Customer billing is a vital element of any business operation. It involves the collection of payments from clients for the goods and services the organization has provided. An efficient billing process ensures that customers are billed accurately and on time and helps minimize complaints and disputes, promoting customer satisfaction. As technology and business practices evolve, organizations must keep up with the latest billing techniques and technologies to maintain efficiency and effectiveness.
In this article, we will explore the best rehab billing practices for 2023, providing insights and recommendations to help ensure that your clinic is operating at its full potential. By implementing these best practices, you can enhance the efficiency of your billing process, improving customer satisfaction and the overall success of your organization.
Codes for Rehab Billing
International Classification of Diseases (ICD)
Before billing clients, you need to document the medical diagnosis of your patient to show the necessity of your services. The documentation should use the ICD-10 codes, an update of the International Classification of Diseases, for the clinic to receive reimbursement for its services. The coding system is more complex, and deciding which codes to use might be challenging. However, rehab therapists should select codes that accurately reflect the diagnosis. When you need clarification on whether the codes you’ve used are reimbursable under the client’s payment policy, contact the client before issuing the claim. The American Physical Therapy Association (APTA) suggests this approach since it ensures claims are paid after the first submission, reducing the necessity of appeals.
Current Procedural Terminology (CPT)
CPT codes are a uniform way to report medical services or procedures to the payers. The American Medical Association (AMA) developed these codes as widely accepted medical nomenclature. The APTA states that rehab clinics should utilize the CPT-4 codes to bill third parties for the services rendered. CPT may not precisely describe the rehab therapist’s interventions, but it provides a reliable framework for billing.
The CPT codes concerning rehab therapists are in the 97000 sections. However, the clinic can bill any code representing its services, provided the service is legal under state law. Legally, billing the code does not guarantee reimbursement; hence, discussing it with your clients before offering the services is crucial. Here are the CPT categories that rehab therapists need to know before billing any services.
- PT evaluations referenced by codes 97161-97163 and OT evaluations referenced by codes 97165-97167 are both tiered according to their complexity:
- PT re-evaluations are referenced by code 97164, and OT re-evaluations are referenced by code 97168.
- The codes 97010–97028 indicate untimed supervised modalities.
- Constant attendance modalities referenced by the codes 97032–97039 are one-on-one and billable using 15-minute increments.
- Therapeutic procedures referenced by the codes 97110–97546 are one-on-one.
- The codes 97597–97606 indicate wound care management.
- Measurements and tests referenced by the codes 97750–97755.
- The codes 97760–97762 indicate prosthetic and orthotic management.
One-on-One and Group Services Billing
It is generally not advisable to use Current Procedural Terminology (CPT) codes for one-on-one services when providing group rehab services. One-on-one services involve direct, individualized attention from a therapist, while group rehab consists of multiple patients receiving treatment simultaneously.
While it is possible to bill for one-on-one services when working with multiple patients, it is important to follow the Centers for Medicare and Medicaid Services (CMS) guidelines. These guidelines allow one-on-one sessions to be conducted in intervals, with sufficient time to provide the necessary treatment. In contrast, group rehab requires constant attention from the therapist, who must attend to multiple patients. Therefore, it is appropriate to bill for these services as a group unit. By following these billing guidelines, rehab clinics can ensure compliance and avoid potential audits.
Billing Forms
Today, most rehab clinics prefer to use electronic claim forms. Rehab therapists use the CMS-1500 claim form, a standard claim form for health care services. You can also print and fill out the claim form for the paper-only payers still around. After offering rehab services, you submit the bill to your patient or third-party payers for reimbursement. You can also use a claims clearinghouse to create and submit the bill on your behalf. Healthcare claim transactions fall under the Health Insurance Portability and Accountability Act (HIPAA); hence, a rehab clinic must adhere to the standards.
Payment Process: Software or Service
Software Billing
Most rehab clinics use billing software to create and submit their billing claims. A software billing system eliminates errors and prevents double entry. When using this method of billing, always ensure it is HIPAA compliant. A software billing system should have the following features:
- Claim tracking
- Payment posting and EOB
- ERAs
- Clearinghouse integration
- Patient Portal, billing and invoicing
- Insurance eligibility verification
- User-friendly interface
- Custom reports
- Detailed activity logs
Service Billing
Rehab clinics that want a hands-off solution can outsource billing to specific billing services. The services offer professional revenue cycle management and maximize reimbursements while minimizing the denials. Service billing ensures your billing is well handled and keeps you on top of some confusing claim processes. Your billing providers must produce accurate and clean claims that expedite payments. Integrating it with the EMR creates a seamless workflow and no data duplication. A service billing provider should have the following:
- Experienced billers.
- A 98.5% acceptance rate for a first-pass claim.
- An almost-perfect retention rate.
Credentialing Process
At a rehab clinic, it is essential to be credentialed by insurance companies to operate as an in-network provider and offer services to a wider patient base. Many payers, such as Medicare, only allow credentialed providers to treat patients and bill for services. To become credentialed, several requirements must be met, including:
- Malpractice insurance
- A National Provider Identifier Standard (NPI)
- A physical location for the clinic
- A state license to practice
Obtaining credentialing can be a complex process. It may be helpful to hire a consultant or seek guidance from an established clinic to ensure that all necessary paperwork is in order and to receive tips and tricks for navigating the process. By taking these steps, a rehab clinic can increase its reach and offer high-quality care to more patients.
Streamlining Rehab Clinic Billing with Logik
Clinic budgets sometimes become tight, and you must start collecting the money owed to meet the revenue targets. It means you require a streamlined billing process to maximize collection and increase reimbursements. With these updated billing tips, you can develop working strategies for your rehab clinic to ensure you make profits in 2023. At Logik, we understand the unique challenges of managing a rehab clinic. That’s why we have developed a comprehensive billing software solution to help streamline billing operations and improve efficiency.
By automating these processes, our software helps rehab clinics increase revenue and provide better care for their clients. With the billing duties handled by the software, clinic staff can focus on providing top-quality patient care. Our secure, integrated solution also simplifies the claims process, making it easier for clinics to get paid for their services. If you’re interested in learning more about how our billing software can benefit your organization, don’t hesitate to schedule a free demo.
We look forward to demonstrating how Logik can help you maximize your revenue and achieve success.