Healthcare Regulations

How Can a Physical Therapy Biller Improve the Quality of Physical Therapy RCM?

How can a physical therapy biller improve the quality of physical therapy RCM

Like any other practice that a medical field relies on, physical therapists also have to go with numbers as they have to obtain the amount for the services they have rendered. Unlike physicians in the healthcare industry, physical therapists are more likely to provide relief to patients through therapies that are more dealt with manually without using a range of apparatus until the patient’s needs. However, physical therapy billers have to deal with complex codes and claims that any other medical biller would.

Although physical therapy is a time-consuming treatment for a patient to actually feel relief from the intricacies and pain that they might have suffered after injury, physical therapists find it daunting to get into billing and filing claims for reimbursements. This is why hiring a physical therapist billing service is more important than hiring people at the office to handle coding and billing.

According to an estimation, one-third of healthcare costs in the United States go straight for administrative tasks and billing service is one of them. To cut costs, medical practices are integrating technologies and utilizing the benefits of digitalization to cut the cost and process error-less bills having a better chance of processing in the first attempt.

However, the chance of integrating the right software for your practice is all you need. How would you find out what billing software would fall perfectly for your practice billing? Here’s a complete discussion on the basic guidelines for your physical therapy billing, managing the RCM better, and the detail on how this solution can help in identifying a better special therapy billing process.

Guidelines to follow for a physical therapy biller

Guidelines to follow for a physical therapy biller

Physical therapy billing depends on the standardized billing system regularized by the World Health Organization specifically known as the International Classification of Disease codes (ICD-codes). After the current legislative amendments, the system currently used is ICD-10. Although the updated ICD-11 coding system is introduced, it will be completely standardized all over the US by 2025. The main reason for continuous amendments in the system is solution updates in the digital world of automation. With every update, it gets even easier to keep the system updated with the latest codes and solutions rather than changing them manually for every disease or symptom.

In addition, ICD-10 codes are not the only codes that are used in the medical billing system. The American Medical Association presented Current Procedural Terminologies (ICT) codes system is also integrated into the medical world. ICT and ICD codes are integral to each other. ICD-10 codes describe the condition of a patient following a range of diseases and symptoms while ICT codes define the treatment that a provider has advised to the patient.

For instance, in physical therapy, a cervical pain diagnosis will get ICD codes while exercises and therapies will get a CPT code.

In order to file a physical therapy billing claim, you need to add both codes following the standardized system i.e. ICD for the problem and ICT for the treatment or the solution you follow.

It may seem effortless, but there are hundreds and thousands of codes that a biller has to choose from which makes it extremely time-consuming to select the accurate code. Here an accurate code is extremely important because a minor mistake can pose serious consequences. Also, they can lead to the rejection of payments and the long resubmission process.

All in all, the shorter period your bills take to get cleared, the quicker you get reimbursements and treat patients without worrying about payments. This eventually makes your revenue cycle management smaller and the cash fluid runs smoothly throughout the system.

Steps to manage RCM effectively

Managing your revenue cycle management effectively includes a series of steps that you have to optimize individually in order to have long-term outcomes. Keeping that in mind, here are some steps for a smooth RCM plan;

Step # 1 – Eligibility verification and pre-authorization of Insurance

Smooth revenue management starts from acquiring all the necessary information about the insurance plans, demographic information, and any other eligibility detail to meet your practice’s financial practice. During these initial processes, you will get to know the patient’s capability of paying the finances for the services they acquire and the eligibility of the insurance plan they are enrolled in.

To make this process quick and smooth you can introduce transparent policies and utilize insurance verification tools to automate the process.

Transparent policies will enable you to realize and filter out the patients who can and cannot afford the services you provide. Besides, this will keep you from providing the services to those who would be a loss to your revenue and eventually save your time of calling/mailing/reminding them to pay your bills.

Steps to manage RCM effectively

Step # 2: Capturing charges

Once the eligibility is confirmed, as a physical therapist, you will see the patient and provide your services. AS you provide the services, it is important to record everything so the correct ICD and CPT codes would be used for the diagnosis and treatment and to target compensation.

By automotive software, the process of selecting the correct code is made simple and error-free. This quick thing can automate the workload and your staff will be free to perform other medical office tasks.

Step # 3: Submission of claims

Once the claim is coded properly, it’s time to submit it for compensation. A medical billing system is digitalized and is often integrated into every practice to automate the billing process with just a button press.

The quicker your claim process works, the quicker you will be reimbursed. Also, error-free coding and compensation processes will increase 99% the chance of timely reimbursement.

Step # 4: Receiving payments

Once the claim is raised and submitted, the concerned insurer will look at it and approve your compensation amount. It is also possible that your patient would be eligible to clear some out-of-pocket payments. For achieving these payments on time, you have to send patient statements and encourage them to make payments through an online portal using credit cards.


It is unlikely that you comply with the guidelines and still your physical therapy billing and claims get rejected. For such complexities, hiring a physical therapy billing service would be a perfect solution. It will not only release the pressure from the staff but make claiming, filling, and submitting less of your efforts.