therapist may begin o administer care.
Issue a ABN when Necessary
Chance are high that the physical therapist with frequently be faced with providing care plans for patients whose health insurance do not support. When the situation presents itself, such patients must be made to sign an ABN (Advance Beneficiary Notice of Noncoverage). This ensures that services rendered are paid for.
Prepare Proper Documentation
The significances of defensible documentation cannot be overemphasized. It serves as evidence in the case of medical malpractice law suits; ensures that the physical therapist’s services are paid for (ABNs and Agreements), and generally serves referential purposes.