Who we serve · Therapy clinics
Physical, occupational and speech therapy clinics. Every therapist enrolled, every visit followed to payment.
A therapy clinic is paid visit by visit, against a plan of care, an authorization and a visit limit. We enroll the clinic and each therapist with every payer, then keep the plan, the authorization and the claim lined up until each visit pays.
Three documents decide each visit.
The clinic, the therapist and the plan of care.
The clinic and each therapist are enrolled separately. A plan can hold the clinic on file and still have no record of the therapist who saw the patient, and those visits come back unpaid. A new hire is a new application with every payer.
Medicare pays for outpatient therapy under a written plan of care that a physician or nonphysician practitioner certifies. A visit outside a current, certified plan is a visit the claim cannot stand on. Past a yearly spending threshold, Medicare also wants the claim to carry the KX modifier and the record to show why more therapy is needed.
Commercial plans add their own layer: an authorization before the first visit or after a set number, and a cap on visits in a plan year. Each plan draws those lines differently. We write them down for every plan on your list, so the clinic does not learn them from a denial.
Fees printed. Billing priced from your numbers.
Enrollment, authorizations and the visit-by-visit claim.
- Enrollment
- The clinic and every physical therapist, occupational therapist and speech-language pathologist, with Medicare, Medicaid and each commercial plan you name. Each new hire filed as soon as the start date is known.
- Authorizations and limits
- Requested before they are due and tracked against the visits used, so the schedule knows when a patient is close to a limit.
- Plans of care
- Certification status checked before claims go out, with a flag when a plan is due for renewal.
- Claims, posting and denials
- Each visit billed to the plan's rules, paid amounts matched to what the plan owes, and every denial traced and worked.
| Piece of work | Fee |
|---|---|
| The clinic, per payer | $350 |
| One therapist, per payer | $250 |
| A therapist's CAQH profile | $150 |
| Billing and the revenue cycle | By agreement |
What clinic owners ask us.
A new therapist starts soon. Can they treat before they are enrolled?
They can treat. The risk is billing a plan under their name before that plan has them on file. We file their applications first and tell you, plan by plan, when their visits can be billed.
Do you handle speech therapy as well as physical therapy?
Yes. Each discipline is enrolled on its own terms, and each plan may treat it differently. The payer rules for every discipline you offer go into one file.
Our visits are being cut off by a limit we did not see coming. Can you help?
That is billing work. We record each plan's limits and authorizations and track visits against them, then work the denials already open. How billing runs
Send us your therapists and your payers.
We set one against the other and show you every gap. No patient information goes into the review.
We get back to you as quickly as possible.