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.
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:
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.
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:
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:
Here’s how the billing process works when you’re partnered with StrataPT:
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
And StrataEMR gives you a lot more useful data about your PT practice, including:
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.