How to Boost Physical Therapy Reimbursement in 4 Steps

Physical therapy reimbursement is a huge challenge for clinics, for a number of reasons:

• Billing codes need to be identified and documented for each diagnosis and treatment—and an incorrect code (or combination of codes) can be the difference between successful reimbursement and a denied claim. 

• Billing protocols change regularly. That means it’s essential you stay up-to-date if you want to submit compliant and accurate claims. As you might know already, clinicians usually don’t have the time or energy to stay on top of these rules. 

• The amount you’re reimbursed for each billed unit can change over time, too. When this happens, it can lead to unexpected cuts in revenue for your clinic. 

Plus, following up on denied or delayed claims typically wastes time, energy, and money for practices. Meanwhile, the costs keep adding up, with practices often expecting to lose more than 20% of their revenue due to payer denials. 

It’s no wonder that clinics typically turn to outsourced billing teams. But while it might save some time, it doesn’t always solve the problem of low reimbursement rates. For example, as small businesses themselves, conventional PT billing services often only have time to chase the larger outstanding reimbursements. They tend to leave the smaller sums unpaid. 

In our experience, these smaller claims can be the difference between your practice just breaking even and making a profit. And PTs across the U.S. know there’s a better way to optimize physical therapy reimbursement claims—by partnering with StrataPT. 

In this post, you’ll learn how you can maximize your successful collections and receive a 99.999% reimbursement rate, while cutting back on documentation time and removing the need to keep track of changing billing codes and payer reimbursement rules. And because we do all the heavy-lifting, you’ll never need to chase a denied claim again. 

4 Steps to boost your physical therapy reimbursements

For many PT clinics, the struggle and stress of getting reimbursed for treatment can be a huge drain on energy and resources. But it doesn’t have to be that way. 

At StrataPT, we experienced the challenges of physical therapy reimbursement first-hand while working in a private practice. That’s why we built StrataEMR, our practice management software that puts successful collections at the heart of everything it does.

Below, we’ll outline the four steps to follow so you can submit clean, compliant, and complete reimbursement claims with StrataEMR. 

1. Automatically stay up-to-date on changing billing codes, protocols, and reimbursement rates

Many physical therapy practices struggle with accurately following payer protocols and documenting the right CPT codes, units, and treatments for each patient. And that’s a particular challenge when payers (e.g. Medicare) regularly adjust their reimbursement policy—or even reduce the amount they reimburse for certain treatments and combinations. 

When clinicians are trying to focus on delivering healthcare, they don’t have time to stay on top of all that. With StrataPT, you don’t have to. Instead, when using our free billing software (and service), you’ll always be kept up-to-date with the information you need to submit accurate and compliant reimbursement claims, so you can focus on patients. 

• Simply search for and select the codes and modifiers you need. No clinician wants to remember the specific code for each diagnosis or therapeutic exercise. With StrataEMR, search the description you require, such as “abnormal gait”, and simply select the relevant ICD-10 diagnostic code. It means no more scrolling through lists of codes to find the one you need.

• Get visibility over reimbursement rates for all physical therapy services. While Medicare cuts are affecting how much PTs can be reimbursed, you can stay up to date on exactly how much you can expect to receive for each treatment. 
  
  (A Medicare fee calculator is handy, but you can see this information live from within the StrataEMR system as you’re delivering therapy.)

• Customize the codes you need from the get-go. During onboarding, let us know which codes and modalities you use most often. If you don’t do splinting, speech therapy, or occupational therapy, for example, we won’t include those codes in your system—so you don’t need to sift through thousands of irrelevant entries. 

Navigating the different rules around codes and modifiers can be a frustrating process. StrataEMR can give you the certainty that you’re billing correctly for the treatment you offer—to ensure you get reimbursed.

2. Create compliant documentation that ensures you get paid

One main reason why physical therapy providers struggle with low reimbursement rates is that they’re encouraged to separate billing from the rest of their clinical workflows. 

For example, they typically create a plan of care, deliver treatment, and only then see that particular therapeutic activities are out of scope or that there’s a mistake in their documentation. As a result, they have to edit and resubmit their reimbursement claims, adding more work for their billing teams.

At StrataPT, we put billing at the core of clinical documentation to give you confidence you’ll get paid from the first moment you see your patient. 

Here’s what you can expect from your documentation with StrataEMR:

• Build documentation templates relevant to your clinic’s needs. When outpatient practices use generic practice management software, they often find that the documentation templates provided just aren’t useful or relevant to their needs. 
  
  With StrataEMR, you can build templates from scratch that are appropriate to your patients, insurance companies, and treatment you offer, to give you the best chance of getting reimbursed. 

• Ensure treatment can be reimbursed with documentation guardrails. With conventional billing systems, physical therapists are required to know which treatments will be reimbursed by payers. But often they don’t—meaning that they can mistakenly issue treatment that simply won’t be paid for. 
  
  When using StrataEMR, if a particular insurer stipulates particular conditions on care, you’ll know this before issuing treatment or submitting documentation. This way, you’ll be aware of any issues before your reimbursement claim gets denied.

• Auto-populate patient information from referral sources, intake forms, or previous healthcare providers. Save clinicians the trouble of copying information from prior evaluations or documentation. Instead, have all the information you need when you need it. 

3. Trust StrataPT’s billing service to follow up any denied claims

Practices that work with StrataPT see that 85% of their reimbursement claims are paid within 30 days without a hitch. 

But you won’t need to correct, chase, or resubmit any of the remaining claims yourself. For any claims that do get denied, our billing team will do the hard work to follow them up. 

That’s because StrataPT doesn’t offer just another billing software—but a complete billing service, too. This way, you’ll enjoy the following benefits:

• See a greater number of successful claims. Clinics we work with see a reimbursement rate of over 99%. While many practices often take for granted that they’ll lose revenue to denied claims, we won’t stop until you’re paid for everything.
  
  (True story: After a month working with StrataPT, one practice owner in Montana called to say that there must be a mistake because there was too much money in their account. In reality, they’d just been paid what they were owed.)

• Receive payments faster. With StrataPT, more than 95% of billings are reimbursed within 60 to 90 days. That’s compared to an industry benchmark of about 75% of billings paid at 120 days. 
  
  Take another example: Before working with us, one clinic had 65% of its accounts receivable (AR) older than 90 days. Now, less than 4% of their AR is older than 90 days. 

• Get an immediate response to any query. When it comes to getting paid, it’s natural that you may have questions or concerns. Our customer service team responds to every request within an average of 22 minutes (during business hours). 

Many clinicians find themselves paying for both documentation software and outsourced billing teams, alongside all the other tools that they need to run their practice. With StrataPT, you won’t pay for our EMR software at all. Instead, you’ll pay a small fixed rate on your successful collections, which we’ll grow to over 99%.

4. Get clarity on all your financial data

A crucial part of maximizing your reimbursement rates is getting a clear view of your clinic’s financial performance. With the right data, you can make better decisions to improve the profitability of your practice and ensure easier reimbursements in the future. 

• Quickly access financial data and billing metrics. With StrataClarity—your financial dashboard—you can immediately see key metrics, such as your accounts receivable, average billed units per visit, health insurance payments, and more.

• Visualize data by patient, clinic, or insurer. Whether you want to see Medicare payments specifically, check in on how individual practices are performing, or dig into a particular patient’s transactions, you can easily see a record of every individual reimbursement, payment, or transaction, so you won’t miss a thing. 
  
  For example, it can help you adjust how your documentation templates are set up for certain healthcare insurers and patients.

• Provide patients with the payment data they need. Help patients see their account balances and let them easily make any payments. Our clients tell us that by offering patients these payment options, they see a higher rate of payment collections.