August 21, 2023

Optimizing the Physical Therapy Patient Financial Journey


The patient experience extends beyond the walls of the PT clinic. Why? Because there's still the matter of billing for services. And let's be honest, when it comes to finances, people prefer simplicity over complexity. If it's challenging, they might seek physical therapy elsewhere. 60% of patients who pay out-of-pocket costs and receive inaccurate estimates or unexpected bills will consider switching providers for a better payment experience.

It's best to offer a patient financial journey that is simple, clear, and modern.

Let's explore the strategies for enhancing your patient's financial experience at your PT clinic in 2023.

Understanding the Patient Financial Journey

Exploring the different stages of the patient's financial journey

It's always beneficial to briefly recap the patient's financial journey today. Although the specific steps may differ among healthcare providers, this is a common framework for understanding what it entails for a patient.

Pre-Visit: This stage involves things for the patient to do before seeing their healthcare provider. It includes figuring out the insurance coverage, checking if the provider is in-network, and getting an idea of the costs.

Registration: During the registration process, patients provide personal and insurance information. This data verifies eligibility, determines coverage, and establishes billing accounts. (You can make this step as seamless as possible by having a solution that lets you create and customize document templates.)

Point of Service: At this stage, patients might pay a copayment, deductible, or coinsurance amount. Depending on the provider's policies, it can occur before or after receiving services.

Claims Submission: Healthcare providers submit claims to insurance companies for reimbursement. This process involves coding medical services, attaching necessary documents, and ensuring accuracy to expedite payment.

Insurance Adjudication: Insurers review and process the submitted claims. They verify coverage, apply contractual adjustments, and determine the amount payable to the provider. This stage may involve coordination of benefits if multiple insurances are involved.

Patient Billing: Once insurance adjudication is complete, patients receive bills for any remaining balance. This includes deductibles, coinsurance, non-covered services, or amounts not reimbursed by insurance.

Payment and Collections: Patients make payments through various methods, such as credit cards, checks, or online portals. Healthcare providers may offer payment plans or financial assistance options for those facing financial difficulties.

Follow-up and Resolution: Patients may need to reconcile billing discrepancies or resolve outstanding issues. This may involve contacting the provider's billing department, insurance company, or third-party service providers.

Lots of steps, right? So, as a PT provider, it's important to ensure a smooth process. If any stage becomes challenging, it can lead to confusion and frustration, ultimately impacting the patient experience.

Challenges faced by patients and PTs

Patients and physical therapists (PTs) face several challenges regarding billing and payments for services throughout a patient finance journey. Some common challenges include:

  1. Insurance coverage: Patients may struggle to understand their insurance coverage for physical therapy services and the associated billing process. 57% said they sometimes avoided medical care because they weren’t sure if their insurance would cover any expenses.
  2. Authorization and pre-approval: PTs may encounter difficulties obtaining authorization or pre-approval from insurance providers for certain treatments or procedures, leading to delays or denials in reimbursement. Also, this process can be a real time-sucker in admin tasks!
  3. Complex billing codes: The use of complex billing codes can be confusing for patients and PTs, potentially leading to errors in documentation and billing. (Need a refresher on PT billing?)
  4. Reimbursement rates: PTs may face challenges with low reimbursement rates from insurance providers, which can impact the financial viability of their practice.
  5. Billing errors and denials: Patients and PTs may encounter issues with billing errors or denials, requiring additional time and effort to rectify and ensure proper reimbursement.

These challenges can affect PTs and patients in terms of finance and billing. It's understandable why a patient's experience may be flawed due to obstacles and why PTs may get flustered with payment. So, how can we simplify this process?

Strategies for Enhancing PTs' Financial Experience

Streamlining the billing and payment process

To streamline the billing and payment process, several strategies can be implemented:

  1. Implementing user-friendly online payment systems: Customers can conveniently make payments without hassle by integrating intuitive and easy-to-use online payment platforms. This can include options such as credit card payments, digital wallets, or even automatic recurring billing. (Tip: Use a practice management platform that offers this feature. Like us!)
  2. Offering transparent pricing and cost estimates: Being upfront and transparent about pricing is crucial for building customer trust. Communicating the costs, fees, and any additional charges associated with the products or services offered helps customers make informed decisions and eliminates surprises during the billing process. To effectively assist patients with billing inquiries, ensure your team has extensive knowledge and maintains a friendly demeanor, whether in-office or remote. (Did you know PtEverywhere has a mobile app for easy patient communication, no matter their location?)

Businesses can enhance the billing and payment experience by focusing on these aspects, ensuring efficiency, convenience, and customer satisfaction.

Improving communication and education between PT and provider regarding billing and payments

Effective communication and education between PTs and patients are vital for streamlining billing and payment processes, reducing confusion while enhancing the patient experience.

This can be achieved through:

  1. Providing clear explanations of insurance coverage and benefits: Knowing insurance policies inside out can make the whole insurance claims and reimbursement process less of a hassle for PTs and patients. Clear communication regarding the covered services and out-of-pocket expenses is essential for both parties. What can help? A user-friendly tool to check eligibility, submit electronic claims, and reconcile ERAs for Medicare, Medicaid, and private insurance companies – all in one convenient place.
  2. Educating patients on financial options and resources: PTs should proactively educate patients on available financial options, such as flexible payment plans, insurance assistance programs, or alternative funding sources. It is important to provide resources and guidance to help patients navigate the financial aspect of their care.

By focusing on these areas, PTs and providers can enhance their collaboration, improving patient experiences and a better financial journey.

A better financial journey for patients means better financial revenue for PTs

The patient experience includes the care they get and how a healthcare provider handles their payment and billing. For PT Providers, it's not as easy as it sounds, but worth it because a happy patient is a returning patient! To make it better for everyone, having tools that streamline insurance claims, improve communication, and provide document templates can really help with patients' finances. 

PtEverywhere can do this and so much more! We are a patient management platform plus for PTs wanting to simplify their admin and patient operations.

To learn more about PtEverywhere for 2023, book a demo or check out our media center for more therapy tips and tricks!