Some things are just better together, like peanut butter and jelly or milk and cookies. And for Medicare patients with other health insurance providers, few things are better than when Medicare and their private payers work together cooperatively.
Congratulations on your practice’s new addition! Bringing on a new PT can be a lot of work, but it’s also highly rewarding. There’s a lot to consider when you make such a big decision, and if you don’t cross all your t’s and dot all your i’s, the road ahead is certain to be bumpy.
Physical therapy billing is complicated enough. When you throw Medicare into the mix, it becomes an even bigger headache. But when you consider the fact that, as of 2015, more than 55 million Americans receive Medicare coverage, every physical therapist is bound to contend with Medicare rules at some point.
Is your relationship with billing complicated at best? I get it. Figuring out how to bill insurance companies for private practice physical therapy can seem daunting, especially in light of ever-changing regulations.
Charging different rates for the same therapy service is possible—sometimes. Learn how to navigate the legal minefield of discounts here:
No one wants to deal with denials, but unfortunately, they happen—and, in some cases, for some PT practices, they happen a lot.
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.
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.
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).