Physical Therapy Billing: Tips and Guidelines

6 min read

Generally, a physical therapist is identical to any other healthcare provider, and they usually don't get information about the profession, for they like to work with digits or numbers. Although, no practice can succeed unless they develop the understanding about complicated medical and physical therapy billing services.

Similar to any several other medical billing procedure, physical therapy billing is dependent on matching solutions administered with standardized codes that allow insurers and relevant parties to know exactly the types of regime a patient receives and what amount is due to the practitioner. It is time-consuming when performed manually, but it is well-suited for automation and digitalization.

According to recent reports, it has been projected that over 1/3 of US healthcare costs are measured for administrative and human resources tasks that include medical billing and vice. Incorporating an online billing solution will seamlessly impact your general practice's profitability by decreasing the time required to process multiple bills and drastically leveraging the option that is effectively charged to process the first instance.

Although, how would you opt for the well-suited software to enhance your billing aspects? Hence, in this post, we'll discuss some FAQs about physical therapy billing, the overall steps required to effectively manage your billing cycle or revenue, and look for solutions to expedite your process of physical therapy billing.

Guidelines for Physical Therapy Billing

Physical therapy billing mainly depends over the standard code from the WHO known as International Classification of Disease (ICD) code. The prevailing system of code is known as ICD-10 by an improved set of codes, ICD-11 that have been developed and are expected to progress in 2025. They would be regularly updated and integrated to an online system. It seems to be easier for to keep up with the automation and with the current code alternations instead of doing it in a manual order.

Steps for Revenue Cycle Management

The proper revenue cycle of the physical therapy spans across an array of steps, allowing you to optimize each of them in an individualistic manner. Understanding the significance of physical therapy billing units is crucial in this process. With that said, here are some of the five stages for a revenue cycle that’s exclusive in its class:

Eligibility Verification and Authentication

The revenue cycle of a physical therapy practice initiates with acquiring a patient's insurance and demographic details and cross-checking their eligibility for financial aid. During the pre-authentication and registration step, you can determine the mode of payment for your patient for the services rendered to them by the practice.

In terms of a practitioner, they can refine this phase by introducing transparency with the policies of pricing and making the best possible use of digital tools for insurance verification. Furthermore, the communicated pricing will assist you in managing patients for whom your services are expensive, which makes your practice more efficient and resourceful. Hence, the digital patient eligibility verification tools and aspects will enable you in a real-time environment as patient's insurance will have to be covered in their treatment, sparing your staff's precious time.

Step # 2 – Capture Charges and Renders Services

Once you have verified patient’s insrance eligibility and completed the patient's intake documentation, the patient can then see a physical therapist and avail of their services. After you're done with it, it is essential to keep a track record of everything via ICD and CPT codes allowing you to correctly capture the costs for the compensation.

Proper medical billing programs helps you to simplify this step in dramatic order. It allows you to search and enter the correct codes instantly and effortlessly. A handful of billing applications will eventually eradicate the claims to ensure accurate coding of each claim. It helps you assign your staff to other work activities to improve the options so your claim is impeccable processed.

Step # 3 – Entitling Claims for Submission

As the claims are accurately coded and prepared for submission, it is always the righteous thing to do the first thing to reimburse your money. A digital medical billing solution makes it relatively easy and effective, as it gets integrated with the workflow, which allows it to perform on a single button press.

Leveraging the submission of your claims procedure focuses on improving your initial pass or cleaning the rate of claim that is classified as a claimed percentage accepted for the first instance. You need to pick up a solution that claims to eradicate and acts as an internal clarification host to validate your accuracy as the best possible solution to attain a clean claim ratio of over 91-99%.

Step # 4 – Making Payments

After reviewing the claim and once it gets endorsed by the payer, your collection will be entitled to be carried forward. In several situations, the patients may be held responsible for no cash at their disposal, which is entirely based on you for collection purposes. The sole purpose is making it easier for the patients to pay you, formulating numerous possibilities.

Step # 5 – Data and Information Reporting

After you've gathered all concerning relating to a particular place, a specific digital dashboard highlights the best possible way to search for adjustments behind your general practice's success, enabling you to improve consistency upon them.

From a beginner's perspective, you'll identify and evaluate an average baseline for the overall tenure of the entire revenue workcycle, number of patients you see every week, the number of no-shows you've determined for an idea, following a few more relevant metrics. A robust and fine-tuned dashboard will help you identify and examine that particular data set to gather profound reports on patient's management and financial performance metrics to explore on the ways encouraging their enhancement.


Indeed, the right set of software is crucial in unbridling the abilities for the improvement of entire PT billing management cycle. Hence, you need to search for a billing company that provides a collection of RCM systems, as per the automated insurance eligibility verifications to ease digital payment and in-depth data and information reporting tactics.

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