Physician and occupational therapy are riddled with their unique billing challenges. This is in part due to the wide variations in utilization and treatment procedures. The most important reason behind the complexity of physician medical billing is time-based reporting.
Both the therapist and the patient spend hundreds of hours working together to help the patient be physically fit. During treatment, a physician will introduce variations as per the needs of the patient.
Every change in a rehabilitation regimen requires therapists to use a different CPT code to record the treatment procedure. The change in coding is dictated by the total amount of time spent by the therapist on specific treatment procedures.
A Closer Look
To understand the complexities of physician medical billing, it is important to get into the details first. The following are the main attributes of physician therapy that add to the complexity of the billing process.
Areas of The Body: Physician therapy covers the rehabilitation needs of the entire musculoskeletal system of the human body. Specific regions of the body require a specific approach. This means the billing process follows this variation as well. Providers need to be specific to justify CPT codes used in the therapy, to receive reimbursements.
Need to Count Units of Time: Payers usually require therapists to consolidate time-based services. Sometimes some care plans require therapists to report these services separately. The sheer amount of variations in the reporting process makes physician medical billing very complex.
Using Modifiers: - Physicians use ‘modifiers’ to denote medical procedures. They need to be aware of and use modifiers accurately. This enables insurance companies to distinguish from group-based therapy sessions and individual sessions that need to be repeated to get a patient back to optimal fitness levels.
Review of Referrals and Utilization: Ensuring that a treatment plan is necessary for a patient should be the primary goal of a therapist. This crucial step saves therapists from dealing with denied claims in the long run. Making the perfect case for utilization can be a lot of work, given the variety of treatment options and regimen changes required during treatment.
Documentation of Physician Presence: The need to document the physical presence of a therapist or a doctor at the time of treatment is vital for physician billing. There are numerous reimbursement caps required by Medicare and they are extremely particular about them. These caps are differentiated based on treatments that require the presence of the therapist at the location of therapy. These caps make physician medical billing and its documentation all the more complicated
The complex nature of physician medical billing requires the help of a dedicated workforce that has the experience to manage it well. Physicians who
choose to outsource physician medical billing services stand to improve the bottom line of their medical practice significantly.
