FAQ: How Does The Billing Process Work?

Billing for physical therapy services is similar to what happens at your doctor’s office. Here at Borja PT, we take care of the billing so you don’t have to. When you become a patient and begin receiving treatment, the following occurs:

  1. The physical therapist bills your health insurance, auto insurance or Worker’s Compensation company based on the procedures performed during that days’ visit.
  2. Those codes, known as Common Procedure Terminology Codes (or CPT Codes) are sent in the form of a medical claim to the respective payer for processing.
  3. The payer processes the claim and determines payment according to their company’s fee schedule.
  4. An Explanation Of Benefits (EOB) document is created and sent to the physical therapy clinic, along with payment, if applicable. A second copy of the EOB is sent to the patient as well, explaining how the services were covered and if the patient is responsible for any portion of the payment.
  5. If there is a patient responsibility, depending on which Patient Payment Option was chosen when starting physical therapy, the patient will either make a payment on their balance each visit or be charged monthly for the previous months’ processed claims.

While it is common for claims to take 60 days or less to be finalized and paid, it’s possible to take upwards of six months or longer after the treatment date for some claims to become finalized. Claims may be delayed due to miscommunication, missing information, processing errors and more.

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Jaime Curl

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