Yesterday, we covered some of the basics of physical therapy billing. (If you missed it, you can read the article in full here.) Today, let’s keep things moving with a few more therapy billing tips:

(In case you missed this blurb in the last post, I’ll say it once more for good measure: This article is by no means comprehensive, so we definitely recommend you seek the services of a billing expert before taking action.)

The Forms

Most payers—and providers—prefer to bill using electronic claim forms. However, some payers do still accept paper claims. According to the APTA, the most common form is the Universal Claim Form (CMS 1500), although some payers may have their own.

The Process

Per the APTA, once you provide your services, you’ll submit a bill to either your patient or a third-party payer. In some cases, however, you may actually provide the billing information to a claims clearinghouse that will then prepare your bill on your behalf. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 covers healthcare claim transactions, so be sure you’re compliant with the Electronic Healthcare Transactions and Code Sets Standards.

The Verification

Before you submit your bill—actually, before you begin treatment—it’s extremely important that you verify patient information, the financially responsible party, and insurance information, including the primary and secondary plans if applicable. This will help you to submit a “clean” claim, which according to the APTA is one that is “complete, accurate, and in the case of a paper claim, legible.”

The Software Solution

Many providers use billing software to prepare and submit their claims. There are even electronic medical record systems that integrate with popular physical therapy billing software to eliminate the double data-entry that can often lead to errored claims. However, if you choose to go this route, the APTA insists that you select a service that is fully HIPAA compliant. For more information on finding the right billing software, check out this article.

The Copayment

If your patient has a copayment, the APTA says you can collect that when you provide your services. In most cases, it is inadvisable to waive the copayment or deductible amount, especially for private insurance beneficiaries. However, there are other ways to offer financial aid. For more information on what’s acceptable, thoroughly review your insurance contracts.

The ABN

Should you wish to provide a Medicare patient with services that you believe aren’t covered or medically necessary, you can have the patient sign an Advanced Beneficiary Notice (ABN) acknowledging financial responsibility should Medicare deny coverage. To learn more about the ins and outs of ABNs, read this article.

The Defensible Documentation

One of the best ways to support your billing process is to ensure your documentation is defensible. Ultimately, it’ll help you demonstrate medical necessity so you receive appropriate reimbursements. Plus, should you ever be the subject of an audit, you’ll be happy you spent a few extra minutes thoroughly describing the patient’s history, your interventions, and your clinical decision-making process. It’ll make a big difference in your ability to justify payment.


Have any great physical therapy billing for beginners resources? Share them in the comments section below.