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Medical Billing for Physical Therapy Telehealth Services

February 5, 2024 Comments Off on Medical Billing for Physical Therapy Telehealth Services

Physical Therapy Telehealth Services: What are the best practices for medical billing?

Physical therapy plays a crucial role in improving the lives of individuals through Applied Behavior Analysis (ABA). ABA therapy is widely recognized for its effectiveness in addressing behavioral challenges in individuals across the lifespan, especially those with mental health challenges. While ABA primarily focuses on behavioral modification and social interaction, physical therapy within the ABA framework is often underestimated, yet it plays a vital role in addressing physical challenges and fostering holistic development.

In recent years, telehealth services have become increasingly important in delivering physical therapy to individuals, particularly due to the convenience and accessibility they offer. According to a survey by the American Physical Therapy Association (APTA), 80% of physical therapists reported offering telehealth services in 2022, up from 22% in 2019. However, along with these advantages come challenges, particularly in medical billing.

Before knowing more about the good practices with medical billing for Physical Therapy Telehealth Services, let us first understand why Physical Therapy is important in ABA.

The Role of Physical Therapy in ABA

Integrating physical therapy into ABA therapy programs offers a comprehensive and holistic approach to improving the lives of individuals facing various challenges. The collaboration between ABA specialists and physical therapists underscores the importance of a multidisciplinary approach to healthcare and therapy. Together, they work to empower individuals to reach their full potential, promoting independence, confidence, and a better quality of life. This combination of expertise demonstrates how the role of physical therapy within the ABA framework is instrumental in helping people of all abilities lead more fulfilling lives. The following are the core areas where physical therapy makes a significant difference in the lives of people of all ages, abilities, and backgrounds:

Enhancing motor skills

  • Physical therapy specializes in improving motor skills.
  • PTs collaborate with ABA specialists to design skill-focused exercises.
  • Targets activities like crawling, walking, running, hand-eye coordination, and fine motor skills.
  • Enhances interaction with the environment and others, improving overall quality of life.

Addressing balance & coordination

  • ABA individuals may struggle with balance and coordination.
  • Physical therapists develop tailored interventions in coordination with ABA specialists.
  • Incorporates balance exercises and coordination drills.
  • Enhances daily activities and boosts confidence.

Building muscle strength

  • Vital for individuals with muscle weakness or hypertonia.
  • Physical therapy combines exercises and therapeutic techniques.
  • Promotes stronger, healthier muscles.
  • Increases functional capacity and independence.

Facilitating functional mobility

  • ABA emphasizes independent living skills.
  • Physical therapy enhances functional mobility.
  • Assists with dressing, grooming, and self-feeding.
  • Empowers self-sufficiency in daily life.

Pain management

  • Some ABA individuals experience pain from musculoskeletal issues or sensory sensitivities.
  • Physical therapists provide pain relief strategies.
  • Alleviates discomfort for fuller participation in ABA and daily routines.

The need for Physical Therapy Telehealth Services

Physical Therapy Telehealth Services provide remote access to essential rehabilitation and
treatment, increasing convenience, accessibility, and continuity of care, especially during restricted physical access or ongoing monitoring. Here are the compelling reasons behind the growing need for these services.

1. Accessibility and Convenience:

Telehealth services eliminate geographical barriers, providing individuals in remote or underserved areas access to ABA Physical Therapy. Patients and their families no longer have to travel long distances to attend therapy sessions. Instead, therapy can be delivered directly to their homes through secure online platforms, ensuring no one is left behind.

2. Flexibility in scheduling:

ABA Physical Therapy often requires regular and consistent sessions to achieve optimal results. Telehealth offers unparalleled flexibility in scheduling, allowing individuals to receive therapy at times that best suit their busy lives. This convenience reduces disruptions and increases the likelihood of therapy adherence.

3. Consistency in treatment:

Consistency is a cornerstone of effective ABA therapy. Telehealth ensures that individuals receive the same level of care regardless of external factors, such as travel restrictions, inclement weather, or unforeseen circumstances. This consistency is essential for progress and positive outcomes.

4. Safety and Minimized exposure:

Telehealth services provide a safe alternative, especially in today's climate, where contagious illnesses are a concern. Individuals with compromised immune systems or heightened sensitivities can receive therapy without the risk of exposure to potentially harmful pathogens.

5. Comfort and familiarity:

Many individuals, particularly those with sensory sensitivities or anxiety, find comfort and familiarity in their own environments. Telehealth allows therapy to occur in the safety and comfort of their homes, potentially leading to better engagement and progress.

6. Parental involvement:

ABA therapy often involves training and collaboration with parents and caregivers. Telehealth facilitates parental involvement by allowing them to actively participate in therapy sessions without traveling, making it easier for them to support their child's progress.

What Does Physical Therapy CPT Codes 2023 Mention?

CPT codes are essential to the medical billing process for physical therapy services, including those provided via telehealth. The American Medical Association (AMA) updates CPT codes annually to reflect changes in medical practice.

Among these, Physical therapy CPT codes are specific to physical therapists’ services.

The CPT codes for physical therapy in 2023 are divided into two main categories:

Evaluation and re-evaluation codes

These codes report the initial assessment of a patient’s condition, the development of a treatment plan, and any subsequent re-evaluations necessary to monitor the patient’s progress.

Evaluation codes

97161

Physical therapy evaluation, low complexity

97162

Physical therapy evaluation, moderate complexity

97163

Physical therapy evaluation, high complexity

Re-evaluation code

97164

Physical therapy re-evaluation

Treatment codes

These codes report the specific treatments provided to patients, such as exercise, manual therapy, and electrotherapy.

97110

Therapy procedure using exercise

97112

Neuromuscular re-education

97116

Manual therapy techniques, direct

97530

Electrotherapy, a modality not otherwise specified

97014

Therapeutic exercise

97025

Manual therapy

97113

Gait training

97530

Electrical stimulation

97150

Hot or cold pack application

In addition to the general CPT codes listed above, there are also a number of CPT codes specific to certain types of physical therapy services, such as pediatric physical therapy, geriatric physical therapy, and neurological physical therapy.

It is important to note that the CPT codes for physical therapy may change from year to year. Physical therapists should always consult the most recent CPT code manual to ensure that they are using the correct codes for the services that they are providing.

Challenges of Medical Billing for Physical Therapy Telehealth Services

Among the many specialties embracing this digital transformation, physical therapy stands out for its unique set of challenges in medical billing. While telehealth offers numerous benefits, such as increased accessibility and patient convenience, it also presents a host of complexities that can be daunting for healthcare providers.
These challenges include:

Insurance Coverage

Not all insurance plans cover telehealth physical therapy services, or they may have restrictions on coverage. This can lead to issues with reimbursement and financial burden for patients and providers.

State Regulations

Telehealth services are subject to varying state regulations, making it challenging for providers to navigate compliance across different jurisdictions.

Billing Codes

Accurate billing is essential for reimbursement, and choosing the right Current Procedural Terminology (CPT) codes is critical. Changes in CPT codes can add complexity to the billing process.

Documentation

Thorough documentation of telehealth sessions is crucial to demonstrate medical necessity and justify billing. Inadequate documentation can lead to claim denials.

Technical Challenges

Technical issues, such as poor internet connections or software problems, can disrupt telehealth sessions, leading to missed appointments and billing complications.

To overcome these challenges, physical therapy providers must invest in training, technology, and compliance measures, ensuring they can continue providing high-quality care while successfully navigating the complexities of medical billing in telehealth. Explore TherapyPM, our Therapy Practice Management Software, which helps you maximize productivity, streamline administrative processes, and deliver exceptional patient care.

Medical Billing for Physical Therapy Telehealth Services – Good Practices

Medical billing for physical therapy telehealth services presents unique challenges that require providers to adopt effective practices to ensure accuracy and compliance. To navigate these challenges successfully, healthcare professionals can implement the following set of recommended strategies:

Verify Insurance coverage

Before scheduling telehealth sessions, verifying the patient’s insurance coverage for telehealth physical therapy services is essential. This step helps prevent surprises for both the patient and the provider. Clearly communicate any out-of-pocket expenses, such as copayments or deductibles, to the patient in advance.

Use correct CPT codes

Accurate coding is crucial in medical billing. Ensure that you are using the most up-to-date Current Procedural Terminology (CPT) codes specifically designed for telehealth physical therapy services. Double-check coding guidelines and documentation requirements to avoid coding errors that can lead to claim denials or delays.

Ensure thorough documentation

Comprehensive telehealth session documentation is essential for patient care and billing purposes. Document the reason for the session, the treatment provided, and the patient’s progress during each session. If appropriate and with patient consent, use video and audio recordings to support your documentation, providing a clear record of the care delivered.

Stay compliant with state regulations

Telehealth regulations can vary from state to state. Familiarize yourself with the telehealth regulations specific to your state and ensure strict compliance with them. Failure to adhere to state-specific regulations can result in legal issues and reimbursement challenges.

Billing software and training

Invest in reliable medical billing software that can efficiently handle telehealth billing processes. Additionally, ensure that your billing staff receives adequate training on telehealth billing procedures, which may differ from traditional in-person billing practices. Proper training helps minimize billing errors and ensures a smoother reimbursement process.

Coding and Billing audits

Regularly conduct coding and billing audits within your practice. These audits can help identify and rectify errors in billing and documentation, ensuring that claims are submitted accurately. Proactive auditing can prevent claim denials, reduce revenue leakage, and improve financial performance.

Patient Education

Educate your patients about telehealth services, including their responsibilities in the billing process. Provide clear and transparent information about copayments, deductibles, and any other financial obligations they may have. Clear communication can reduce patient confusion and improve collection rates.

Utilize telehealth platforms

Select secure and Health Insurance Portability and Accountability Act (HIPAA)–compliant telehealth platforms for your virtual sessions. Protecting patient privacy and data security is an ethical obligation and a legal requirement. Utilizing the right telehealth technology can help ensure the confidentiality and integrity of patient information during telehealth encounters. Try TherapyPM today to experience the best ABA Behavioral Telehealth Solutions for your practice.

In conclusion, physical therapy holds a pivotal role within the framework of Applied Behavior Analysis (ABA), contributing significantly to the holistic development and improved quality of life for individuals facing various challenges. The collaboration between ABA specialists and physical therapists underscores the importance of a multidisciplinary approach to healthcare, empowering individuals of all abilities to reach their full potential.

With the advent of telehealth services, the accessibility and convenience of physical therapy have expanded, offering a lifeline to individuals in remote or underserved areas and those who require ongoing monitoring.

By implementing these recommended strategies, healthcare professionals can navigate the intricacies of medical billing for physical therapy telehealth services, ensuring accurate reimbursement and the continued delivery of high-quality care to those who need it most. As the healthcare landscape continues to evolve, these practices will be instrumental in fostering the well-being and independence of individuals across the spectrum of abilities.

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