No one wants to deal with denials, but unfortunately, they happen—and, in some cases, for some PT practices, they happen a lot.
So, you’re opening a brand new PT private practice—but is your billing process actually ready to handle patients?
Are you happy with your billing system? Would you recommend it to a friend? Those might be tough questions to answer truthfully, especially if you’re the one who chose your practice’s billing software or service.
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).
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.
Software? RCM Service? A little bit of both? Which one’s right for your practice?