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
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.
