We understand the many specialties that fall under physical medicine, we can help build your business.
Physical medicine can encompass a variety of treatments. Physiatrists are able to bill multiple elements of physical medicine and rehabilitation aspects including physical therapy services, evaluation and management services, and consults.
Physical therapists often bill out the E&M codes, as well as modalities, stimulation, and manual therapy components. A key component in all of this is understanding the limitations of each code, as well as the bundling the associated procedures.
Etransmedia’s team of physical medicine experts have the knowledge and skills necessary to successfully work denials and provide our physical medicine clients with valuable feedback to assist in managing and decreasing the most frequently seen denial types. We have streamlined this process to make it efficient and cost effective. We have also extensively researched guidelines and limitations for each frequently used CPT code. Getting you paid fast!
What we know…
Here are some of the complications that are affecting physical medicine revenue collection procedure:
No precertification or authorization: Many physical therapy codes (especially modalities) are required to have an authorization or precertification in place to obtain reimbursement. We work with our provider offices to ensure that they are aware of carrier requirements, and are obtaining the required authorizations prior to the patient being seen.
Benefits exhausted: In a specialty where patients are seen twice a week for months at a time we often run into denials where a patient has exhausted their benefits. It is important to check a patient’s coverage information at each visit to make sure that the office and the billers are aware when benefits max are reached and no longer payable, or are patient responsibility.
Timed codes denials or underpayment: Some physical medicine services, such as the ultrasound and therapeutic exercises, are billed out based on the number of minutes the provider spent performing the service. Timed codes must be documented both in the notes and on the super bill for reimbursement by the carrier. It is essential that this information is communicated to the biller to ensure that ALL services are captured, billed out appropriately and reimbursed at the correct level.
Bundled services: It is not uncommon to see services or supplied unpaid because of bundling policies at the carriers. Etransmedia works with our clients to make sure that they are aware of these policies, so that providers can effectively manage costs in the practice and understand the reimbursement rates trends. We also pull both carrier policy and contracts to make certain the bundling and reimbursements are appropriate.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for Physical Medicine practices. Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date on what is happening in their practice so any issues can be addressed quickly. Having an experienced medical billing team who understands the details of physical medicine, with visibility into performance, is vital to your practice’s financial health.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package