Physical Therapy (PT) Billing, Credentialing

Advanced Physical Therapy Coding Expertise

Physical therapy billing requires precision and deep knowledge of specialized procedures. Our certified coding specialists maintain current expertise in:

Therapeutic Procedures and Modalities

• Manual therapy techniques and joint mobilization
• Therapeutic exercise and neuromuscular re-education
• Gait training and balance activities
• Therapeutic ultrasound and electrical stimulation
• Hot and cold therapy applications
• Mechanical traction and compression therapy

Evaluation and Assessment Services

• Initial physical therapy evaluations
• Re-evaluations and progress assessments
• Functional capacity evaluations
• Work hardening and conditioning programs
• Vestibular rehabilitation assessments
• Pediatric and geriatric specialty evaluations

Revenue Optimization Strategies

Physical therapy practices often struggle with claim denials due to documentation requirements and therapy cap considerations.

Our revenue cycle management approach addresses these challenges through:

• Authorization and Therapy Cap Management
  Physical therapy services frequently require prior authorization and careful monitoring of therapy caps under Medicare and commercial payers. Our team proactively manages the authorization process, tracks visit limits across different payers, and ensures proper documentation is maintained for medical necessity. This proactive approach significantly reduces claim denials and maximizes allowable visits.
• Functional Limitation Reporting (FLR)
  Medicare requires detailed functional limitation reporting for physical therapy services. Our coding specialists maintain expertise in G-code reporting, accurately documenting functional limitations and projected outcomes to ensure compliance with CMS requirements while optimizing reimbursement potential.
• Claims Processing Excellence
  We maintain detailed knowledge of payer-specific requirements for physical therapy claims, including documentation standards, medical necessity criteria, and modifier usage. Our clean claims rate consistently exceeds industry averages, resulting in faster payments and improved cash flow.
• Denial Management and Appeals
  When claims are denied, our experienced appeals team conducts thorough reviews and submits compelling documentation to overturn denials. We track denial patterns to identify systemic issues and implement preventive measures, particularly for common PT denial reasons such as insufficient progress documentation or medical necessity questions.
• Technology Integration
  Modern physical therapy practices rely on electronic health records and practice management systems. Our billing platform integrates seamlessly with leading PT software solutions, enabling automatic data transfer and reducing manual entry errors. This integration streamlines workflows and improves accuracy across the entire revenue cycle.

Provider Enrollment and Maintenance

Credentialing physical therapists and support staff requires understanding of specialty-specific requirements and maintaining current knowledge of evolving standards.

Our credentialing services include:

Physical Therapist Credentialing

• Licensed physical therapists across all specialties
• Orthopedic certified specialists (OCS)
• Neurologic certified specialists (NCS)
• Sports certified specialists (SCS)
• Geriatric certified specialists (GCS)
• Pediatric certified specialists (PCS)
• Initial enrollment with all major insurance networks
• Re-credentialing and maintenance activities

Physical Therapist Assistant Credentialing Licensed physical therapist assistants require proper credentialing to ensure appropriate reimbursement rates. We manage credentialing for PTAs across all practice settings and maintain compliance with state supervision requirements.

Specialized Therapy Services

• Aquatic therapy specialists
• Manual therapy certified practitioners
• Dry needling certified therapists
• Lymphedema therapy specialists
• Pelvic floor rehabilitation therapists

Facility Accreditation Support

Physical therapy practices benefit from accreditation to ensure quality care and optimal reimbursement.

We provide support for:

Commission on Accreditation of Rehabilitation Facilities (CARF)

• Initial accreditation application assistance
• Ongoing compliance monitoring
• Re-accreditation preparation and submission
• Quality improvement program development

Joint Commission Certification For hospital-based and larger outpatient practices seeking Joint Commission recognition, we provide guidance on meeting standards and maintaining compliance with certification requirements.

Network Contracting and Negotiations

Our team manages payer contracting relationships, negotiating favorable rates and terms that reflect current market conditions for physical therapy services. We monitor contract performance and identify opportunities for rate improvements during renewal periods.

Regulatory Compliance Management

Physical therapy billing involves multiple regulatory considerations, from therapy cap monitoring to Medicare coverage determinations.

Our compliance program addresses:

Documentation Standards

• Plan of care requirements and physician orders
• Progress note documentation for medical necessity
• Functional outcome measurements
• Discharge planning and summary requirements

Billing Compliance

• Accurate CPT and ICD-10 coding
• Proper modifier usage for multiple procedures
• Therapy cap tracking and exception processes
• Incident-to billing requirements where applicable

Performance Monitoring and Reporting

We provide detailed analytics and reporting to help physical therapy practices understand their financial performance and identify improvement opportunities.

Regular reports include:

• Key performance indicators for revenue cycle metrics
• Denial analysis with trend identification
• Payer performance comparisons
• Accounts receivable aging and collection rates
• Therapy cap utilization tracking
  

Improved Financial Performance

Physical therapy practices partnering with our services typically experience significant improvements in key financial metrics:

• Reduced days in accounts receivable
• Increased clean claims rates
• Higher collection percentages
• Decreased administrative overhead
• Optimized therapy cap utilization

Enhanced Operational Efficiency

By outsourcing billing and credentialing functions, physical therapy staff can focus on patient care and clinical excellence rather than administrative tasks. This improved efficiency often leads to increased patient satisfaction and better clinical outcomes.

Scalability and Growth Support

As physical therapy practices expand services or add locations, our scalable platform accommodates growth without requiring additional administrative infrastructure. We support expansion into new markets and help establish relationships with local payer networks.