I am often asked how I document and bill for visits in my cash-based 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 up front!” 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 adopt some cash-based services.
The advantage of being cash-based is that I enter into a contract with the patient to provide physical therapy services in a manner that I have determined will help them reach their goals most efficiently. The thorn on the rose is that 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.
You may find it shocking, but my 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, it’s the patient who is waiting for reimbursement. I am required to document evaluations and treatment visits just like any other physical therapist. I use WebPT for my documentation because I like the portability of EMR, the lack of paper charts to store for seven years in my basement (I just got rid of some from seven years ago!), and the professional quality of the notes I send to physicians and other professionals. My documentation provides the support for my billing.
My physical therapy billing is quite simple. I charge a flat rate for the first visit/evaluation (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 charge never changes based on the interventions I use. Patients pay with credit or debit cards (I use Square on my iPhone for charges). I provide patients with an invoice at the time of service and they submit that invoice to their insurance company for reimbursement. The invoice has all of my pertinent business information (contact information, tax ID, etc.) as well as the patient’s ICD-9 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 varies widely from one company to another. I provide information to assist patients in navigating their benefits as well as any necessary paperwork to help with authorization for companies that require it. (Yes, even cash-based practices have to request authorization!)
Through careful documentation and billing practices, I assist patients in receiving reimbursement for the services I provide. It is a win/win situation for me and the patient and has allowed me 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!
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