• EDI, ERA, and EFT Overview for Rehab Therapists Image

    articleAug 27, 2019 | 4 min. read

    EDI, ERA, and EFT Overview for Rehab Therapists

    What would health care be without its love for initialism? And healthcare billing is no exception, which is why we decided to shed some light on three common ones: EDI, ERA, and EFT. If you’re in the rehab therapy billing world, you’ve probably heard these terms bandied about. But because they directly impact your practice’s ability to make money, it’s imperative that you’re crystal clear about electronic data interchange, electronic funds transfer, and electronic remittance advice definitions. …

  • 4 Common Reasons for PT Claim Denials (and What to Do About Them) Image

    articleAug 21, 2019 | 8 min. read

    4 Common Reasons for PT Claim Denials (and What to Do About Them)

    No one wants to deal with denials, but unfortunately, they happen. In some cases—for some PT practices—they happen a lot. And they can be a major drain on clinic resources and cash flow. The best method for dealing with denials—including medical necessity denials—is to prevent them from happening in the first place. With that in mind, here are four common reasons for PT claim denials—and what you can do to avoid them (or, at the very least, …

  • Stamp of Approval: How to Obtain Prior Authorization for PT Services Image

    articleAug 12, 2019 | 8 min. read

    Stamp of Approval: How to Obtain Prior Authorization for PT Services

    If you contract with third-party payers , then you’re most likely already familiar with the term [cue ominous thunder sounds] “prior authorization (a.k.a. preauthorization)”. And if you’re not yet, just wait. This Verywell article —written for patients—explains that when an insurance company requires prior authorization, healthcare providers must obtain approval from said insurance company before providing patient services, treatment, or equipment. Otherwise, the insurance company won’t pay for it—and either the provider or the patient will be …

  • 3 Times When You Absolutely Must Issue a Patient Refund Image

    articleAug 8, 2019 | 4 min. read

    3 Times When You Absolutely Must Issue a Patient Refund

    When we talk about the billing side of rehab therapy , we’re usually referring to getting money—not giving it back. However, failure to refund patients when necessary can result in some dire financial consequences—including heavy fines and other penalties. The government is pretty clear about its stance on this: according to guidance from the Office of the Inspector General (OIG), “Billing companies should institute procedures to provide for timely and accurate reporting to both the provider and …

  • Founder Letter: The Cost-Shifting Conundrum: How to Combat High Patient Copays Image

    articleAug 6, 2019 | 9 min. read

    Founder Letter: The Cost-Shifting Conundrum: How to Combat High Patient Copays

    In our 2019 State of Rehab Therapy survey , 80% of respondents cited payer requirements as the top reason their organizations require physician referrals as a condition of treatment (even in states with unrestricted direct access ). Additionally, high copays and coinsurances were by far the top-ranked regulatory issue in terms of impact to the physical therapy industry and profession. In other words, as it stands, the insurance industry (and its propensity to shift costs onto patients …

  • Credentialing vs. Contracting: Everything Rehab Therapists Need to Know Image

    articleAug 2, 2019 | 6 min. read

    Credentialing vs. Contracting: Everything Rehab Therapists Need to Know

    There’s a lot of confusion about the difference between credentialing and contracting —as well as what PTs, OTs, and SLPs must do to complete each process. In fact, questions about the insurance credentialing process are some of the most common inquiries we get from new clinics. So, I decided to do a little digging. And with some help from clinical-biller-turned-WebPTer Asia Giuffrida, our Therabill Onboarding Team Lead, I’ve compiled everything rehab therapists need to know about credentialing …

  • The Difference Between Medicare and Medicaid Billing and Reimbursement Image

    articleJul 31, 2019 | 8 min. read

    The Difference Between Medicare and Medicaid Billing and Reimbursement

    At first glance, Medicare and Medicaid might seem like twins, or a dynamic duo, or two peas in a pod—basically, inseparable. They’re both government healthcare programs; they were both created at the same time ; they’re both confusing and usually don’t boast the best reimbursement rates ; and they even sound alike (they both start with “Medi-,” right?). In reality, though, these two programs are very, very different. For starters, Medicare is a federally run program, which …

  • The Rehab Therapist's Guide to Using CMS-1500 Claim Forms Image

    articleJul 29, 2019 | 17 min. read

    The Rehab Therapist's Guide to Using CMS-1500 Claim Forms

    Healthcare billing can get even the best billers tangled up in knots—and it’s no wonder why. Between tracking and adhering to shifting payer guidelines, managing patient claims, verifying insurance , and defending against denials , billers are pulled and twisted in a million different directions. That’s why it’s so important to have a strong billing foundation; a concrete understanding of your billing basics will help you pivot and twirl and handle the whirlwind of the billing office …

  • Physical Therapy Billing for Beginners Image

    articleJul 26, 2019 | 7 min. read

    Physical Therapy Billing for Beginners

    Most physical therapists chose this profession to help people—not to become the world’s greatest biller. And yet, in order to stay in business long enough to truly make a difference for your patients, you’ve got to know how to make a profit—and that requires a solid understanding of PT billing. If you’re new to physical therapy, you might be feeling a little overwhelmed by the prospect, so below, we’ve provided some billing basics:  Codes ICD To properly …

  • Physical Therapy Billing Live Q&A Image

    webinarJul 24, 2019

    Physical Therapy Billing Live Q&A

    Billing Blunder Blues got you down? Let our RCM experts mend your broken heart. Anyone who’s worked on the revenue cycle management (RCM) side of rehab therapy knows how complicated things can get—it’s enough to make a ramblin’ man lose his mind. Whether it’s a payer that suddenly denies a claim (even though you’ve submitted similar ones a thousand times before without issue) or confusion over which CPT code to select for patient education, a whole lotta …

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