Top Five Reasons Physical Therapy Insurance Claims Get Denied

Literally no one on this planet looks forward to dealing with insurance red tape. That goes double for you when submitting claims so your physical therapy practice can be paid for the services it’s already provided. You just need the income and there’s nothing more frustrating than having claims delayed or denied.

How many times have you heard an insurance rep say to you “Okay, we understand the mix-up, we’ll take care of you”? None, right?

This is why you need a specialized PT billing and collection service, so you don’t have to deal with the red tape and can avoid these five common reasons why physical therapy claims get denied.

Errors in Transcription

People in your practice who fill out claims sometimes make mistakes. Unfortunately, even the smallest mistakes are often the cause of claims being denied. You know only too well how even the simplest data entry error like spelling a name wrong or switching numbers in a date of birth can result in a flat denial. It will also leave you with no legal recourse and no income from the services you provided until the problem is found and a new claim submitted.

Insurance Company Confusion

There are dozens of insurance companies your practice may have to deal with. It’s confusing. Some branch out into subsidiaries or smaller groups, some operate by a plan name. Your admin staff have enough to think about with your practice, patients and procedures – aside from all the insurers. Regardless, if you submit a claim to Insurance Company #1, but it was intended for Insurance Company #2, that claim won’t go anywhere. You may not even hear back from Company #1 and then waste time following it up.

Progress is Required

Insurance companies don’t want to pay out money if they don’t have to – no matter the circumstances. In physical therapy, results can show themselves in different ways and at differing speeds. Some insurance companies need to see that you are making detailed notes about progress with treatment. If you fail to note improvement – regardless of how slight – some of them can deny a claim.

Treatment Purpose

Almost as important as the progress of the patient is the purpose of the treatment. To get paid for treatment, you must explain the goal(s) you hope your patient will achieve. You must be precise and the goal(s) must be able to be tracked and measured. The wording needs to give the insurer an escape from paying indefinitely, meaning they can see exactly when goals are achieved and treatment can stop. Otherwise, a claim may be denied.

Multiple Filing for One Treatment

It happens: a plan gets submitted several times for the same treatment. In such an instance, an insurance company won’t go into detail; it will simply deny everything because there are multiple claims for the one treatment. That forces you to start again and list everything that needs to be done.

Physical therapy is both a science and an art. Billing insurers and collecting from them is another art all by itself. To avoid these main reasons why PT insurance claims get denied, and many others, it makes sense to place your billing and collections in the hands of an experienced, effective third party company. Then you can focus on your therapy work and patients and your administrative staff can focus on serving patients and running the practice. You’ll be secure in the knowledge that insurance companies are being taken care of by people who specialize in this line of work and who serve to gain you the maximum out of every claim in the shortest time possible.

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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