I-Med Claims - Medical Billing Company
Physical Therapy eligibility verification

Comprehensive Guide To Physical Therapy Eligibility Verification

Physical therapists treat various conditions, from chronic pain to restoring physical mobility and strength to handling hand, wrist, arm, elbow, and shoulder injuries and situations. Physical therapy concentrates on returning people to their daily lives and activities, such as sports and work. While physical therapy practice provides specialized services to treat each patient’s injury or condition, they must also have adequate processes to verify patients’ insurance coverage eligibility. Your front office is the beginning of improved revenue collection. The most crucial step in revenue cycle management is patient insurance verification. Physical therapy eligibility verification may appear simple, but it is not. You cannot route your claim to the correct payer and collect appropriate revenue for your therapy services unless you have eligibility and benefit details. You must perform physical therapy eligibility verification before the patient’s appointment for each visit and inform them about financial stability, if any, before treatment. This makes accumulating your money easier for you.

Why Is Physical Therapy Eligibility Verification Important?

Physical therapy eligibility verification helps you determine whether the patient’s insurance plan will support the physical therapy services you provide and whether or not the patient is in your network. Every patient’s insurance coverage and benefits must be verified before the office visit – both at the initial appointment and regularly after that, as data can be altered at any time. Prior authorization is also required to confirm the approval of the treatment, care, or service. The first and perhaps most crucial step in the physical therapy billing process is verifying patient insurance eligibility. That implies your front office must be proactive in obtaining and accurately recording all eligibility information. Your staff is in charge of assessing each patient’s insurance eligibility, which includes:

  • Coinsurance or copay
  • Deductible
  • Where to send the claim
  • If the payer requires additional documentation, and if the payer requires authorization.

Some payers will authorize services retroactively, but others will require authorization before you begin providing service.

Verifying physical therapy eligibility and benefits in advance is critical for avoiding claim denials and revenue loss. It is essential in healthcare revenue cycle management to help with faster and smoother claim processing at all stages. Finding accurate patient demographic and insurance information is a critical first step for a healthcare organization to function effectively! Failure to do so may result in payment denials and delays. Healthcare practitioners used to rely on multiple phone calls and websites to verify patient and insurance information. This used to be an inefficient process. The possibility of noncompliance is another reason to strengthen your physical therapy eligibility verification processes. Furthermore, healthcare organizations that fail to comply with HIPAA and HITRUST requirements risk high fines and penalties. One method to prevent these penalties is to develop a patient eligibility verification system that completely automates the process, making human mistakes impossible.

Healthcare providers benefit from patient eligibility tools in a variety of ways, including:

  • Quick and accurate determination of their patient’s eligibility for coverage, payment commitments, and benefits.
  • Decrease claim resubmissions and delays by submitting clean claims.
  • Reduce denials and rejections based on eligibility or demographics.
  • Improve the billing process and patient satisfaction by increasing upfront collections.

Process Of Physical Therapy Eligibility Verification 

When scheduling appointments, the insurance verification process involves gathering patient information and validating it with the insurer. Comprehensive physical therapy eligibility verification occurs at numerous points during the revenue cycle, particularly during patient scheduling and pre-registration.

Patient scheduling:

Patient scheduling is the first step in the insurance verification procedure. Schedulers collect the information required to schedule a patient’s appointment. Patients can be scheduled via phone, text, fax, email or self-scheduling. Telephone staff can also capture insurance information and perform real-time eligibility verification. The registration software captures and enters the necessary demographic and financial information. Patients can be educated on copay collection practices and reminded to acquire a referral if their plan demands it.


Whenever possible, collecting patient information before the appointment can assist in simplifying the onboarding process. Appointments might have been planned for months, and insurance details could have changed. This is why insurance verification is critical 3-7 days before the appointment. A pre-visit eligibility verification is essential to confirm that the data recorded in the registration/billing system corresponds to the data collected from the payer. Any data discovered to be incorrect should be changed as soon as possible to ensure a smooth claims procedure.

Benefits Of Physical Therapy Eligibility Verification For Providers

Physical therapy eligibility verification can benefit providers in the following ways.

  • It enables you to estimate how much a patient will owe for treatments, allowing you to collect payment at the time of service.
  • It enables you to obtain the required authorizations before providing care or services.
  • It encourages higher clean claim rates by ensuring that the correct insurance is billed. It also aids in determining the billing sequence (in cases where a patient has more than one active policy).

Benefits Of Physical Therapy Eligibility Verification For Patients

The following are the main advantages of therapy billing verification for patients.

  • It assists patients in planning for their financial responsibilities, reducing stress or fear over a surprise bill.
  • It allows patients to hunt for a lower-cost provider or a new insurance policy.
  • It enables patients to make service plans.

Best Practices for Improving Physical Therapy Eligibility Verification

  • Collect, analyze, and apply data from available sources of information about patients and their insurance plans.
  • Examine all acquired information thoroughly to avoid the possibility of missing data or using old or inaccurate information.
  • Conduct regular follow-ups to recognize and fill in the missing information.
  • To avoid discrepancies, double-check the data provided by patients with payers.
  • To improve the patient experience and avoid claim denials, acquire pre-authorization approvals ahead of time.
  • To obtain immediate access to all payers, use real-time tools for data analysis.
  • Verify insurance coverage and communicate with patients about their options.

An Accurate Physical Therapy Eligibility Verification Solution Is The Need Of Hour

Healthcare organizations concentrate on improving patient eligibility verification. You must establish an automated method for confirming patient eligibility and an integrated registration procedure to prevent future fines. You can make the proper choices for your organization by following the guidelines for enhancing patient eligibility verification. As eligibility issues get more complex, providers cannot rely on a basic “yes or no” check. An automatic and precise eligibility solution is required. I-Med Claims provides thorough physical therapy eligibility verification to assist healthcare professionals in obtaining accurate and relevant information in real time. We assist in avoiding errors in eligibility checks caused by inefficient verification procedures, which serves as a keystone in the healthcare revenue cycle. Our objective is to make the patient qualifying process simple, quick, and efficient! We enable you to obtain rapid and dependable benefit verification for all insurance payers in one spot. Our solution allows doctors to confirm patient eligibility in seconds, allowing them to devote more time to their patients, improve revenue, and simplify the insurance verification process.

Things that Make Our Physical Therapy Eligibility Verification Services Unique

  • Cost-effective services
  • Guaranteed data security
  • High precision
  • High-performance technology
  •  Recent billing software
  • Error-free verification
  • Minimal denials and delays 
  • Quick turnaround time
  • Automated pre-appointment insurance checks

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