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Common Mistakes Occupational Therapists Make When Billing

To err is human. But making errors on your claims forms can result in delayed or denied reimbursements. From clerical mistakes to inaccurate coding, there are many ways that billing trips up therapists handling their own claims. This post will explore some of the most common mistakes in occupational therapy billing and share how to avoid them so you can improve your acceptance rate and get paid faster.

General Errors in Occupational Therapy Billing

General billing errors are the easiest to avoid. You can prevent these errors by paying close attention to the information you record on your patient data, claims forms, and therapy notes. 

Clerical Errors

Incorrectly spelling a patient’s name or entering the wrong date of birth significantly raises the chances of an insurance claim rejection. Simple mistakes like entering the incorrect insurance provider details can be time-consuming to fix. Rushing through the claims submission process rarely saves time in the long run. 

Duplicate Billing 

If two staff members file a claim, both claims will likely be rejected. Make sure everyone is on the same page about who’s responsible for filing claims. Having a clear division of labor in your office will help prevent this error. 

Insufficient Documentation

Insurers want proof that you’re providing the services you’re billing for. Your claims form should include the patient’s diagnosis with their presenting problems and the services you provided. If you’re asked to provide documentation describing your reasoning for choosing the treatment, you’ll need to be able to present it.

Did you know you can sometimes bill for the time you spend doing documentation? Learn more by reading When Can Pediatric Therapists Bill for Documentation Time?

Coding Errors in Occupational Therapy Billing

CPT codes are the language of insurance billing. When you use an incorrect code, the intended message gets lost in translation. Let’s examine some of the most common CPT coding missteps.

Upcoding or Undercoding

Upcoding is coding for a higher-paying treatment than was actually performed. Undercoding is the opposite — it involves coding for a lower-paying treatment than you delivered. Upcoding can be used to generate higher payments from insurers. While it may be an innocent mistake, insurers take it seriously. Intentional undercoding is sometimes used to avoid audit scrutiny or to save a patient money. Both practices are unethical.

Using an Incorrect CPT Code

With so many CPT codes to choose from, it’s easy to select the wrong one. Using an incorrect CPT code exponentially increases your chances of a claims rejection or denial. Even if your billing claim is paid, incorrect information may become part of your patient’s billing record, so it’s important to avoid incorrect codes. 

Incorrect Use of Modifiers

Billing modifiers supply additional information about the type of service that you performed. Modifier 59 is one of the most commonly used. This code indicates that two services that would typically be billed together were provided independently and should be reimbursed as separate interventions. If you use a billing modifier, make sure the services provided match the modifier’s intended use. 

Unbundling Codes

Unbundling involves billing for two services separately that are usually billed together as a bundled service. In most instances, bundled codes must be used for a combination of services performed in the same session, rather than coding the services separately. 

Overusing Codes

Overreliance on a single CPT code is a red flag to insurers, and rightly so. In any occupational therapy practice, therapists provide a broad menu of services. It may be tempting to reach for your old standby, but locating the CPT code that best represents the diagnosis or intervention you provided is always the right choice.

Exceeding the Capped Daily Maximum for Fixed Rate Payers

Fixed rate payers like Medicare have a capped daily maximum payment. If you provide services that exceed this amount, you won’t be paid for any services you rendered beyond the maximum. 

Undertiming a Therapy Session 

Keeping accurate records of how long you spent in a session ensures you’re able to bill for timed codes accurately. Guesstimating can result in billing for one unit rather than the two you were entitled to. Gradually, the cost of undertiming sessions will add up.

Not Coding for Telehealth-Based Services 

Telehealth-based services have experienced a rapid expansion in 2020. Some insurers require the use of a CPT modifier when billing for services provided via telehealth. As a general rule, Medicare providers and private insurers require the 95 modifier to indicate the service was provided via telehealth. 

How to Avoid Coding Errors

The good news about billing errors is that they’re avoidable. The time you spend tightening up your practice’s billing procedures and building a deeper knowledge of billing-related issues will pay off many times over. Here are three best practices that will help you prevent errors.

  • Train Your Staff — The importance of a well-trained staff cannot be overestimated. Periodic training for office staff responsible for billing helps to calibrate everyone’s efforts and makes it easier to correct potential issues quickly. 
  • Stay Current on CPT Codes — CPT codes and the guidelines that govern their use change frequently. Keeping up with what’s new ensures your billing claims use the most up-to-date information.
  • Look for Patterns in Claims Rejections and Denials — Claims rejections and denials happen to even the most careful billers. Look for common reasons why your office’s claims are rejected or denied. They may vary by insurer, so pay close attention to any themes you see. Recognizing patterns can help you right the ship quickly.

Use Software Technology to Avoid Errors

Occupational therapy billing is a complex process, and it’s easy to make mistakes. But because coding correctly the first time is essential for prompt payment, you’ll want to ensure you avoid errors. Using a good practice management software that automates much of the process will help. With software, you can store information digitally and auto-populate your claims forms. You can also see an updated list of codes that apply to your services.

See how Fusion’s practice management system can help you improve your claims acceptance rate. 

Check out our Complete Guide to Occupational Therapy Billing to learn more about how to simplify and improve your billing processes.