Resources
How insurance billing actually works for PTs
If billing feels like a black box, it's usually because the “work” isn't just submitting a claim—it's everything before and after.
This guide is informational and not legal, compliance, or billing advice. Requirements vary by payer and plan.
1) Eligibility & benefits (before the visit)
- Confirm coverage is active
- Understand copay/coinsurance and deductible status
- Check authorization requirements (if any)
2) Patient financials (copays and responsibility)
A clean patient payment workflow reduces bad debt and awkward conversations.
3) Documentation & coding (the visit record)
- Write notes that support what was done
- Capture codes/units consistent with payer expectations
- Keep required Medicare documentation artifacts organized
4) Claim creation & submission
A claim is a standardized request for payment. Small mismatches can cause denials or delays.
5) Adjudication & remittance (ERA/EOB)
The payer processes the claim and sends a remittance explaining what was paid, reduced, or denied—and why.
6) Denials & follow-up
Denials aren't the end. The work is: interpret the reason, correct issues, resubmit when appropriate, and track outcomes.
7) Payment posting & tracking
You want to know what you earned per visit, what's pending, and what requires action—without spreadsheets.