Physical Therapy And Reimbursement – Where Are We Heading?

The professions of Physical Therapy and Rehabilitation have always been professions of healing, caring and educating. In the past 10 years, we have had to adapt and advance our professional therapeutic skills to include a dual specialty of therapist and reimbursement coordinator and manager. We enter the profession of therapeutic rehabilitation to heal our clients and provide education. We are now experiencing an ever-increasing demand on our time to complete extensive documentation required by multiple insurance companies.

The amount of reimbursement received for Physical Therapy services has remained largely flat over the past several years. In the same amount of time, the amount of required documentation has exponentially increased in volume as well as in complexity. The increase in documentation requirements, with a relatively flat level of reimbursement, does not keep pace with inflation. This effectively lowers the cost of reimbursement even further. These factors combine to produce lower levels of professional productivity due to extensive documentation time, and increased cost for additional office staff to support claims processing. The end result is working harder for less profit.

The National APTA Medicare Fee Schedule Calculator provides average reimbursements for CPT codes from 2000 to present. For a PT evaluation (97001) in upstate New York reimbursement rates have ranged from a low of $60.79 in 2000 to a high of $73.19 in 2005 and have continued to fall since that time. With reimbursement rates decreasing, paperwork increasing and increasing costs of malpractice, unemployment, disability, and workers compensation insurance for private practices, where do we go to improve the efficiency of our practices and get back to what we were trained to do? Treat patients!

Many organizations and data management companies have designed software programs for the end user offering electronic medical records and scheduling. Others offer evaluation forms and Billing/Claims/Account management systems. What becomes evident while researching these software systems is two things:

a. Software packages are aimed at improving the workflow within an office or office system that must then be managed by the provider. The full responsibility of the success of the system is placed back on the Physical Therapy Practice owner and/or the office staff, which must be hired to manage, support and facilitate the system.

b. Each software system is only as up to date as the date it was published or downloaded. With insurance regulations changing on a regular basis, the practice owner must again manage processes to update EOB’s, CCI edits and new memorandums released by multiple insurance companies to assure complete and timely payments.

An internet based system with real time integrated billing management, claims processing, automated coding and reimbursement regulations is a necessary tool in getting the therapist back in the clinic and getting paid in a timely, efficient and effective manner. This process must be a shared, long-term relationship allowing the therapist to do what we are trained to do; treat patients and let the practice management solution do what it is designed to do:

o process claims faster than the national average

o provide quick access to AR and claims processing and management

o facilitate documentation to assure clean claims processing

o reduce the risk of audits with streamlined documentation

As Physical Therapists we must seek practice management systems which provide expert web based billing, coding and reimbursement solutions with an electronic medical record and scheduling capabilities. As Practice owners this will allow us to focus our efforts and expertise on improved professional staff productivity, decreased documentation time, reduced complexity and ambiguity which has existed in the PT billing and reimbursement process for years, and get back to doing what we do as Physical Therapists…client care and rehabilitation.