Physical Therapy Billing Services for Therapy Practices
In a busy therapy clinic, billing details are easy to lose. Timed codes are billed in units of time. Modifiers show which discipline gave the care. The plan of care has to be certified, and many plans cap visits or ask for authorization after the first few. Add assistant billing rules and bundling edits between common codes, and even a well-run clinic can leave money behind. We bill physical therapy and rehabilitation practices with those details in mind, one visit at a time.
Where therapy billing slips
Six details that cost clinics money.
Timed and untimed codes
Many therapy codes are timed and billed in 15-minute units, while evaluations and some modalities are untimed. Medicare and many payers have rules for turning total treatment minutes into units, and mistakes mean over- or underbilling.
GP, GO, GN and assistant modifiers
GP, GO and GN identify physical, occupational and speech therapy. Assistant modifiers such as CQ and CO affect payment when assistants provide care, and other modifiers apply when codes bundle together.
Plan of care and recertification
Medicare requires a certified plan of care, recertification when it expires, and progress reports at set intervals. Missing signatures or dates lead to denials, and sometimes recoupment.
Visit caps and authorizations
Many commercial plans limit therapy visits per year or require authorization after a set number. When the front desk tracks remaining visits, patients are not caught off guard.
Bundled treatment codes
Certain common treatment codes are bundled under NCCI edits, so billing both on the same day may need a modifier the documentation supports, or may not be payable at all.
Medicare thresholds and payment reductions
Medicare applies annual thresholds that call for a documentation modifier once they are passed, plus a multiple procedure payment reduction for therapy services. Both change what you should expect to be paid.
How we help therapy practices
Use us for the whole cycle, or for the parts that eat your front desk's time.
Visit limits and copays at intake
Before the first visit, eligibility verification covers coverage, therapy visit limits, copays and authorization rules.
Authorization for more visits
We prepare requests for the first visits and for extra ones, and follow them through prior authorization so a patient's care is not interrupted.
Units, evals and modifiers
Evaluation codes, timed units, modifiers and bundling are matched to the visit note by our medical coding team.
Visits and units from your notes
Visits and units are keyed in from your notes through charge entry, then compared with the schedule so a visit does not slip through.
Right payer, right modifiers
Claims leave through our claim submission process with the modifiers each payer expects.
Patient responsibility on every line
We post payments by line, update what the patient owes and flag short payments.
Plan-of-care and visit-limit denials
Our A/R and denial team handles anything denied for authorization, visit limits, plan of care or modifier reasons.
Statements patients can follow
Patients get statements that explain copays, deductibles and visit limits in plain words, through our patient collection service.
Visits used against visits authorized
The report shows A/R by payer, denials by reason, and visits used against visits authorized.
Your therapy EMR
Your therapy EMR and billing software stay as they are. We work inside them.
Starting with a therapy clinic
The first few weeks, step by step.
Get to know your clinic
We look at your disciplines, payers, referral sources and how your therapists document.
Build a visit-limit cheat sheet
We write up visit caps, authorization triggers and recertification dates for each major payer.
Plug in securely
We set up secure access to your EMR and give the front desk an intake checklist.
Bill and follow up
Eligibility, unit checks, claims, posting and denial follow-up begin on the schedule we set.
Review with the clinic
Denials, A/R and visit-limit trends are reviewed with your team.
Before you go
Eligibility and authorization
Visit caps start at the front desk. See our eligibility verification services and prior authorization services.
Patient balances
Copays and deductibles add up over a course of care. See our patient collection service.
Orthopedic referrals
Many therapy patients come from orthopedic surgeons. See our orthopedic billing services.
Look at your therapy claims with us
Visit caps, modifier denials and plan-of-care problems tend to show up together. If that is your clinic, tell us a bit about it. A free billing audit makes an easy first step.
Get a Free Billing AuditCall (321) 788-3655Frequently Asked Questions
Questions from therapy practices and rehab clinics.
1. Do you apply the timed-code unit rules?
Yes. We convert treatment time to units under each payer's rules and check the result against your documentation.
2. Can you handle GP, CQ and other therapy modifiers?
Yes. We apply discipline, assistant and bundling modifiers where the payer requires them and your documentation supports them.
3. Can you keep track of plan of care certifications?
Yes. We flag missing or expiring certifications and progress reports so they can be fixed before claims are affected.
4. What do you do about visit limits?
We check limits at eligibility and track visits against them, then ask for more authorization where the plan allows it.
5. Do you bill workers' comp and auto cases?
Yes. We follow the rules and forms for each payer type.
Specialties therapy clinics work alongside
Referrals often come from, or go to, these practices.
Orthopedics Billing
Surgery, fractures and injections that often lead to therapy.
Pain Management Billing
Procedures that sometimes pair with a course of therapy.
Home Health Billing
Episodes, authorizations and documentation for in-home care.