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Rules, Regulations and Codes… UGH! Stay on Top of Insurance Changes

You and your team are physical therapy specialists working to change people’s health and lives for the better. What a shame it’s so easy to sometimes feel shackled by the rules, regulations, and billing codes of insurance companies. It would be OK if there were some constancy in these things, but they change all too frequently. And every time those regulations and codes change, you end up submitting some bills for reimbursement only to find they get rejected because you didn’t use the correct, up-to-date information. That means revenue loss.

Let’s help you with a few thoughts about staying on top of everything.

The Subtle Nuances of Billable Time

While you know what your billable time is regarding a patient, an insurance company may look at things differently.

Will that insurer consider prep time billable? No. Even though your prep time can often be as long as a treatment session.

Is your practice using more than one therapist for a client? The insurer may not always consider both in billable time. More about this later.

Each insurer may do things a little differently. How do you stay on top of that? Well, one way or another, you need a dedicated team that handles only your billing and collection. That team needs to be highly trained if they are to keep up.

The Dreaded Co-Pay

Many of your clients come to you because a primary care physician referred them. Nearly every patient will have a co-pay. You can collect this at the time of service or after, if you so choose. You cannot, however, waive it. There are ways around this, of course, so that you can help patients who need it. The problem is that the insurance company controls what it deems to be acceptable. Staying on top of acceptability rules for helping the less fortunate will involve sifting through the most current contract.

This is where hiring a PT billing service becomes a major time and headache saver. You have patients to help. You don’t need to spend hours on hold waiting for an insurance representative.

Re-evaluations Sinkhole

Sometimes a patient needs to be reevaluated. It’s more than common, it’s a necessity to providing proper treatment. So, is this billable? Maybe. Again, it depends on the insurance company and its rules and regulations. For instance, if you note a significant change in a patient that you didn’t foresee on the POC, or new findings are unearthed during treatment that could be considered somewhat related to the original reason for the treatment, or a patient doesn’t respond to your POC, or the patient is chronic, or your state requires it. Regardless, there is a lot of research involved that could be better handled by someone else.


There’s a code for everything you do. Being aware of what code goes with what problem, procedure, or billable item is a challenge – especially because codes change and because different companies may require different codes in different formats.

I suppose the question still remains mostly unanswered… How do you keep up with these quirks and changes of insurance rules, regulations, procedures and codes for your PT practice? Well, it’s part of billing and collections, which is a full-time job in this day and age. A regular administrative staff member with other duties will struggle to keep up and your practice will have lower and slower revenue due to claim delays and denials. Some practices employ their own people specifically for this entire task, but keeping them up to date – and keeping them from quitting when the pressure gets high – can be yet another challenge.

In the end, the best solution is often to hire a physical therapy billing and collection service to do it all. You get professional specialists – just like you are a professional specialist – whose entire livelihood depends on serving you well by reducing your billing errors and increasing your returns on claims.

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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    • "This rapidness has completely turned my company around and I highly recommend this team to all physical therapist." Read more »

      Matt Jackson

      Lonoke Physical Therapy, Inc

    • "Jet PT Billing is the best billing company that I have used. They have a comprehensive statistical approach to billing..." Read more »

      Scott Cole

      Franklin Rehabilitation

    • "They provide us with timely billing services at very competitive rates. Their team is very knowledgeable and communicate well with us..." Read more »

      Nathan Stack

      Optimal Physical Therapy


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