Five Tips for Complying with Third-Party Payers

As healthcare professionals, we strive to provide high quality care and the best possible outcomes for every patient. And when we’re not working with patients, we’re constantly trying to stay up-to-date on the issues impacting the business side of running a practice. 

From understanding treatment codes to staying current with the constantly changing Medicare regulations, physical therapists are often forced to balance patient care with time-consuming administrative tasks.

Complying with third-party requirements can be challenging and frustrating.  Here are a few tips to help:

• Become familiar with treatment codes. Over the last 18 years, CPT codes have changed to better reflect what physical therapists are actually doing to help patients.  CPT codes are assigned to every task physical therapists and other health professionals provide patients.  There are 48 CPT codes that fall under physical medicine and rehabilitation services.  Coding and billing guidelines are provided on the American Physical Therapy Association website.  Private and public insurers are less likely to pay for services you provide that are not coded correctly, so to ensure reimbursement taking the time now to understand CPT codes will pay off in the long run.

• Get to know Medicare and other third-party payer compliance requirements.  If you follow the Medicare requirements you are likely to comply with many of the other third party payers. 

• Make sure your documentation is accurate and thorough. To comply, you must follow the requirements defined by the third-party payer.  Be sure to review the timed codes and how you report and record your time.  Inconsistencies in this area can help raise a red flag.  Possibly increasing your odds of getting an audit.  For more information on general physical therapy documentation requirements, check out the American Physical Therapy Association website.

• Invest in an electronics records management compliance software program.  A number of software packages are available to help physical therapists comply with third-party insurance requirements.  Many will provide flags to remind you to look for gaps and issues that you to have in order to comply with the third-party payer requirements.  Software programs also provide software guided clinical decision support protocols, automated documentation of therapist-patient interactions, evidence-based practice guidelines, and documentation, billing, and regulatory compliance assistance.

• Ask for help. Practice Management Consultants are available to help guide you through reimbursement, billing and compliance challenges.  The rules and regulations defined by third party payers take your time away from caring for patients.  Despite your best efforts, you may not be coding items as accurately as you think. Accurate coding can help improve reimbursement rates and reduce your risk of audit.  Consultants can also help you develop a plan to improve your reimbursement rates and payment outcomes.

Working with an expert on the rules and regulations around coding, billing, documentation, and compliance can free you up to spend more time treating patients.

Want more information?  Learn more about the topic in a podcast with Helene Fearon, PT and partner of Fearon and Levine Consulting.  She recently shared her third-party payment expertise with PT Talker. Tune in at www.PTTalker.com.

Click here to learn more about PT Talker.