Submit Physical Therapy Claims Weekly or Daily
Submit Physical Therapy Claims Daily
Best practice is to submit physical therapy claims daily. This allows the practice to maintain a steady cash flow and allows you the chance to catch problems quickly.
Personal Injury and Medpay
When physical therapy claims are being submitted to an insurance company following an automobile accident or personal injury case, these claims are often paid on a first come first serve basis. Since Medpay is limited, I want to get my claims in as fast as possible.
In these cases, I will often have my administrative team fax my physical therapy claim within the hour following treatment.
Medicare Part B
“Timely filing” is the terminology used to describe how long a third-party insurance payer will allow providers to submit a claim for services.
Medicare Part B allows providers 12-months to submit a claim from the date the service was delivered.
Despite this 12-month timely filing limit, it is best practice to submit physical therapy claims to Medicare Part B within 24 hours.
A 24-hour claim submission cycle allows the therapist and practice owner to catch problems quickly. Medicare Part B typically processes a physical therapy claim submitted electronically in 12-days.
Physical therapy patients are likely still receiving physical therapy services beyond 2-weeks so if there is a problem like an incorrect Medicare subscriber ID or a transposed letter on an ICD-10 diagnosis code, the provider will be notified by Medicare and may resolve the problem before the patient is discharged.
Submit Physical Therapy Claims Weekly
Some single owners, operator physical therapists, and mobile physical therapists do not have an administrative team or billing team to submit claims daily. These providers choose to submit claims weekly.
This is an option but will delay catching problems early and may result in delayed cash flow.
Some payers like Unitedhealthcare have a 90-day timely filing limit.
Weekly Physical Therapy Claims Submissions
If you do choose to submit physical therapy claims on a weekly basis, it is recommended that you still only bill a single date of service on each CMS 1500 claim form.
Whether you are submitting PT claims on paper or electronically, creating a unique claim per each date of service will help to identify problems or data entry errors more easily.
Submit Physical Therapy Claims Monthly
Submitting physical therapy claims on a monthly basis is simply put “A bad idea!”
There is absolutely no advantage to monthly claim submissions. Missing timely filing limit deadlines and interrupted cash flow will make it nearly impossible to operate a physical therapy business.
Low Patient Volume
Even if you are a new physical therapy practice and you don’t have more than 1 or 2 patients, I still would not recommend a monthly physical therapy billing cycle.
Build the system you will use when your physical therapy practice is busy and successful. Work the kinks out of your systems now, in the early days.
Submit Physical Therapy Claims at Discharge
Another really terrible idea is to wait until discharge to submit physical therapy claims. For the same reasons as monthly billing, waiting until discharge makes catching data entry mistakes and rejection reasons more challenging than it should be.
Additional Resources:
| Learn how to bill Medicare |
| Medicare PTAN Lookup |
| Home-based Outpatient Physical Therapy |
Timely Filing Limits
- Medicare Part B 12-months
- UnitedHealthcare 90-days for in-network providers
- UnitedHealthcare 180-days for out-of-network providers
- Anthem Blue Cross Blue Shield (verify by state)
* Note – due to the public health emergency, several third-party insurance payers have modified or extended timely filing requirements for claim submissions. Verify this with your specific payers.
Intentionally Delaying Claim Submission
On rare occasions, there is a benefit to intentionally delaying claim submissions of your physical therapy claims.
For example, when a patient has recently had surgery and is utilizing an insurance plan with a high deductible. Many of these high deductible insurance plans will pay 100% of the allowed amount once the deductible and out-of-pocket maximum has been satisfied.
If a provider will able to delay physical therapy claim submission a couple of weeks or months without going past the timely filing limit, the surgical claims will process and the patient will satisfy the out-of-pocket maximum.
This will allow the patient to receive physical therapy services with no out-of-pocket cost.
Prompt Pay Discount
An additional benefit to the patient in the scenario above is that the patient may be eligible for a prompt pay discount from the surgical center. Often, after an expensive procedure, the hospital or surgical center will offer a 30% or 40% discount if the entire amount due is paid at once.
