• Founder Letter: Out of Pocket, Out of Luck: Why Patients Can't Always Pay Cash—And Why PTs Should Care Image

    articleAug 2, 2017 | 6 min. read

    Founder Letter: Out of Pocket, Out of Luck: Why Patients Can't Always Pay Cash—And Why PTs Should Care

    In a perfect world, health care wouldn’t need reform; patients would have access to quality, affordable care and providers would be paid well for their services without having to jump through onerous—and numerous—regulatory hoops to minimize the potential for fraud and abuse. But we don’t live in a perfect world, which is why patients and providers—including PTs, OTs, and SLPs—are understandably frustrated with the status quo. To gain a better understanding of the state of rehab therapy …

  • What 500,000 Evaluative Notes Told Us About the New CPT Codes Image

    articleAug 2, 2017 | 7 min. read

    What 500,000 Evaluative Notes Told Us About the New CPT Codes

    Back in January, PTs and OTs experienced a pretty dramatic shift in the way they coded for initial evaluations. As you probably—hopefully—recall, this change required therapists to select evaluation CPT codes based on the complexity of each individual eval. (If this doesn’t sound familiar—or if you want a refresher on the details of the new evaluation code set—then I’d recommend reading this post ASAP.) This was a major change—one that thrust our entire profession into uncharted territory. …

  • When Should I Use Modifier 59? Image

    articleJul 28, 2017 | 7 min. read

    When Should I Use Modifier 59?

    In a PT’s paradise, the billing process wouldn’t exist. Therapists would simply provide treatment and receive payment accordingly, no explanation—or coding—required. In the real world, though, claims—and the codes and modifiers you submit with those claims—are your ticket to getting paid. And in many situations, one little modifier could have a big impact on your bottom line. Such is the case with modifier 59. Not sure of the rules governing proper use of this much talked-about modifier? …

  • The 8-Minute Rule: What it is and How it Works in WebPT Image

    articleJul 28, 2017 | 8 min. read

    The 8-Minute Rule: What it is and How it Works in WebPT

    With most buyer-seller transactions, calculating the cost of a product or service is fairly simple. There are no complicated formulas for determining the monetary value of a pizza or a movie ticket; you simply pay the business’s advertised price. When it comes to Medicare’s payment for rehab therapy services, however, things aren’t always so simple. Yes, I’m talking about the dreaded 8-Minute Rule (a.k.a. the Rule of Eights). The Basics The 8-Minute Rule governs the process by …

  • Cashing In on Private Pay: The PT's Guide to Going Out-of-Network Image

    webinarJul 27, 2017

    Cashing In on Private Pay: The PT's Guide to Going Out-of-Network

    For many rehab therapists, submitting a claim to a third-party payer feels a lot like pulling the lever on a slot machine. You never know for sure what you’re gonna get—and most of the time, it’s less than you’d hoped for. With seemingly ever-increasing regulations—and constantly shrinking reimbursements—it’s no wonder so many PTs, OTs, and SLPs feel like the financial odds are stacked against them.

    As a result, more and more rehab therapy providers are trying …

  • Legal Compliance: One More Reason to Collect Patient Deductibles and Copays Image

    articleJul 24, 2017 | 6 min. read

    Legal Compliance: One More Reason to Collect Patient Deductibles and Copays

    Collecting coinsurance, copays, and deductibles upfront is an important piece of the effort to accurately value the services we provide. And yet, we still hear about practices that routinely waive their patients’ deductibles and copays. Today, I’ll discuss another reason not to routinely waive deductibles and copays. In the past, I’ve written about collecting deductibles and copays when a patient presents with a federally funded insurance like Medicare . In cases involving the Department of Justice, the …

  • Physical Therapy Billing for Beginners, Part 1 Image

    articleJul 16, 2017 | 5 min. read

    Physical Therapy Billing for Beginners, Part 1

    Of course, you got into physical therapy to help people—not to rake in the dough. But in order to do the former well, you’ve also got to know how to make a profit—and that requires billing for your services. If you’re new to physical therapy, you might be feeling a little overwhelmed by the prospect, so here are a few things to remember about billing for physical therapy services—the basics, if you will. (Keep in mind that …

  • How to Bill for PT Assistants Providing Physical Therapy Services Image

    articleJul 12, 2017 | 5 min. read

    How to Bill for PT Assistants Providing Physical Therapy Services

    This post comes from PT Compliance Group compliance officer Tom Ambury, PT, and WebPT President Heidi Jannenga, PT, DPT, ATC/L. We get a lot of questions when it comes to billing for private practice PT services. One of the most common has to do with billing for licensed PTAs—especially when Medicare and state practice acts have different requirements when it comes to supervision . Our advice? Adhere to the most stringent requirement, which usually comes from Medicare. …

  • The Dos and Don’ts of Working With Insurance Companies Image

    articleJul 7, 2017 | 6 min. read

    The Dos and Don’ts of Working With Insurance Companies

    In 2016, Forbes reported that doctors spend more than 66% of their time on paperwork. And a good deal of that paper-pushing is insurance-related. There’s no denying that working with insurance companies is a challenging—yet required—part of running a rehab therapy clinic. One of the biggest hurdles in this professional relationship is negotiating contracts. Most medical professionals have at least heard a story of a nightmare negotiation that led to nothing but frustration. Ultimately, insurance companies usually …

  • How to Stay in Business in this Uncertain Healthcare Environment Image

    articleJun 29, 2017 | 17 min. read

    How to Stay in Business in this Uncertain Healthcare Environment

    Health care as we know it is changing. But that’s nothing new, right? Health care has been in a state of flux for a while now—what with ever-changing payer regulations and the steady push toward more patient-centric, value-based collaborative care. And while putting patients first is surely good for everyone, increasing regulations—and decreasing reimbursements—can make it challenging for providers to keep up, let alone keep the lights on. That’s why we’ve spent much of this quarter discussing …

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