Coronis Health, Physician

Long Term Care/Rehab/Physiatry

Long-term care, physical medicine, and rehabilitation providers face unique challenges that can cost facilities vital resources.

Pain management billing encompasses a variety of specialties from different providers. Most medical billing processes center on the procedure and the diagnosis of the patient. Unlike other types of medical billing, pain management and physical therapy Current Procedural Terminology (CPT) codes include both the procedure and the anatomical location of where the procedure will be performed.

Physical therapy, podiatry, and pain management billing require a level of expertise and sophistication to utilize certain modifiers and an understanding of how global days affect relative treatment procedures. Proper coding of aspirations, pain pumps, and injections are also expected to satisfy the pain management billing procedures.

With 35+ years of revenue cycle management (RCM) experience, Coronis Health understands the importance of staying ahead of the curve when it comes to changes and updates to medical billing codes, insurance industry regulations, and requirements for pain management and physical therapy facilities.

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6 Common Types of Physical Therapy You Should Know

Physical therapy billing is a complex process. With multiple specialties, unique CPT codes, and a wide range of robotic and assistive devices, physical therapy facilities often lose out on revenue for services rendered. Coronis Health appreciates the intricacies of physical therapy billing for various specialties. Our team is committed to optimizing your facility’s RCM for maximum revenue.

Popular types of physical therapy specialties include: 

Neurological Physical Therapy

Neurological physical therapy focuses on the evaluation and treatment of nervous system diseases and injuries, such as:

Many physical therapy facilities strive to improve patient mobility, muscle function, and postural alignment through hands-on techniques, like exercises, assistive devices, and core stabilization. 

Understanding the billing process for these treatments can be a full-time job in and of itself, particularly when you need concrete data to seek reimbursement for justifying the use of robotics and other assistive technologies.

Occupational Physical Therapy

Occupational physical therapists help patients participate in their daily activities, such as work, school, and even their tasks at home. Occupational therapy allows patients with injuries and degenerative diseases to reclaim their independence.

Missing certifications, incorrect modifiers, and underbilling fixed-rate payers are among the most common challenges occupational therapy facilities face when seeking reimbursement. Outsourcing to an experienced revenue cycle management company like Coronis Health ensures that no documentation or coding errors slip through the cracks.

Geriatric Physical Therapy

Geriatric physical therapy delivers whole body care to aging populations. With costly equipment and extended reimbursement times from Medicare/Medicaid, geriatric physical therapy facilities often struggle with overhead costs that make it difficult to hire in-house billing and coding specialists.

Pediatric Physical Therapy

Pediatric physical therapists enable children with injuries, degenerative conditions, and other disabilities to function independently at home, school, and in social settings. While physical therapists play a critical role in their clients’ ability to function, consistent underbilling, denials, and lost reports can threaten the financial health of their facilities.

Rehabilitative Physical Therapy

Rehabilitative physical therapy helps patients improve their physical function after an injury. Although rehabilitative therapy is an essential recovery tool, the billing and coding process for services rendered is often too complicated for facilities that are already stretched thin in resources. 

Underbilling fixed payers, misuse of the therapeutic exercise code, and incorrect plan of care documentation can delay reimbursement and take much-needed revenue away from these facilities.

Hand Physical Therapy

Hand physical therapy targets strength and range of motion in the upper extremities. As a result, many therapists integrate orthosis and assistive devices into their treatment plans. These devices can significantly improve a patient’s hand function, but the restrictions that the Centers for Medicare & Medicaid Services (CMS) have placed on reimbursement for certain braces and assistive devices can hurt a facility’s bottom line.

Coronis Health has been working with pain management, physical therapy, and ambulatory surgery centers for over three decades. Our billing and coding professionals understand the unique challenges that physical therapy facilities face.

Outsource Billing

Enlisting the assistance of professional medical billing companies is the preferred course for several pain management centers in order to assist in turning their revenue cycle management into a success. While the medical staff of a physician practice is skilled at assisting day-to-day activities in the clinic, or medical facility, other responsibilities in the job may hamper productivity when billing tedious pain management and physical therapy claims.

Self-Audits

Pain management and physical therapy facilities can be adversely affected by a streak of erroneous billing claims from most pain management practices. Experts always advise medical practices to perform self-audits and ensure that all data submitted to the payer, or insurer is one hundred percent accurate. Most pain management and physical therapy facilities assess their own practice in reviewing their office’s conformity with CMS guidelines for rendering pain management services.

Erroneous Billing

According to the Office of the Inspector General (OIG), pain management billing is one of the most erroneous billing in the medical industry. This may be attributed to an inconsistency in the documentation.

Pain management billing is always reviewed with a higher level of scrutiny to make sure that reimbursements are fair to both the pain management practice, and the insurer.

Pain management centers are not the only medical practices that experience scrutiny from auditors. However, insurance payment auditors cannot discredit the fact that pain management and physical therapy claims have an elevated margin for error. Based on several sources, the technicalities of pain management billing always get the best of clinicians.

CPT codes provide accurate descriptions of the procedure. Performing an internal audit will expose areas for improvement to enhance accuracy in billing and prevent adverse auditing.

Find out how we can maximize revenue for your facility by scheduling a free financial health checkup today.

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