PTs, OTs, and SLTs: Stop Making These Billing Mistakes

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Medical billing and coding are complex, and the rules are always changing, which can lead to mistakes that can ultimately impact your practice’s revenue because of delayed reimbursements, financial losses, and even legal consequences. In this blog post, we’ll discuss the most common billing mistakes that physical, occupational, and speech therapists make, and how to prevent them from occurring.

 

General Billing Mistakes

  1. Inaccurate Client Information: One of the essential practices when billing is to ensure that the client’s information is correct. This information includes the client’s name, address, insurance details, phone number, and social security number. It is crucial to ensure that this information is updated and accurate.
  1. Coding Errors: When filling out claims, therapists must follow CPT (Current Procedural Terminology) codes for each service rendered. Using the incorrect codes can lead to a denial of the claim, which can slow down reimbursement and cause a loss of revenue to the practice. In order to bill accurately, it is important to stay updated with the current coding guidelines and regulations. Verify the specific requirements for each code, such as time-based billing, supervision requirements, or any special modifiers that may be necessary. Adopt a system for regular code updates and staff training to minimize coding errors. Some EHRs can use your AMA license to have codes handy. If you need more information about coding, here are guides for physical, occupational, and speech therapy.
  1. Missing or Incorrect Signature: The client’s signature is a crucial element of a valid billing claim. A miss or an incorrect signature can lead to claim rejection or denial. You must make sure that the client’s signature is present, clear, and valid. Your EHR should alert you when signatures are missing, and allow you to send documents for virtual signing via the client portal.
  2. Inaccurate or Insufficient Documentation: One of the most common mistakes therapists make is failing to properly document the treatment provided. Incomplete or inaccurate documentation can lead to claim denials or audits. It is crucial to capture all patient details, treatment goals, interventions, and the progress made during each session. Ensure all documentation includes the necessary codes and descriptions, as well as the medical necessity of the services provided.
  3. Overbilling or Underbilling: Both overbilling and underbilling can have serious implications. Overbilling, intentional or not, can lead to severe consequences, including fraudulent claims and penalties. On the other hand, underbilling may result in financial losses and reduced reimbursement. It is essential to ensure accuracy when documenting and coding services, aligning them with the actual treatment provided and the applicable billing regulations.
  4. Lack of Timeliness: Timeliness is key when it comes to billing. Delayed submissions can lead to delayed payments or even claim rejections. Establish clear processes and timelines for claim submissions to avoid unnecessary delays. Regularly review and optimize your billing workflow to ensure claims are submitted in a timely manner, and payments are received promptly. Automated billing can keep your billing cycle timely without burdening your staff.
  5. Inadequate Follow-Up on Unpaid Claims: Unpaid claims can result from various reasons, including errors, denials, or missed deadlines. Failing to follow up on these claims promptly can result in lost revenue. Implement an effective system for tracking claims and establish a follow-up process to address any outstanding or denied claims. Regularly communicate with insurance providers to resolve discrepancies and appeal denials.

 

Insurance Billing Errors

  1. Not Verifying Insurance Coverage: Therapists often overlook the importance of verifying insurance coverage prior to providing services. This oversight can result in unpaid claims or unexpected denials. Verifying a client’s eligibility and benefits with their insurance provider before appointments should be standard practice. This step helps ensure that the client is eligible for the services provided and confirms whether the claim is covered by the insurance provider. Keep detailed records of all verification efforts, including contact information and authorization dates, to resolve potential discrepancies in the future. Some EHRs include reminders to verify coverage or alerts that a client’s coverage is ending soon.
  2. Not Verifying the Service Requirements: Insurance providers specify the requirements for services covered under a client’s insurance policy. If a therapist provides a service that is not covered under the client’s policy, the provider may issue a denial of claim.
  3. Improperly Using Modifiers: Modifiers are used to explain additional details of the service rendered. Using the incorrect modifier or using it inappropriately will affect the reimbursement and can eventually result in denied claims.

 

Medicare Billing Errors

  1. Not Documenting Therapy Effectively: Physical, occupational, and speech therapists are required to document the services provided to the clients adequately. If the therapy is not documented correctly, Medicare will not pay for the service rendered.
  2. Not Performing Functional Limitation Reporting: Functional Limitation Reporting (FLR) is a Medicare requirement where physical, occupational, and speech therapists must report a client’s functional limitation at the beginning and end of therapy. Negligence of this requirement will result in a denial of claims.
  3. Not Providing the Correct Amount of Therapy: Physical, occupational, and speech therapists must provide clients with the required amount of therapy. These treatments are to be provided according to the client’s plan of care allocated by the physician or the therapist. Any deviation from the scheduled plan of care can lead to the denial of claims.

 

For more information on how to submit Medicare claims, click here.

 

Medicaid Billing Errors

  1. Not Considering the Medicaid Fee Schedule: The Centers for Medicare and Medicaid Services (CMS) publish a Medicaid Fee Schedule that includes prices for covered services. It is essential to check the Medicaid fee schedule before providing services.
  2. Not Verifying Medicaid Program Requirements: Each state Medicaid program has its requirements for billing. Therapists should verify these requirements with their state’s Medicaid program before providing services.
  3. Not using NCCI (National Correct Coding Initiative) edits: The NCCI is a CMS program that works to reduce improper coding that leads to inappropriate payment of Medicaid claims. Physical, occupational, and speech therapists should ensure they use NCCI edits when preparing Medicaid claims.

 

Preventing Billing Mistakes

To prevent billing mistakes, physical, occupational, and speech therapists should adopt these practices:

  1. Establish accurate record-keeping practices to ensure documentation is complete and compliant. Standardize documentation and establish a workflow to avoid bottlenecks like supervisor signatures. Leverage your EHR’s templates and quick phrases, and keep them up to date.
  2. Conduct training sessions for all staff on the latest billing guidelines, practical aspects of coding, and correct use of modifiers. Provide easily accessible guidelines and information staff can check when in doubt. Your EHR vendor might also provide billing training and ways to use the EHR to bill more effectively.
  3. Train front desk staff to verify and authenticate clients’ information, eligibility, benefits and verify insurance requirements. This should be done before appointments. Your staff must also regularly check and update insurance coverage information.
  4. Use the electronic filing feature while submitting claims. Electronic claims filing ensures that the claims are correct and can track and resubmit the error holds. Your EHR should allow you to file batch claims and track claim status. Some EHRs, like Fusion, automate billing features like invoice and claims creation and processing.
  5. Establish a systematic review process to ensure the claims are correctly submitted and processed and monitor patterns of claim rejection or denial. Take advantage of your EHR’s reporting and dashboards to monitor claim status.

 

Alternatively, you can outsource billing to experts. By outsourcing your revenue cycle management, you can focus more on your clients and less on administrative tasks. This not only helps streamline your revenue cycle but also helps increase your revenue and cash flow. Fusion’s team of billing experts is well-versed in the latest industry regulations and guidelines to help ensure accuracy and compliance. By partnering with us, you can reduce your workload and improve your financial performance, ultimately allowing you to provide more quality care to your patients.

 

Physical, occupational, and speech therapists need to be aware of the risks associated with billing errors and the steps they can take to prevent them. Accurate record-keeping, verifying insurance and Medicare/Medicaid program requirements, using NCCI edits and correct documentation are essential to ensure a flawless billing process. Adopting and implementing these billing practices speeds up reimbursements and ensures a steady revenue flow to your practice.

 

Fusion’s integrated billing helps you save time and earn more money. We take the stress out of insurance billing with simple tools even non-billing professionals can use – without compromising on the functions you need to manage your practice’s financial side. Let us show you how much easier billing could be with Fusion. Schedule a demo today.

 

Fusion: The premier 
all-in-one solution for PT, OT, and SLP practices. Get a demo today!

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