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How the Different Components of Claims Management Affect Reimbursement

Physical therapy can be complicated, as we well know. But dealing with insurance claims can make practice seem like a breeze by comparison. Not only must you prove the necessity of treatment, but also that the procedures are working toward discernible, measurable recovery. With insurance claims, there are dozens of moving parts that need to be lined up before you can get reimbursed for your work. A PT claims management service can relieve you of all the issues that follow, but it makes good business sense to be sure you understand them yourself.

No Clear Progress

One of the more unfair burdens that insurance agencies put on a physical therapy practice is providing proof that the treatment is actually working. Good therapy takes time and patience with a mixture of successes and failures, but insurance companies want you to fill out complex forms detailing precise proof. In some cases, they might even ‘check your work’ with another therapist. Handling these complex forms, and dealing with headaches from denials, falls on the shoulders of your PT claims management personnel. Unfortunately, because of the countless other things they need to accomplish, this paperwork can suffer and, as a result, treatment can be denied and your reimbursement stopped/delayed.

Clear and Recognizable Goal

Goals and progress can be strange bedfellows when it comes to PT claims. While proving in writing that the patient is making clear and precise progress in their treatment, you also need to provide a clear set of goals, kind of like a benchmark ‘test’. You must properly document each step and provide a clear narrative on the goals you expect a patient to make. This is a very fickle demand and, most assuredly, will be compared to the progress statement you have to provide. It’s a very finicky area of PT claims management and insurers can be very demanding over it.

Mountains of Paperwork

Managing PT claims involves a mountain of paperwork that needs filing and tracking. This alone could lead you to hiring a professional billing and collection company. One mistake, like misspelling a name, can cause an insurance company to deny a claim. Many claims personnel in PT practices become overwhelmed by the paperwork and data crunching requirements. (Hint: You’re not alone!) Fatigue causes costly mistakes. If you’re having more claims rejected than processed, it may be time to rethink your claims management procedures.


There are many things that can go against you in getting a claim reimbursed. Coding errors are probably the most common. Selecting the wrong code, miscoding, using codes from the wrong company, or typing an incorrect procedure code are all issues that will see a claim denied. You know too well that codes can change without notice. Getting coding right not only gets you paid, it ensures that your patients don’t lose the care they need.

Add all these components up and they have an enormous effect on insurance reimbursements (your revenue!) and your entire claims management process. If it has become too much for you and your colleagues to handle, it might be time to entrust it to a PT billing and collections service that specializes in obtaining high returns by being frontline experts in insurance issues. You have everything to gain.

Creative Commons Attribution: Permission is granted to repost this article in its entirety with credit to Jet PT Billing and a clickable link back to this page.

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      Nathan Stack

      Optimal Physical Therapy

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      Franklin Rehabilitation

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      Lonoke Physical Therapy, Inc


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