Physical Therapy Eligibility Verification

Physical Therapy Insurance Verification:

Your improved revenue collection starts with your front office. Patient’s Insurance verification is the most critical step of your revenue Cycle Management. Eligibility Verification may look simple, but it is quite tricky. Without accurate Eligibility and benefits details handy, you can’t route your claim to the correct payer and collect appropriate revenue for your therapy services on a timely manner. For each and every visit, you need to do Eligibility Verification prior to your patient’s appointment and notify them about financial responsibility if any well in advance prior to the treatment. This makes your life easier on collecting your money.

If your front office staff does the Insurance Verification and benefits along with the real time patient’s out of pockets including

Save on logistical and capital expenses: An efficient billing system requires office space, computers, expensive software, and regular upgrades on the software. Outsourcing billing services to qualified companies helps save on a lot of money that would otherwise be used as logistical costs and expensive software and hardware.

Qualified and dedicated specialists : Outsourcing allows medical practitioners to have access to a highly trained and qualified workforce. Many medical billing outsourcing teams exclusively focus on improving and maintaining the financial position of its clients’ practices.

Atlantic RCM – Physical Therapy Insurance Verification

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Therapy Cap:

Annual Medicare Spending limit per-beneficiary is known as Therapy Cap. Once the cap is reached, patients are required to pay out of pocket for further services. Normally, private practices, physician offices, comprehensive outpatient rehabilitation facilities are affected due to this Cap. The threshold process consists of 2 tiers:

1. When patients reach the outpatient therapy threshold for that year, you must use KX modifier to confirm your services are medically necessary and document the reasons for the additional services

2. For services over $3,000, a targeted medical review process kicks in

Following grid explains about the KS Modifier Threshold for the year 2021 and 2022

Therapy Services	2021 – KX modifier Threshold	2022 – KX modifier Threshold
PT and SLP Services combined	$2,110	$2,150
OT Services	$2,110	$2,150

Atlantic RCM offers Real Time Eligibility & Benefit Verification services for various Therapy Services like

Physical Therapy
Occupational Therapy
Speech Therapy
Massage Therapy
Sports Physical
Rehabilitative Physical Therapy
Hand Physical Therapy
Orthopedic Physical Therapy
Pediatric Physical Therapy
Aquatic Therapy
Work Injuries
Women's Health and many more

Information Required for Eligibility Verification:

NPI#
Patient’s Name
Patient’s DOB
Insurance Name & Policy#
Date of Service

How do you share patient details to Atlantic RCM?

Secured excel file extracted from your scheduler
Direct API (Application Programming Interface)
Provide access to your scheduling system

What Atlantic covers under Eligibility Verification?

Coverage Active/Inactive Status
Effective From & To Date
Group # & Name
Insurance Type (HMO, PPO, EPO, POS..)
Real-time deductible remaining
Pre-Cert Requirement info
Out of Pocket Stop loss
In/Out of Network benefits
Co-insurance percentage
PCP/Specialist Co-pay
Primary Care Physician
Managed Care Plan details (MCO, Replacement plans…)
Other/Additional Coverage information if any
IPA information
Limitations in terms of Visits/Monitory benefits
Claim mailing address and more

If you want us to take care of your Therapy billing too, we are more than happy to extend our billing services, where your Benefit verification comes at free of cost for the list of payers.

Contact Us:

Reach us @ (469) 501-1500 or email to Info@atlanticrcm.com for more details