Physical therapy deals with the treatment and rehabilitation of physical limitations to manage the onset and progression of the patient’s impairment or disability after an illness or injury. Physical therapy sessions are usually a string of treatments and exercises performed at a medical facility or clinic. Physical therapy treatments are usually done over a significant period of time.
The physical therapy billing process is a billing process that encompasses the charges that a medical facility, hospital, or clinic charges for services rendered by an individual. The physical therapy billing practice has been under the watchful eye of several auditing firms and the Office of the Inspector General (OIG) for multiple audits returning inconsistencies and errors in billing.
Several physical therapy practices have been investigated for fraud, and some are just cited for non-compliance. The majority of the claims paid for physical therapy are paid out to physicians and physical therapists. Several physical therapy rehabilitation facilities operate on a small scale, and these circumstances increase the potential for incorrectly coding a billing to the insurer for the services rendered by the patient.
Health Insurers have released several billing guidelines to accurately charge Physical Therapy and rehabilitation services. The basis for these guidelines are the results of a compiled data based on the Local Coverage Determinations of the Centers for Medicare and Medicaid Services.
According to the guidelines, the common duration of a physical therapy session does not exceed an hour. Based on these guidelines, some insurers have made it possible for medical facilities and private clinics to use reimbursement codes in a combination for a maximum use of 4 timed codes. Codes are utilized per date of service, provided by the same specialty physician, physical therapist, or another health care professional.
The law requires that reimbursements for physical therapies and rehabilitation services are done under the supervision or under the care of a physician – a doctor of medicine, preferably a specialist for physical medicine and rehabilitation, with specialties in osteopathy, podiatric medicine, or optometry.
Compensating medical providers require that the patient be treated in a medical facility, with a clearly laid out plan for care. The plan should exhibit the complete details about the duration of the therapy, the frequency, the amount charged for the services, and the type of therapy that the patient will have.
Physical therapy sessions can go on for lengthy periods of time, and if so, the physician supervising the care of the patient needs to recertify the treatment at certain points in the therapy.
The plan of care must also include the patient’s diagnosis that requires the patients to undergo physical therapy, the patient’s past history, the physician’s orders, and the prognosis and end goal for the therapy.
The Centers for Medicare and Medicaid Services allow physicians to submit claims for physical therapy services that they do not perform personally. According to CMS, “As long as the service is in part, integral, although incidental, part of the physicians’ service.”
These conditions by CMS allow physicians to get compensated without having a physical interaction with the patient during therapy and they also make the physicians responsible for the services. Physicians are required to assume responsibility for actions made by the person 
who is administering or supervising the physical therapy sessions.
Physical therapy and rehabilitation services can be billed directly to the physical therapist as long as it meets certain guidelines. The physical therapist administering or supervising the treatment must be a licensed physical therapist in the state where the physical therapist is practicing. Physical therapy sessions must meet the guidelines of CMS for outpatient physical therapy.
Physical therapy sessions can be conducted at physical therapists’ own private practice or at a medical facility, such as a hospital, or a nursing home. In cases where physical therapies are declared incidental to physicians, then the physician will assume full credit and responsibility for the physical therapy conducted by an individual, regardless if the individual is a licensed physical therapist or not.
MPMR is a top medical billing provider for physical therapy clinics. With Certified Coders and Medical Billing Specialists, MPMR works with PT clinics nationwide to increase revenue and efficiencies.
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