Are you using only 30% of Athenahealth’s capabilities? Most PT practices leave powerful features unused. They manually enter charges. They forget modifiers. They miss authorization deadlines. Meanwhile, competitor PT clinics collect 25 to 35% more per patient.
This guide reveals the best practices for PT clinics. You’ll discover system configurations that increase collections. We explain billing workflows designed for physical therapy. Stop leaving money on the table and optimize your system today.
Set Up Athenahealth for PT
Proper system setup is the foundation. These settings optimize Athenahealth for PT practices.
Create PT Templates
Create templates for each therapy type. The initial evaluation template includes all required elements. Treatment note templates prompt for time. Discharge summary templates ensure complete documentation. Templates automatically suggest codes. This prevents coding errors.
Add Therapy Modifiers
Physical therapy requires specific modifiers. Modifier GP indicates physical therapy services. Configure Athenahealth to auto-apply GP. This prevents the most common PT billing error. The system adds GP to every PT code automatically.
Build Code Library
Create a favorites list of common PT codes. Include 97161, 97162, 97163 for evaluations. Add 97110, 97112, 97116, 97140 for treatments. Favorites speed charge entry. They reduce code selection errors.
Document Efficiently
Efficient documentation improves billing accuracy. It also saves clinician time.
Use Smart Templates
Smart templates guide complete documentation. They include all required elements. Evaluation templates prompt for history and testing. Treatment templates track progress toward goals. Configure templates to calculate time automatically.
Track Progress
Track patient progress in Athenahealth. Record initial baseline measurements. Document progress at each visit. Compare the current to the baseline automatically. This data supports medical necessity.
Document Goals
Create standard goal templates. Functional goals work better than impairment goals. “Patient will climb stairs independently” is better. Link treatments to specific goals. This supports continued care authorization.
PT Billing Best Practices
Master Time-Based Billing
PT codes are time-based. Accurate time documentation is critical.
Understand the 8-Minute Rule
8 to 22 minutes equals 1 unit. 23 to 37 minutes equals 2 units. 38 to 52 minutes equals 3 units. Each additional 15 minutes adds 1 unit. Athenahealth can calculate units automatically.
Document Time
Document the exact treatment time for each code. Start time and stop time for each service. Total time for multiple services. Athenahealth templates can capture this automatically. Never estimate time later.
Use Calculators
Configure Athenahealth to calculate units from time. Enter total minutes for each service. The system calculates correct units automatically. This prevents both under- and overbilling.
Choose Evaluation Codes
Choosing the correct evaluation codes maximizes payment.
Know Complexity Levels
Code 97161 is low complexity. Code 97162 is of moderate complexity. Code 97163 is high complexity. Complexity depends on clinical presentation. The payment difference is $40 to $80 between levels.
Document Elements
High complexity evaluations need specific elements. Three or more personal factors. Multiple comorbidities affect treatment. Unstable clinical presentation. Document these elements clearly.
Use Templates
Create templates for each complexity level. Templates prompt for required elements. They provide complete documentation. This ensures you capture an appropriate level.
Manage Authorizations
Authorization failures cause 20% of PT denials. Effective management prevents these.
Track Requirements
Different payers have different requirements. Medicare doesn’t typically require PT authorization. Commercial payers often require it after 10 to 20 visits. Configure Athenahealth to track requirements by payer.
Set Alerts
Configure alerts 5 visits before authorization expires. Alert again at 2 visits remaining. This allows time to request an extension. Athenahealth can send automatic alerts.
Document Need
Authorization requests need strong justification. Include objective measurements. Show functional improvements. Explain continued treatment need. Athenahealth can generate reports from progress data.
Capture All Charges
Unbilled services lose money. Proper charge capture prevents this.
Enter Charges Same Day
Enter charges within 24 hours of service. Don’t batch charges weekly. Delayed entry causes forgotten services. Same-day entry while memory is fresh.
Link to Documentation
Link charges directly to treatment notes. When a note is signed, charges are created automatically. This prevents unbilled services. Athenahealth can automate this linkage.
Review Daily
Review all charges entered daily. Check for missing modifiers. Verify time calculations. Confirm diagnosis linkage. Daily review catches errors quickly.
Handle Denials
Despite prevention, some denials occur. Quick response recovers revenue.
Use Denial Dashboard
Athenahealth’s denial dashboard shows all denials. Filter by denial reason code. Identify patterns requiring fixes. Address patterns systematically.
Respond Fast
Work denials immediately upon receipt. Don’t let them age. Simple corrections resubmit within 48 hours. Complex appeals start within 1 week.
Track Trends
Monitor denial rates monthly by reason. Calculate the percentage for each category. Increasing denials signal problems. Address root causes immediately.
Schedule Smartly
Smart scheduling improves both clinical and financial outcomes.
Create Appointment Types
Create appointment types for each service. Initial evaluation appointments. Follow-up treatment appointments. Each type has a different duration and charges.
Set Time Blocks
Set time blocks matching actual service. 45-minute initial evaluations. 30-minute treatments. Accurate time blocks prevent overbooking.
Track Productivity
Monitor visits per therapist daily. Track units billed per therapist. Compare productivity across therapists. Athenahealth productivity reports show these metrics.
Verify Insurance
Verifying insurance before service prevents denials.
Verify Every Visit
Don’t assume insurance remains unchanged. Patients change insurance frequently. Verify coverage at each visit. Real-time checking takes 30 seconds.
Confirm PT Benefits
Specifically verify PT is a covered benefit. Ask about visit limits. Confirm deductible and copay amounts. Document verification in Athenahealth.
Check Authorization
Verify authorization is active and current. Check remaining authorized visits. Confirm dates of service covered. Athenahealth stores authorization details.
Communicate with Patients
Clear communication improves collections.
Explain Costs
Tell patients their expected costs. Explain deductibles and copays. Discuss visit limits if applicable. Transparency prevents billing surprises.
Collect at Visit
Collect copays at check-in. Estimate deductible portions and collect. Don’t wait for insurance processing. Collection rates drop after 30 days.
Offer Payment Plans
Large deductibles create problems. Offer payment plans for balances over $500. Collect the first payment immediately. Athenahealth can manage payment plans.
Train Your Staff
Well-trained staff use Athenahealth effectively.
Train on PT Features
Teach time-based billing rules. Explain modifier requirements. Cover authorization processes. Quarterly training reinforces skills.
Track Training
Track which staff completed which training. Ensure all billing staff are trained on PT rules. New hires complete training before billing.
Update Regularly
Monthly update sessions keep staff current. Review new features and changes. Test new features first. Then roll out to production.
Use Reports
Regular reporting identifies opportunities.
Monitor Metrics
Track AR days weekly. Calculate the clean claim rate monthly. Monitor denial rate by category. Athenahealth dashboards display all metrics.
Analyze Payers
Compare payment by payer. Some payers pay better than others. Use data to inform network decisions.
Review Productivity
Track productivity by therapist. Compare units billed per visit. Monitor documentation completion rates. Athenahealth reports show this data.
Stay Compliant
Maintaining compliance prevents audits.
Audit Charts
Audit a random sample of charts monthly. Verify time supports units billed. Check diagnosis supports treatment. Internal audits find problems early.
Check Coding
Review code selection against documentation. Ensure evaluation complexity matches. Verify treatment codes match services. Monthly audits maintain accuracy.
Document Properly
Documentation must support all billing. Time documented for time-based codes. Medical necessity is clear in the notes. Athenahealth templates guide documentation.
Conclusion
Best practices for PT clinics using Athenahealth include proper system setup with templates. Master time-based billing using the 8-minute rule. Choose appropriate evaluation codes. Manage authorizations with tracking and alerts. Capture charges through same-day entry. Handle denials quickly. Verify insurance at every visit. Communicate costs clearly with patients.
FAQs
What are the most important Athenahealth features for PT?
Time-based billing calculators, automatic modifier application, authorization tracking, & evaluation templates are most important. These directly impact revenue.
How can PT clinics reduce claim denials?
Configure automatic modifier application. Use time calculation tools. Set authorization alerts. Implement claim scrubbing. These prevent common PT denials.
Should PT clinics use templates?
Yes, use templates for consistency. Templates ensure all required elements are documented. They speed up documentation while improving billing accuracy.
How often should PT staff receive training?
Provide initial comprehensive training. Conduct quarterly refresher training. Monthly updates on new features. This keeps skills current.
What reports should PT clinics run?
Run AR aging weekly. Run denial reports monthly. Run productivity reports by therapist. Run clean claim rate reports. These show financial health.
