Why Most Physical Therapy Billing Services Don’t Cut It (+ A Better Solution)

Billing is a major headache for many physical therapists. Insurers rejecting or delaying claims—even for minor technical errors—is a painful fact of life. 

Sadly, the legwork involved with fixing, resubmitting, and chasing unpaid claims means PT practice managers now expect a pile of insurance claims to remain unpaid. In fact, one of our clients was only being reimbursed for half of what they were owed before they started working with StrataPT. 

If you run a physical therapy practice, you can probably relate to these experiences:

• Getting paid is a nightmare. Insurers regularly reject claims for small, unclear, or seemingly spurious reasons. In fact, it’s not uncommon for practices to lose 20-40% of their revenue to unpaid reimbursements. 

• Staying up-to-date on processes is time-consuming. Different insurance companies have different rules and claims processes, which change regularly. Your team needs to keep on their toes (and even get extra training) to make sure you’re compliant.

• Claims take a long time to be settled, which can cause cash-flow problems for the day-to-day running of the company and prevent you scaling the business. Unpaid claims keep piling up over time, giving you an ever-growing mountain to climb.

Billing services promise to fix these problems. But unfortunately, most billing services won’t drastically improve your reimbursement levels. You may see a modest uptick in claims getting paid, but it won’t be game-changing—and you’ll still be leaving a lot on the table. 

This article digs into why that’s the case, and why most billing services aren’t up to scratch. 

We also introduce our own billing and revenue cycle management (RCM) service, backed by StrataEMR—which consistently collects 99.999% of all claims.

With StrataEMR, you can simplify your work while also securing a lot more revenue (e.g. California-based practice, Genesis Physical Therapy, cut down their documentation time by 30% while growing their profits by 20%).

Different options for PT billing services (and why they fail)

We constantly speak with PTs who have tried various strategies for improving their billing process and reimbursement rates. For example:

• They’ve considered building a dedicated in-house team of billing specialists, but:
  
  • It’s time-consuming (and hard work) to keep hiring and onboarding new staff.
  • It’s expensive to keep adding extra staff who don’t provide billable services.
  • It’s tough for everyone to stay up-to-date with the latest rules and processes.
  • It’s not easy to scale the business without adding more staff to the mix.

Plus, in the end, even the hardest-working team won’t be able to chase every claim.

• Some PTs have tried bringing in individual service providers (i.e. freelance billing experts) to handle their billing. While this might help you stay on top of billing when your office is starting out, the costs quickly increase as the practice grows. More importantly, this creates a single point of failure. We’ve had clients come to us because their freelance billing specialist simply stopped responding one day, leaving them unable to collect reimbursements until they got another system up-and-running.

• Many of our clients were previously outsourcing to a medical billing company. Having a team of people to submit and chase bills on your behalf sounds great, but typically their size works against them. They usually charge a modest percentage of billings—say 5.5%. This means they only tend to chase the larger reimbursements.The problem for many practices is that chasing the small claims is the difference between making a profit and barely breaking even. It all adds up. 

• Finally, it’s common for a physical therapy practice to rely on the bolt-on billing functionality within their EMR system. This could be a widget, plugin, or an integration with third-party billing software. It seems like a decent option, but most EMRs aren’t actually billing solutions; they’re primarily built for clinical documentation, scheduling, and practice management.
  
  This means:
  • The EMR doesn’t collect data in a way that matches claims requirements.
  • The EMR doesn’t provide real-time feedback or alerts for billing compliance.
  • The EMR doesn’t have safeguards in place to prevent therapists from submitting claims before their insurance credentialing has been approved.
  • You end up paying for two (or more) different tools at the same time.

We developed StrataEMR in response to these challenges. It’s an all-in-one EMR, but with billing and revenue cycle management at its core. This means that everything from patient scheduling to staff workflows are designed to facilitate a clean claims process. 

Our software and RCM service largely automates your billing, keeping your system up-to-date with the latest insurer rules, codes, and modifiers, so you don’t have to think about them. The vast majority of your claims will be paid without a hitch (currently average 85% within 30 days), but our billing team will chase every single unpaid claim until it gets paid—no matter how small. 

This means you can be much lighter on your feet. In fact, some of our customers are managing millions of dollars in revenue through StrataEMR with just one admin staff responsible for patient intake, scheduling, eligibility, and authorizations.

How StrataEMR makes PT billing effortless

Many PTs start using StrataEMR because they’re frustrated by a painfully low reimbursement rate and an ever-growing accounts receivable (AR). Some have tried alternative solutions but haven’t seen the benefits; we’ve also heard nightmare stories about customer service not responding to insurance claims queries for three weeks. 

That’s why we’re always completely transparent with the results we get for PTs. We’ve already mentioned our 99.999% reimbursement rate, but our clients also experience faster payments—with more than 95% of their billings being paid within 60-90 days.

On average, our customer service team will get back to you within 22 minutes.

Alpha Rehab’s Dr. Miguel Q says:

“If you want your life back, you want to change to StrataPT. You have a lot more time on your hands and can actually do a better job with your patients, versus being stuck in front of a computer the whole time.”

We know these are some bold claims, so let’s look at how StrataEMR actually works.

A simple and streamlined billing process that gets you paid 

Here’s what the billing process looks like when you use StrataEMR:

1. Your front desk starts the process by entering patient demographics into StrataEMR. Before their appointment, the patient receives an email or SMS link where they can upload all their documentation and make a copayment. Once your staff confirms the patient’s arrival at the office, their job is complete and the clinician can take over. 

2. The clinician welcomes the patient for their session, and records all the treatment, activities, and exercises in StrataEMR. No need to research the rules or processes regarding units or modifiers; the system does everything. All potential reimbursement issues are flagged at this stage, in real-time. For example, if a combination of services cannot be included in the same plan for insurance purposes, the clinician is notified. 

As soon as the therapist clicks ‘save’ the StrataEMR billing service kicks into gear. It checks all the components for compliance, making sure the claim is accurate and ready to go. The software then submits the claim automatically, and on the rare occasion there’s a rejection or denial the StrataPT team will fix, resubmit, and chase.

That’s it. No need for ongoing training to keep up with CPT codes or complicated modifiers. No need to sift through a growing pile of rejected claims. Practices can enjoy an effortless billing process, and see an instant improvement in their reimbursement rate.

(In fact, one client from Montana told us she wrote off nearly $40,000 in unpaid reimbursements the year before she started using StrataEMR. These days, she writes off zero.)

Billing Plan of Care: Using guardrails to minimize hassle for clinicians

A common issue with using billing services is that they don’t end up saving you much time on the front-end. Your team still needs to submit the claims correctly in the first place. 

This usually means staying up-to-date with all the latest rules and regulations from insurance firms and providing checklists and cheat-sheets to guide clinicians on how many units can be billed and which CPT codes can or can’t be used for certain treatments, patients, or insurers. 

We remove this hassle and give you peace of mind with our Billing Plan of Care.

If, for example, you have a flat-rate contract with an insurer that outlines certain limitations on care, you can set up a default Billing Plan of Care at the insurer level, which is automatically applied to all patients who have that insurance policy. 

StrataEMR then sends the therapist a reimbursement warning if there are any potential issues with their report that could affect the claim (for example, if they’re using deniable CPT codes). The therapist can then choose to make some changes, push the charge up to an extra level of approval, or send the charge on the basis of having seen the warnings. You set the rules.

StrataEMR also allows you to take this a step further with proactive clinical auditing. 

This feature allows you to set ‘required selections’ for your clinical documentation. If those selections aren’t present, the document will be considered incomplete and the clinician won’t be able to finalize it. This is useful for reducing medical necessity denials, and puts validation at the beginning of the process to minimize the challenge of retrospective clinical auditing. 

Patient billing

StrataEMR gives your patients access to a personalized portal where they can answer health questionnaires, upload documents (e.g. registrations or Electronic Visit Verification [EVV]), and sign privacy or consent forms. They also get a breakdown of their balance statements, alongside an option to pay via credit card through the online portal itself.

This takes the weight off your front desk staff, and makes patient onboarding much easier. 

And because patients can clearly see a transparent breakdown of their balance and pay in one place, PT practices using StrataEMR have told us they’ve massively boosted patient collections while reducing queries about the charges on patient statements.

Note: Each patient has what we call a Clarity Panel. This gives you patient-level financial reporting—meaning you can see the status of each individual’s account—and a full understanding of their different treatments, charges, and payments. 

Dr. Jonathan Mullis, owner of Physical Therapy Doctors of Florida, says:

“I have more insight into my billing with Strata’s Clarity Panel than I have ever had, including when I was doing my billing in-house.”

Get a clear picture of your performance with real-time financial data

StrataEMR doesn’t just help you maximize reimbursements, it also gives you a completely transparent view into your practice’s financial performance. This allows you to make smart decisions, and identifies sources of waste and inefficiency that would otherwise be hidden. 

As just one example, your dashboard will show how certain CPT code combinations impact reimbursement rates. This can help you make better decisions about how your Billing Plan of Care is set up for certain healthcare insurers and patients.

At a glance, StrataEMR will let you keep track of:

• Accounts receivable (AR)
• Billed visits and billed units
• Billed dollars
• Average units per visit
• Insurance payments and patient payments
• Average payment per visit, per hour, and per insurer

What else does StrataEMR do?

StrataEMR is covers everything you need for therapy practice management:

• Patient documentation
• Patient scheduling
• Patient engagement
• Workflow management
• Patient satisfaction and outcome tracking

And of course, every touchpoint is designed to facilitate a clean claims process.

Speak to an expert today

Using StrataEMR as your physical therapy billing service will make your medical claims process effortless, while achieving reimbursement rates of 99.999%. 

To see how StrataPT can keep your billing up-to-date and compliant without the need for ongoing training, schedule a free, no-pressure call today.