Building from the Ground Up: Billing Checklist for New PTs

You might say that when you’re building a table, the most important tool to have on hand would be a saw. Another person might say it’d be a sander—and another might argue that you can’t do anything without a tape measure. I’d personally say that, while you definitely need all those tools, the most important tool to have on hand is a calm, clear-headed frame of mind. (Seriously, don’t use dangerous equipment if you’re not 100% present in the moment.)  However, not a single one of these tools by itself will allow you to build something from the ground up—not even a clear head. After all, you can’t just walk over to a pile of lumber, say, “I’m going to make a table,” and expect anything to happen. You have to grab your blueprint and assemble your square measure, your level, your power drill, your saw, and all the tools you might need before you start building something great.  

When you think about it, building a PT practice from the ground up is exactly like making something out of wood or steel: you have to assemble your toolbox before you even think about getting started. And, in this case, one of your cornerstone tools is a clear and efficient billing foundation. 

Have a space for your practice—and a plan to get patients. 

Okay, so this isn’t a billing-specific box to check, but it does technically affect your billing process. Before you begin billing—before you begin much of anything, really—you need to have a space to practice therapy, whether it’s a section of a gym or an entire building. This may sound like a no-brainer, but our onboarding team here at WebPT sees this problem more often than you’d think. Sometimes, people get caught up in the excitement of opening their own clinic, and they start buying software before they’ve even rented (or in some cases, built) a building. 

Other prospective PT owners may have a location locked down, but they don’t have a marketing strategy in place to get patients once they open. Needless to say, you can’t bill payers (let alone provide therapy) without patients.

Get credentialed and negotiate your contracts. 

Once you have a building and a plan to get patients, it’s time to set yourself up with some payers by getting credentialed and contracted. And before you ask, no: credentialing and contracting are not the same thing. Credentialing is the process insurance companies use to verify your identity, while contracting is the process of establishing your relationship—and reimbursement rates—with each payer.

Start the credentialing process by creating a list of all the payers in your area that you’re interested in contracting with. Consider things like: 

• The local patient population (e.g., Will you work with college students or with Medicare patients?);
• The largest insurance carriers in the area (e.g., If you contract with Aetna, will you get any patients?); and
• What you need to make to stay profitable (e.g., Are BCBS rates high enough to keep you in business?).

Once you decide which payers are worth contracting with, it’s time to get credentialed. But before you actually fill out each payer’s paperwork and apply to get credentialed (a process that can take several months), you need to have your practice’s ducks in a row. Here are the basics that you need to cover: 

• “Secure your own tax ID number;
• Obtain malpractice insurance;
• Get an NPI number;
• Have a license to provide services in your state; and
• Find a clinic location in which to practice.” (Looks familiar, right?)   

After you’ve gotten credentialed with your chosen payers, you’ll begin the contracting process. This is when you review the contracts that payers initially provide, and either:

1. agree to the rates presented, or
2. negotiate for better rates. 

Learn the lingo—and make sure your staff knows it, too. 

There’s nothing more frustrating than a facing big billing mistake that was caused by a little miscommunication. And when you have a lot of hands in the pot (e.g., front office staff, billers, PTs, and techs), it’s easy for these little miscommunications to pile up and throw a wrench into the whole operation. So, your best bet is to make sure everyone starts out on the right foot—and with the right lingo. For example: Ensure that your PTs don’t call a progress note a reevaluation—and that your front office staff know an order is also called a referral. For a full list of crucial billing terms, check out our PT billing guide. 

Educate yourself (and your staff!) about CPT and ICD-10 codes. 

The next step is to invest time into some good ol’ education. It takes a really long time to learn (and understand) the differences between all the common PT CPT codes—let alone all the relevant ICD-10 codes—but it’s absolutely crucial that your billers and your PTs are operating out of the same code book. This advice flies hand-in-hand with the previous point: more education means less miscommunication. Just be careful not to underestimate the time it takes to educate multiple people about a subject this complicated. It’s tough, to put it lightly. 

Get your paperwork in order. 

Next, you’ve gotta get all your paperwork together and ready to go. The paperwork you need on hand may vary based on your payers, but generally, it’s safe to assume that you’ll need ABNs for Medicare patients and CMS-1500 claim forms in case you need to file any paper claims. It would also behoove you to create a patient intake form that asks for patient insurance information. Securing that billing information as soon as the patient walks through the door (or even before his or her first appointment) will smooth out your billing process and help prevent billing delays and hangups.  

Team up with an all-star billing pro—when you’re ready to do so. 

Medical billing is extremely complicated, and our onboarding team here at WebPT frequently encounters practice owners who completely underestimated its complexity—and its time-sucking nature. And even when you’re a total billing aficionado, it’s tough to keep up with frequent payer changes and annual government-mandated compliance updates. That’s why it’s so important to find a billing solution that can help you navigate (and adhere to) constantly changing billing requirements—a solution that can get you paid faster. 

Whether your perfect solution is a billing software or an RCM service, a good billing partner will help set you up for success—provided you purchase one at the right time. Asia Giuffrida, our Therabill Onboarding Team Lead, cautions against purchasing a billing service or EMR too early. While it’s great to shop for an EMR or a billing solution a few months in advance, she says, you generally don’t need to purchase a system more than 30 days before you open. 

While this may not be a comprehensive checklist of everything you need to do to get your billing process revved up and ready to go, it does cover the foundational basics. And with a sturdy billing foundation, you’re one step closer to building your practice from the ground up. Good luck!

• Have a space for your practice—and a plan to get patients. 
• Get credentialed and negotiate your contracts. 
• Learn the lingo—and make sure your staff knows it, too. 
• Educate yourself (and your staff!) about CPT and ICD-10 codes.  
• Get your paperwork in order (e.g., ABN, CMS-1500, and patient intake form). 
• Team up with an all-star billing pro—when you’re ready to do so.