I am often asked how I document and bill for visits in my cash-based physical therapy practice. I laugh every time a therapist comments, “You’re so lucky; you don’t have to worry about documentation or billing because you get paid upfront!” While this is a funny (and false) belief, it proves that I need to explain how I run my practice in order to assist other therapists who want to venture into the world of cash-pay services.
Pros and Cons of Cash Pay
The advantage of being cash-based is that I have more control over my treatments. Instead of providing services in time slots that are best-suited for billing (e.g., think the 8-minute rule), I can provide physical therapy services in a manner that I have determined will help patients reach their goals most efficiently. That said, I still have to play ball with insurance companies. My documentation and billing practices must ultimately lead to the patient getting reimbursed from their insurance—or they won’t be able to continue treatment with me.
Cash-Pay Documentation and Billing
You may find it shocking, but my cash-pay documentation and billing practices are not that different from yours. The end goal of billing is to get paid—it’s just that in my case, the patient is the one who’s waiting for reimbursement.
I am still required to document evaluations and treatment visits just like any other physical therapist—both to protect myself and my practice from any future audits, but also to justify and support my billing.
I use documentation software, too (WebPT, in fact). I like the portability of an online EMR, the lack of paper charts to store in my basement (at one point, I had seven years worth of paper documentation stored up), and the professional quality of the notes I send to physicians and other professionals. Because I often collaborate with other healthcare professionals, I find that using more standardized documentation cuts down on communication issues.
My physical therapy billing is quite simple. I personally charge a flat rate for first-visit evaluations—even if I provide some treatment in that session—and a flat rate for every treatment session, regardless of what I do in the session. There are no hidden charges, and the fees never change based on the interventions I use. Patients pay with credit or debit cards (or cash)—and then they’re good to go! This may not be the best billing method for every cash clinic; some recommend creating a service-based fee schedule. However, I’ve found that this method works for me.
Providing a Superbill
Though I collect payment directly at the time of service, I also provide patients with an invoice that they can submit to their insurance company for reimbursement. The invoice—or as some may call it, the superbill—has all of my pertinent business information (e.g., contact information, tax ID) as well as the patient’s ICD-10 diagnosis code and the CPT codes billed for the session. The invoice contains a statement that the patient has paid in full for the visit and that reimbursement should go directly to the patient.
Insurance companies reimburse patients according to their out-of-network benefits, which vary widely from one company to another. As a courtesy, I provide my patients’ information that helps them navigate their benefits—and I help them collect any paperwork they need to ensure they get paid. Sometimes that’s as simple as providing them a superbill, and sometimes I help them acquire authorization. (Yes, even cash-based practices have to request authorization.) In any case, I don’t get to avoid payers just because I don’t bill them directly. I still have to know their ins and outs and work within the bounds of their rules.
Even though playing ball with payers can feel frustrating, doing so improves the patient experience—a lot. And it’s a win/win situation for me. The patient is happy, they continue to see me, and I get to keep my business small instead of hiring billing staff.
What questions do you have for me about billing in a cash-based practice? Please comment below—and be sure to check out all WebPT has to offer cash-pay therapy practices!