How to Do PT Billing and Get a >99% Reimbursement Rate

Author: Adam Peacock

Billing is a major headache for physical therapists. Insurance companies’ billing processes are complicated and differ from provider to provider, which makes it cumbersome to accurately and successfully prepare claims. As a result, a significant percent of claims filed by physical therapy offices go unpaid—many due to minor technical errors. 

In fact, many physical therapy offices see at least 20% of their revenues go uncollected (in one case we came across, a PT was only being reimbursed for half of what they were owed). This PT billing issue is a massive drag on physical therapy practices’ profit margins.

While there are several articles out there offering a guide to the ‘basics’ of physical therapy billing, explaining details like current procedural terminology (CPT) codes, what units are, or how the 8-minute rule works, few give any strategies or tools for solving the main problem in PT billing: how to increase reimbursement rates. 

That’s what we’re setting out to do in this article. We use our software, StrataEMR, as an example of how PT offices can achieve reimbursement rates of more than 99%. 

First, we’ll look at how standard PT billing practices cost physical therapy offices thousands every month. Then we’ll show how StrataPT’s technology-powered platform and service helps practices achieve an industry-leading 99.999% reimbursement rate.

Poor PT billing can cost PTs 50% of their revenues

From what we’ve seen at StrataPT, some physical therapy practices are losing as much as 50% of their monthly revenue to billing problems. For a $250,000 per year practice, that’s $125,000. 

Whether you’re already using software or you’re managing claims manually using spreadsheets, paper records, and/or mail, you’ll run into confusing modifiers, billable rules, and claims processes from different insurers that lead to difficulties in submitting accurate claims that get paid on time. Reimbursement rates suffer, admin increases, and the accounts receivable (AR) keeps piling up.

Put simply: Thousands of dollars get delayed—or lost—each month due to claim errors, compliance issues, and hidden glitches in the process. 

If you run a physical therapy practice, you might be feeling the following headaches:

  • A constant battle against unpaid reimbursements, building up month-on-month. Your team spends hours every week resubmitting claims, chasing collections, and working their way through a pile of paperwork just to get paid. 
  • The impossible task of keeping up with ever-changing modifiers, rules, and processes.
  • Too many different pieces of software to juggle your operations. For example, separate solutions for EMR, patient scheduling, RCM (revenue cycle management), team workflows, and more. High monthly software fees and no central source of truth. 
  • A lack of transparency, both in terms of why certain claims are going wrong—but also in terms of where exactly you’re losing revenue and what is being done to remedy those claims. What claims data you do have is impossible to make sense of and hard to share within the organization. 
  • Endless manual work. As the practice grows, the number of claims to be submitted grows with it, meaning you need to hire more and more staff to handle claims processing, or enlist a billing service that does not integrate with your EMR in order to protect your time for patient care. 
  • Too many different types of patient coverage, different deductibles, Medicare patients who or may not have Part B coverage. All this affects the interventions and therapeutic exercises you use, meaning PTs have to think like a billing company and a therapist, rather than just focusing on care.

We created StrataPT after experiencing these headaches first-hand while working in the billing department of a physical therapist office. In the next section, we’ll detail exactly how we’ve designed StrataPT to maximize reimbursement rates while simultaneously eliminating the employee hours needed to submit and chase health insurance claims. 

How StrataPT drives 99.999% reimbursement for physical therapy practices

A 99.999% reimbursement rate sounds unbelievable. We get that a lot. But it’s real. And we can boil this down to StrataPT doing four key things for PT practices:

  1. Automatically keeping up with all the latest updates in rules, codes, and processes for all US insurers and making sure claims are accurately constructed and submitted. Any potential issues with compliance are flagged before claims get put through.

  2. Putting successful billing at the heart of your operational processes. Put simply, that means your whole EMR system is geared towards getting you paid. From the moment a patient is scheduled and their demographics are entered, StrataPT sets guardrails to make sure the resulting claims get out clean, complete, accurate, and compliant. 

  3. Relentlessly pursuing any rejected or denied claims, fixing issues, and troubleshooting to make sure nothing gets left on the table. Our full-service billing team doesn’t stop at anything, and we also provide 24/7 customer support if you have any questions. 

  4. Giving you complete transparency into your PT practice’s financial performance in the context of data about the care you’re providing. Everything is laid out so you can make smart business decisions that increase your revenue.

Our software gives you an all-in-one platform for running your PT practice. You get an EMR system with scheduling, patient engagement, and workflow functionality that’s built with revenue cycle management (RCM) at its core. Everything is designed to facilitate a clean claims process and get you paid, and our team will tie up every single loose end. 

This has been a game-changer for many PT practices. For example, one client in Arkansas came to us as a single clinic with one therapist. StrataPT’s EMR and billing enabled him to grow his business to 12 clinics and 100+ staff; from a few hundred thousand dollars per year to more than $5 million in annual revenue. 

Another client in California reached out to us after working with another billing company while using a separate EMR. At the time, they had more than $200,000 in receivables older than 90 days—65% of their accounts receivable. Terrible for cash flow. After transitioning to StrataPT, they now have less than 4% of their AR older than 90 days—and our team continues to pursue all of that outstanding amount to be collected.

Below, we’ll outline how you can partner with StrataPT to drive reimbursements to >99%, by:

  • Streamlining your claims process to maximize reimbursement, without you having to think about it or do anything extra
  • Building a complete view of your PT practice’s performance

Streamlining (and simplifying) your claims process

Here’s how the billing process works when you’re partnered with StrataPT: 

  1. Your front desk staff kick off the process by entering patient demographics into StrataEMR. Ahead of their scheduled appointment, the patient receives an email or SMS link which they can use to upload all their documentation and make a copayment (if necessary). This can also be done at your office while they’re waiting. All your staff need to do is confirm the patient’s arrival for the clinician to take over. Job done. 
Example of Client View: Consent and Policies, Benefits Confirmation, Patient Registration Form, Health Questionnaire
  1. The physical therapist takes over for the appointment itself. As they guide the patient through their session, they document the treatment, activities, exercises and units in the StrataEMR interface. The system automatically flags potential reimbursement issues in real-time; for example, if ice cannot be reimbursed, or when a combination of services cannot be included in the same insurance claim for a certain payer. 

Once the session is over, the therapist simply presses ‘save’ and StrataPT’s billing service takes over the rest of the process for you to get paid. It’s that simple. StrataPT ensures that the claim is accurate, up-to-date, and compliant. And if there are any rejections or denials, we do the legwork and chase every penny for you.

StrataEMR Interface: StrataPT’s Billing Service

And that’s it. No need to fiddle with CPT codes or modifiers, or manually sift through piles of claims. Once you’re set up, your team enjoys an effortless billing process right away. The benefits are immediate, and you’ll start to see an instant improvement in reimbursement.

(True story: One practice owner in Montana called us up concerned after just a month of partnering with StrataPT, saying that there must be a mistake because they had too much money in their bank account. It wasn’t a mistake—they’d just been paid what they were owed.)

The process remains just as simple as your practice grows; you don’t need to build out a team of people to oversee billing. You keep the same high reimbursement rate regardless—and in fact, we know PT offices earning millions of dollars every year while managing their entire practice with just one administrative support staff.

Billing Plan of Care: Using guardrails to maximize your reimbursement

One common issue with PT billing is that there aren’t any guardrails for clinicians when they’re completing their notes. This means you need to provide up-to-date checklists and cheat-sheets to guide therapists on which CPT codes can or can’t be used for certain insurers or patients, how many units can be billed, and all the other ever-changing rules. 

But therapists want to focus on care, rather than having to wrestle with billing admin. 

StrataPT’s Billing Plan of Care solves this. If, for example, you have a fixed-rate deal with an insurer that stipulates certain care limitations, you can set up a default Billing Plan of Care at insurer level, which is applied to all patients who are with that healthcare insurer. 

StrataEMR: Administrative and Billing Details

The therapist is alerted with a reimbursement warning if their report does not meet the default Billing Plan of Care (e.g. if they’re using certain deniable CPT codes), and the charge won’t be finalized. The therapist can then make the necessary tweaks to their notes, push the existing charge through to an extra level of approval within your office, or send the charge on the understanding they’ve seen the warnings. You can set whatever rules you need to set.

Metrics and Analytics with StrataPT

Proactive clinical auditing

StrataPT removes the burden of retrospective clinical auditing by putting validation at the front of the process. Put simply, you can make sure that what’s being documented is what’s being billed by setting ‘documentation safeguards’—meaning if certain clinical documentation is not presented, the document is considered incomplete and unable to be finalized. This drastically reduces medical necessity denials, while also making sure you’re compliant based on the payer’s requirements. 

Patient billing

StrataPT gives your patients a personalized portal where they can answer health questionnaires, upload documentation such as the Electronic Visit Verification (EVV) and registration documents, and sign forms for privacy and consent. This takes the weight off your front desk staff and makes patient onboarding incredibly smooth. 

Through this portal, the patient also gets a breakdown of their balance statements and they can make payment securely online using their credit card

Patient Signature example

When we speak to PT practices and look at the data, it becomes very clear that this feature has significantly boosted patient collections. And because the patient stays informed about their balance, there’s a lot less back-and-forth; far fewer questions about where certain charges have come from.

Each patient also has what we call the Clarity Panel. This gives you real-time financial reporting at a patient level. You can see the status of each patient’s individual account, and get a full view on the dated play-by-play of all their treatments, charges, and payments. 

Clarity Panel with StrataPT

Building a complete view of your practice’s performance 

Of course, billing problems are probably the biggest obstacle to profitability. But there are other sources of waste and inefficiency that remain hidden for many PT practitioners. These may be small issues that add up to you leaving money on the table. StrataPT doesn’t just help you maximize reimbursements, but you also get full transparency into your practice’s performance so you can make informed RCM, operational, and marketing decisions. 

Real-time financial data

Financial Metrics: Billed Visits and Billed Units, Billed Dollars, Average Units Per Visit, Insurance Payments, and Patient Payments

Your practice’s accounts receivable (AR) report is a key indicator of the health of your business. If the amount you’re owed keeps steadily rising, you know there’s a problem getting paid. Partnering with StrataPT, you should expect to see AR over 30 days drop dramatically  (for most of our customers it drops at least 50%). 

With StrataPT’s real-time financial reporting, it’s easy to keep an eye on your AR—plus all the other important financial metrics. 

At a glance, you can keep track of:

  • Accounts receivable
  • Billed visits and billed units
  • Billed dollars
  • Average units per visit
  • Insurance payments and patient payments
  • Average payment per visit, and per hour
  • Reimbursement averages by payer/insurer

You can also dig much deeper into this financial data. For example, you can see how (and why) certain CPT code combinations affect reimbursements. This can help you adapt your Billing Plan of Care for different insurers or patients.

Annual Reimbursement Averages by Payer: Average Payment per Visit and Average Visits per Patient

And StrataEMR gives you a lot more useful data about your PT practice, including:

  • Patient scheduling data, including the number of no-shows and cancellations—as well as evaluations and discharges. You can dig into these numbers to spot patterns, either organization-wide or for individual team members (and for patients, too).

    Note: StrataEMR’s patient engagement functionality—including electronic intake, appointment reminders, mobile bill pay, and patient satisfaction surveys—is designed specifically to reduce cancellations and no-shows, and to keep your patients happy. 

  • Marketing data, including information about top referrers, campaigns and conversion rates. This can be used to help you double-down on the best channels and tactics for generating new business. 

Get started and maximize your PT reimbursements 

You can get your team onboarded with StrataPT in a matter of hours. We handle the secure migration to port your practice data across automatically, with no downtime whatsoever. Training is a breeze; we run free online sessions for your team to learn how the system works, and we remain on hand for 24/7 support—wherever you’re based. You can be up-and-running quickly, enjoying >99% reimbursement rates within just a couple of days. 

Schedule a free demo today.