Specialties
Physical therapy billing
For physical therapy, occupational therapy and rehab clinics. Therapy is billed in minutes and units, so small documentation gaps turn directly into lost revenue.
What makes therapy billing hard
- Timed codes and the 8-minute rule. Medicare calculates units from the total minutes of timed treatment, while some commercial payers count each code separately. The same visit can produce a different number of units depending on the payer.
- Plan of care certification. For Medicare, a physician or qualified practitioner must sign the plan of care and recertify it at set intervals. Treatment without a valid certification is at risk.
- The KX threshold. Above Medicare’s annual therapy amount, claims need the KX modifier and documentation showing that continued therapy is medically necessary.
- Therapy modifiers. Discipline modifiers for physical, occupational and speech therapy are required on every line by Medicare and many other payers.
- Visit limits and authorizations on commercial plans, plus workers compensation and auto injury claims with their own rules.
How we work it
Units are calculated with each payer’s own rule, plan of care dates are tracked so recertifications are requested before they lapse, and authorized visit counts are watched so the clinic knows before the limit is reached. Workers compensation and auto claims are worked as their own queue.
Common questions
Do you apply the 8-minute rule for every payer?
No. Medicare and payers that follow it use total timed minutes. Others count each timed code on its own. We set the rule per payer so units are billed correctly for each one.
Can you track plan of care recertifications?
Yes. Each patient’s certification dates are tracked and the clinic is alerted ahead of the deadline, so visits aren’t delivered under an expired plan.
Start with the free audit
Send us ninety days of claims data and we’ll show you what was left uncollected. No charge, no obligation, and the findings are yours either way.
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