A cash-based physical therapy clinic offers personalized care by removing insurance restrictions. This model prioritizes one-on-one sessions, eliminates visit limits, and reduces administrative challenges. By focusing on patient needs instead of insurance policies, clinics can provide high-quality treatment and streamline billing with superbills, ensuring a smoother experience for both therapists and patients

As a clinic owner you have to make the decision as to whether or not you will accept healthcare insurance or if you want your services to be cash-based, meaning the patient pays on their own, a set rate for each session. There are pros and cons to accepting both types of payments so your decision ultimately depends on what your goal is for your clinic. There is also no rule that says if you start out accepting healthcare insurance that you cannot switch over to cash-based services at a later date.

Cash-based physical therapy clinics have increased in frequency over the past several years with the main reason being that companies are tired of having to follow the rules of insurance for continued therapy approvals and reimbursements. So the question becomes, if you accept healthcare insurance as the main form of payment for your clinic, at what point is the insurance reimbursement just not worth it?

Over the years, healthcare providers, specifically physical and occupational therapists, have seen significant cuts in reimbursement from insurance companies, such as third-party payers and Medicare. For instance, consider the Medicare reimbursement cut that is happening for therapists in 2022. With these reimbursement cuts comes the added issue and concern of how healthcare providers and clinics can provide care while remaining profitable. In most cases, physical therapy practices will take the following measures to ensure their clinic doors can remain open:

• Seeing multiple patients per hour, sometimes double or triple booking patients each hour, resulting in decreased 1:1 patient care
• Using inexpensive modalities that may not be as effective as others
• Eliminating physical/occupational therapy assistants and assigning more responsibilities to technicians/aides who lack specific therapy education

When you look at these measures, the number one thing they have in common is that they all lead to overall decreased quality of care because the patient is no longer coming first. Instead, patient care is being driven by insurance reimbursements to be able to maintain a profit margin. When the patient no longer comes first because the reimbursement rate is so low, perhaps it is time for your clinic to consider switching to out-of-network or cash-based services.

By switching to providing cash-based or out of network services, your clinic no longer has to follow the rules of insurance. This means you can focus on putting the patient first and providing them with the care they deserve, without having to worry about additional approval for more visits or if your reimbursement claim will be denied.

Below are some of the benefits of running or transitioning to a cash-based clinic:

• Exclusive 1-on-1 Treatment: Yes, you read that correctly. When insurance is not the primary source of income for a clinic, the physical therapist is able to spend one-on-one time, for an entire hour, with each patient. One-on-one time allows the patient to receive the therapist’s full attention each session to be able to provide the highest quality of care which typically results in decreased recovery times!

• No visit limits: Oftentimes after surgery, many patients will require 8-12 weeks of recovery to be able to achieve their goals and return to their prior level of function. However, insurances typically limit the number of visits a patient is able to be seen meaning therapists then have to go through a rigorous authorization process for more visits, which typically results in no additional visits being improved. When you take insurance out of the equation, the patient is able to be seen for as many sessions as needed without having to worry about a cap or limit allowing each patient to be treated as a whole, instead of being viewed as just an injury.

• Typically less expensive than normal physical therapy: A lot of times the first quarter of the year is slow for physical therapy clinics because many patients have not reached their deductible for the year. If a patient has not met their deductible and they go to an insurance-based clinic, the cost of their copay on top of paying out of pocket (because they haven’t met their deductible), can cost the same if not more than a cash-based session. By going to a cash-based clinic, the time of year the patient receives treatment is no longer based on whether or not they have met their deductible, instead it’s based on when the patient needs the treatment!
• The patient can submit therapy bills to insurance: Oftentimes cash-based clinics will provide patients with superbills that can be submitted to their insurance companies, meaning patients submit for the reimbursement, not the clinic. This allows the physical and occupational therapists to focus their attention on the patient, instead of using up the majority of their energy trying to ensure they are typing in the correct treatment and billing codes for each session.

If you are a clinic owner, it is ultimately your decision as to whether or not you accept insurance payers or choose a cash-based model for your services. When determining whether or not your clinic should accept insurance as the primary payer, consider the above and the goals you have for your specific clinic. Regardless of which route you choose, HelloNote can assist you with all of your documentation needs, and if accepting insurances, billing needs, while eliminating all of the usual billing stress and hassle!

Trends in Cash-Based vs. Insurance-Based Therapy Practices 2025 the latest update.

Boost your outpatient physical therapy clinic’s success with these five proven marketing techniques. From building a professional website to leveraging social media and word-of-mouth referrals, discover actionable strategies to attract new patients and grow your practice.

Whether you are a first-time clinic owner or a veteran, marketing can truly help to either make or break your outpatient physical therapy clinic. Marketing, both online and offline, is essential for spreading the word about your services and bringing new referrals into your practice. New referrals mean new patients and continued business, which are crucial for keeping your clinic thriving.

Historically, therapy marketing efforts focused heavily on physician referrals. However, with direct access to physical therapy now available in several states, modern marketing techniques tailored for outpatient physical therapy clinics must be adopted. These strategies, combined with the integration of an EMR (Electronic Medical Records) system, can streamline operations and improve patient care while driving community engagement.

Below are five marketing techniques to increase visibility and attract more patients to your outpatient physical therapy clinic.

1. Create a Website for Your Outpatient Physical Therapy Clinic

In today’s digital world, a strong online presence starts with a well-designed website. When potential patients search for outpatient physical therapy services, they often turn to the internet first.

Your website should include essential information about your clinic, such as who you are, what services you provide, and what makes your practice stand out. Additionally, include patient testimonials, as they build credibility and trust. Ensure your website has an interactive component, such as a contact form, to allow potential patients to reach out easily.

An integrated EMR system can further enhance your website by enabling online appointment scheduling and secure patient communication, making your clinic more accessible to the community.

2. Utilize Social Media to Promote Outpatient Physical Therapy

Social media platforms like Facebook, Instagram, LinkedIn, and TikTok are excellent tools to promote your clinic. Creating a dedicated page for your outpatient physical therapy clinic allows you to share educational posts, videos, and links to your website.

Posting content related to your clinic’s specialties—such as tips for pain management or rehabilitation exercises—can attract and engage potential patients. Use a call-to-action in every post to guide viewers to your website or EMR-enabled patient portal.

Additionally, webinars and blog posts on trending topics (e.g., benefits of physical therapy for specific conditions) can establish your clinic as an authority in the field. Repurpose this content for future social media posts or newsletters to maintain consistent engagement.

3. Partner with Local News Stations for Community Outreach

Getting featured on local news channels can significantly increase awareness of your outpatient physical therapy clinic. News stations often look for compelling community stories or educational content.

You could gain attention by organizing local events, such as free therapy workshops or charity fundraisers, or by pitching an educational segment about the benefits of physical therapy. Highlight how your clinic leverages modern tools like EMR systems to improve patient care and outcomes.

This approach not only builds awareness but also establishes trust with potential patients, especially among older populations who may prefer traditional media.

4. Encourage Word-of-Mouth Referrals

Word-of-mouth referrals remain one of the most effective marketing tools for outpatient physical therapy clinics. Offering incentives like discounts or small gift cards can encourage your current patients to refer friends and family.

With an EMR system, tracking referral sources becomes simpler. You can analyze referral trends and optimize your strategies to boost new patient acquisition. According to HubSpot, “90% of people believe brand recommendations from friends,” making this an invaluable method for expanding your client base.

5. Attend Networking Events to Expand Connections

Networking with other professionals can open doors to new opportunities for your outpatient physical therapy clinic. Collaborating with wellness professionals, such as chiropractors and nutritionists, can help you reach a broader audience.

An EMR system can support this strategy by providing data insights into patient demographics and referral patterns. Use these insights to highlight your clinic’s strengths when forming partnerships. While large events may still be limited, virtual networking groups and smaller local events can still provide valuable connections.

Why EMR Integration is Vital for Outpatient Physical Therapy Clinics

Integrating an EMR system into your outpatient physical therapy clinic enhances both operational efficiency and patient care. EMR systems offer features like:

• • Automated appointment scheduling and reminders.
  • Streamlined billing and coding processes.
  • Real-time tracking of marketing and referral metrics.

By leveraging these tools, you can focus on implementing effective marketing strategies while reducing administrative burdens.

Conclusion

Marketing an outpatient physical therapy clinic requires a mix of traditional and modern approaches. By creating a strong online presence, utilizing social media, engaging with local media, encouraging referrals, and attending networking events, you can significantly boost your clinic’s visibility and patient base.

Integrating an EMR system into your practice not only enhances these efforts but also ensures efficient clinic management. With the right strategies and tools, your outpatient physical therapy clinic can thrive in today’s competitive landscape.

Tracking key metrics is crucial to ensure your physical therapy clinic thrives. From monitoring cancellations and revenue to gaining referral insights, leveraging an EMR system can simplify processes, improve efficiency, and enhance patient care. By adopting data-driven strategies, you can optimize operations and achieve long-term success for your clinic.

Running a thriving physical therapy clinic requires more than delivering excellent care to patients—it also involves continuously evaluating performance and identifying areas for growth. With the right data at your fingertips, you can make informed decisions to maintain and enhance your clinic’s operations. Monitoring key metrics is essential to help you understand what’s working and where adjustments are needed. Incorporating an Electronic Medical Records (EMR) system simplifies this process, enabling your clinic to operate more efficiently while providing outstanding patient experiences.

Key Metrics Every Physical Therapy Clinic Should Monitor

1. Cancellation Percentage

Monitoring cancellation percentages allows you to address missed appointments and maintain consistency in patient care. A cancellation rate below 10% is generally considered optimal for a successful physical therapy clinic. High cancellation rates may indicate issues with scheduling, communication, or patient engagement. Using an EMR system, you can automate appointment reminders via email, text, or phone, significantly reducing no-show rates and improving your overall arrival rate.

2. Average Billed Units Per Visit

The average billed units per visit reflects the efficiency of your clinic’s billing process. Proper billing ensures therapists accurately document the care provided without underbilling, which can lead to lost revenue, or overbilling, which may trigger denied insurance claims. With an EMR system, you can gain insights into each therapist’s billing patterns, identify discrepancies, and ensure that billing aligns with patient services provided.

3. Referrals and Total New Patients

Referrals are essential for growing your patient base. By tracking referral sources, you can identify which marketing strategies are effective and which ones need improvement. Additionally, keeping tabs on the number of new patients coming in for evaluations provides insights into the success of your outreach efforts. An EMR system simplifies referral tracking and generates reports that help you understand how patients are finding your clinic, enabling you to focus on strategies that yield the best results.

4. Net Revenue Per Month

Net revenue is one of the most critical financial metrics for a physical therapy clinic. While many clinics focus on the amount billed, tracking collected revenue gives a more accurate picture of financial health. An EMR system automates this process, consolidating financial data into easy-to-read reports. These insights help you identify payment delays, discrepancies, or opportunities to increase profitability.

5. Revenue Per Therapist

Understanding the revenue each therapist contributes to the clinic’s success is another important metric. This data not only measures productivity but also helps assess how effectively therapists are utilizing their time and resources. With an EMR system, you can correlate therapist revenue with patient outcomes, ensuring both business and patient care goals are met.

6. Billing Metrics

• • Days in Receivable Outstanding (DRO): DRO measures how quickly you’re collecting payments, whether from patients or insurance providers. A DRO of less than 35 days is ideal for maintaining financial stability. An EMR system provides real-time tracking of outstanding receivables, helping you identify and resolve delayed payments efficiently.
  • Profit/Loss Reports: Regular profit/loss reports are vital for understanding your clinic’s financial sustainability. These reports calculate your net profit by subtracting expenses from revenue, offering a comprehensive view of your clinic’s financial health. An EMR system simplifies this process by automating the consolidation of financial data, allowing you to make informed decisions.

How EMR Systems Empower Physical Therapy Clinics

Manually tracking and managing metrics can be time-consuming, error-prone, and overwhelming. This is where EMR systems shine. These systems not only streamline the documentation process but also offer robust tools to improve clinic efficiency, including:

• • Automated billing and coding features: Reduce errors in claim submissions and ensure timely reimbursements.
  • Integrated appointment scheduling and reminders: Minimize cancellations and no-shows by keeping patients informed.
  • Real-time reporting: Track key metrics like revenue, cancellations, and patient outcomes at the click of a button.
  • Centralized data management: Consolidate financial, operational, and patient information into one secure platform.

By adopting an EMR system, your physical therapy clinic can eliminate unnecessary administrative burdens, allowing therapists to focus on delivering exceptional care.

Conclusion

Running a successful physical therapy clinic requires a combination of exceptional patient care and data-driven decision-making. Metrics such as cancellation percentages, revenue tracking, and referral reports are essential for understanding clinic performance and identifying areas for growth. Monitoring these metrics ensures that your clinic remains financially healthy, operationally efficient, and patient-focused.

Incorporating an EMR system like HelloNote can simplify the tracking process, providing automated reporting and actionable insights. These systems help reduce administrative workload, minimize errors, and enhance overall clinic operations.

By staying informed about your clinic’s performance, you can implement strategies that foster growth and ensure long-term success. Combine quality care with smart business practices, and your physical therapy clinic will continue to thrive.

Set competitive private pay therapy rates for your practice with insights on market research, expense calculation, and fee schedules. Achieve your financial goals while providing personalized care to patients.”

In today’s day and age, it seems like many clinicians’ who are opening their own therapy practices are deciding to open cash-based clinics. One of the biggest reasons for this is that oftentimes with third-party insurances there are limits on the number of sessions a patient can receive and most practices prefer to treat the patient as a whole. Treating the patient as a whole means seeing them through the recovery process rather than having limits on the patient’s ability to receive therapy sessions, based on what insurance companies deem as appropriate.

If you are considering opening a cash-based physical therapy practice, the first question that will likely come to your mind is how much should I charge? If you charge too little, you are at risk of undervaluing your services and potentially not having enough money to keep your clinic running, but if you overcharge, then there’s a good chance that you might not attract enough patients, resulting in not being able to cover your business expenses. So how do you find that sweet spot of what to charge to bring in the clientele you want while being able to cover necessary business expenses? If you are looking to open a cash-based physical therapy business in your area, you must consider the following:

Will you accept third-party payers or is your business going to be strictly cash-based?

Bottom line is you have to know where your payments are going to be coming from in order to accurately and appropriately price your services. If you decide to be an all cash-based clinic, then you will have a lot more wiggle room with how you price your services.

However, if you decide that you will be accepting third-party payers, such as different insurance companies, then you need to do a little bit more research on what the reimbursement rates are for each insurance company in your state. After figuring out reimbursement rates, then you will have a more accurate picture of how much you will need to charge cash-based payers to be able to meet your revenue goals.

The importance of knowing and surveying your market!

Research, research, research! When opening any business, you have to research the area that you want to have your practice in. Not only that, but you should also be researching what the general cost of therapy rehabilitation services are in your area.

The most important question to ask yourself is: would your target patient population, in that specific location, be willing to pay for cash-based physical therapy or not? If you answered no, then maybe a solely cash-based physical therapy business isn’t the right option. If you answered yes, then dig deeper into the demographics of your market, as that will often provide valuable insight as to what you should be charging for cash-based services.

If you are opening a clinic in an area where other therapy services are not yet available, meaning you are unable to determine what other practices are charging, one tip for determining your rate is to figure out what the individuals in that market are paying for personal trainers, massage therapists, etc. and use that information to help determine your fee schedule, based on your expertise and experience.

Figure out the numbers!

Another thing to consider is your estimated business expenses and your financial goals for the business. For this one, you’ll have to sit down and estimate your annual business expenses, such as overhead costs, marketing, insurance, etc., and set your annual financial goals for the clinic. After determining both of those, then you can use that information to set an appropriate fee schedule.

When determining the numbers, keep in mind that a lot of people may have a difficult time comprehending why they should choose cash-based physical therapy vs going through their insurance for therapy services. One of the ways to emphasize why they should choose cash-based therapy is through figuring out how much to charge so that you are not having to see 12-15 patients a day. By decreasing your caseload, while still meeting your financial goals, as a therapist you are able to avoid burnout and provide overall improved patient care plus your patients receive that 1:1 time that isn’t always guaranteed in larger clinics!

Determine and stick to a single fee schedule!

While it might be tempting to create a different fee schedule for third-party payers, the APTA highly recommends that you stick to a single fee schedule and instead offer discounts based on negotiated contracts with payers. Similarly, with a cash-based practice, you should stick to a single fee schedule which allows you to still offer discounts to patients.

There are many things to consider when starting a cash-based private physical therapy business. The bottom line is that you should set your fees so that you are charging enough for your services, but not double-booking or treating an unrealistic amount of patients each day. Through considering the above, researching, and developing a plan for your fee schedule that does not undervalue your expertise, while also keeping in mind market rates, your goal of achieving a successful cash-based clinic can come true!

Understand how to create defensible documentation that ensures medical necessity, prevents claim denials, and supports skilled therapy services. Includes actionable tips, key questions, and tools like HelloNote to streamline the process

If you’ve ever asked a therapist what their least favorite part of the job is, the answer is often unanimous: documentation. While it may feel like a tedious task, proper documentation is more than just a box to check—it is a critical component of patient care and professional practice. For physical therapists, the ability to produce defensible documentation can make the difference between seamless reimbursement and costly claim denials.

What is Defensible Documentation?

Defensible documentation goes beyond simply recording a patient’s story. It must demonstrate medical necessity, justify the need for skilled therapy services, and ensure that all notes are detailed enough to withstand scrutiny from auditors or legal reviews. Inadequate documentation can result in denied claims, compliance issues, and even legal challenges.

To create defensible documentation, therapists must ensure that their notes:

• • Reflect the patient’s story and their functional limitations.
  • Justify why skilled intervention is necessary.
  • Provide clear evidence of medical necessity.

Why is Defensible Documentation Important?

According to the APTA, defensible documentation is essential for several reasons:

1. It serves as a detailed record of the patient’s care, including their diagnosis, treatment plan, and progress.
2. It communicates the therapist’s expertise and the medical rationale behind their interventions.
3. It justifies that therapy services were medically necessary.
4. It acts as a legal record of interactions between the patient and therapist.
5. It facilitates continuity of care by providing other healthcare providers with the necessary information for ongoing treatment.

Key Questions to Address in Documentation

When creating defensible documentation, therapists must answer these two critical questions:

1. Why does the patient need physical therapy services now?
   • • Explain the onset of the condition, symptoms, or exacerbation that led to the therapy visit.
     • Include relevant medical and psychosocial factors affecting the patient’s presentation.
     • Ensure that the functional history aligns with the current impairments and limitations.
2. Why does the patient require skilled PT services?
   • • Provide proof that the diagnosis or impairments require the expertise of a licensed therapist.
     • Document the objective tests, measures, and education provided to demonstrate why the treatment cannot be performed safely or effectively by non-skilled personnel.

9 Tips for Defensible Documentation

According to Rehab Management, adhering to these nine guidelines can help therapists create defensible notes and avoid claim denials:

1. Ensure Legibility
   • All documentation must be clear and easy to read. Use digital documentation tools if handwriting is difficult to read.
2. Support the Diagnosis
   • Clearly link the diagnosis or evaluation findings to specific functional limitations and justify the need for skilled rehabilitation.
3. Outline the Plan of Care
   • Include measurable goals, expected frequency, and duration of therapy based on objective findings.
4. Detail Time Spent
   • Accurately document the time spent on procedures or modalities, ensuring it aligns with billing codes like the 8-minute rule.
5. Track Patient Progress
   • Regularly update notes with the patient’s progress or reasons for lack of improvement to justify continued therapy.
6. Include Therapist Identification
   • Sign each note with the therapist’s name and professional designation to ensure accountability.
7. Incorporate Patient Feedback
   • Add subjective input from the patient or caregiver regarding their progress, concerns, or unusual events.
8. Justify Billed Units
   • Clearly show how the billed units match the documented treatment.
9. Summarize in Discharge Notes
   • Provide an objective comparison of the patient’s initial evaluation and their final session.

Challenges Therapists Face with Documentation

Despite the importance of defensible documentation, many therapists find it overwhelming. Between managing extensive caseloads and addressing the individual needs of patients, documentation often becomes an afterthought. This can lead to rushed or incomplete notes, increasing the risk of claim denials.

How Technology Can Help

Tools like HelloNote streamline the documentation process, ensuring that therapists meet defensibility standards without added stress. With customizable templates, automated prompts, and built-in compliance checks, therapists can focus on delivering quality care while maintaining accurate records.

Conclusion

Defensible documentation is not just about satisfying insurance requirements—it’s about delivering quality care, communicating effectively with other healthcare providers, and protecting yourself as a professional. By following the nine tips outlined above and addressing the key questions, therapists can ensure that their notes are thorough, accurate, and defensible.

For those looking to simplify the process, tools like HelloNote can help reduce the administrative burden, enabling therapists to focus more on their patients and less on paperwork. Documentation may not be the most enjoyable part of the job, but with the right approach and tools, it doesn’t have to be overwhelming.

Co-treatment vs. duplicate services: understand the key differences in therapy. Tips for accurate co-treatment documentation and effective progress notes.

If you work in a setting that offers multiple types of therapy, such as a skilled nursing facility (SNF) or inpatient/acute rehabilitation unit, you have probably, or eventually will encounter something called co-treatment.

So what exactly is co-treatment and how does it impact you as a therapist? According to Medicare, co-treatment is when different professional disciplines can effectively address a patient’s treatment goals, in a single therapy session. For example, a Physical therapist might be addressing balance training for improved functional mobility while an Occupational therapist focuses on ADL training for increased independence. Co-treatment is covered by Medicare, but as a therapist, you must follow specific rules to ensure documentation and billing is completed correctly so that rendered services are not seen as duplicate services by insurance companies.

Now that you know what co-treatment is, you might be asking yourself when exactly co-treating is appropriate? The answer provided by the ASHA, AOTA, and APTA is: when coordination between two disciplines will benefit the patient, not simply for scheduling convenience. Co-treating should also be limited to only two disciplines providing interventions during one single therapy session, so whether that is PT and OT or PT and ST, just no more than two disciplines at one time.

When documenting for a co-treatment session, be sure to include the following:

• The rationale for co-treatment
• The specific task and goal that was addressed by each therapist and how it is related and/or interdependent upon the goals of the other therapist
• Must be documented and explicitly state in the documentation, by both disciplines, that the interventions provided were part of a co-treatment session

***The most important part of documenting a co-treatment session is explaining why this is the correct treatment for this specific patient and how it will lead to better outcomes for the patient, specifically when compared to a 1:1, single discipline therapy session.

While accurate documentation is crucial, as a therapist you must also appropriately bill for the co-treatment session. How you bill will depend on which part of Medicare you are billing for as well as the collaborating disciplines and setting. Here are some general guidelines when billing different parts of Medicare:

• • Part A (SNF setting): If a patient receives therapy from two different disciplines in a single therapy session, then both therapists may separately bill for the entire treatment session.

• • Part B (outpatient hospital or clinic setting): If co-treatment occurs in this setting, therapists cannot bill separately, but can split the units billed between them, specifically for PT and OT. The units and total time billed must be equal to the total duration of the session performed.

**Please note: The exception to co-treatment billing for Medicare part B is if speech therapy is the second discipline. Since the codes billed by SLPs are typically not time based, if co-treating, SLPs should bill for one untimed session and the OT/PT should bill for all of the timed treatment codes.

***Also, if a PTA or OTA provides the co-treatment, you must bill using the respective modifiers, CO for OTA and CQ for PTA. Beginning in 2022, if more than 10% of services during one session are being provided by an OTA/PTA, Medicare will only provide reimbursement for 85% of the Medicare fee schedule for services.

Keep in mind, co-treating will be appropriate for some, but not all, patients and if providing this service, your documentation must clearly justify why co-treating is appropriate for that particular patient. If you provide a co-treatment session, but your documentation does not provide justification, then insurances can deem your services as “duplicate services” and decline reimbursement for those services.

Here are 4 tips to prevent duplication of therapy services:

• Educate all therapists: The claim will be denied if documentation shows two different disciplines treating the same goal or treatment area.

• Define the differences between each discipline, especially when addressing functional mobility, transfers, and/or balance.

• Relate the treatment session back to discipline-specific goals: Be sure to have at least one goal for each functional deficit and/or area that you plan to treat. For instance, if a PT plans to treat for gait deficits, there must be a SMART gait goal. Similarly, if an OT plans to treat for shower deficits, there must be a specific shower goal in their plan of care.

• Progress notes are important: When writing progress notes, be sure you are providing rationale for why your discipline-specific skilled therapy services are required for that particular patient.

If you find yourself in a situation where co-treating is the right choice for your patient, be sure to refer back to this guide to ensure you are appropriately documenting and billing for co-treatment services so that Medicare does not think you are duplicating services during your co-treats. For all of your therapy documentation and billing needs, be sure to check out HelloNote, an EMR documentation system made by therapists for therapists.

Resources:

Joint Guidelines for Therapy Co-Treatment Under Medicare

Co-Treatment Things to know and consider

How to Avoid Duplicating PT/OT Services

CMS Final Rule: Physical Therapy Medicare Guidelines 

Billing Examples Using CQ/CO Modifiers for Services Furnished In Whole or In Part by PTAs and OTAs

This article discusses the upcoming updates to the ICD-10 manual, particularly focusing on the changes to the M54.5 code for low back pain (LBP). Effective October 1st, therapists who continue using M54.5 in their documentation and billing risk facing denials for reimbursement. The article explains the replacement of the M54.5 code with more specific options, such as M54.50, M54.51, and M54.59. It highlights the importance of updating patient records to ensure compliance and avoid claim rejections from Medicare, Medicaid, and private insurance providers. Additionally, the article offers advice on handling potential delays from insurance payers during the transition

According to the Centers for Medicare & Medicaid Services (CMS), there will be an update to the ICD-10 manual, likely affecting many therapists.

Every October, there are changes made to the ICD-10 manual, which include replacement, removal, and addition of codes. The change this October 1st will affect a common code used by many rehab professionals – low back pain (M54.5). This means that if you are using M54.5 on your documentation and billing on or after October 1, you risk getting denied reimbursement.

How HelloNote Helps You Stay Compliant
To maintain compliance with the updated codes, HelloNote’s built-in ICD-10 management system ensures that any existing or new patients have the correct and updated version of this code. HelloNote automatically updates codes such as M54.50 (Low back pain, unspecified), M54.51 (Vertebrogenic low back pain), and M54.59 (Other low back pain), preventing coding errors that could lead to claim denials.

Impact of ICD-10 Code Changes
Beginning October 1, stop using the outdated ICD-10 code for low back pain (M54.5). It will be replaced with more specific codes that reflect different types of low back pain. For some payers, it may take time to update their databases, so even though you bill with the new codes, you might still face denials or delays in claims processing.

M54.50 (Low back pain, unspecified)
M54.51 (Vertebrogenic low back pain)
M54.59 (Other low back pain)

How HelloNote Supports Billing and Reimbursement
With HelloNote’s integrated ICD-10 code tracking and validation system, you can easily revise codes to ensure your documentation aligns with medical necessity. The system automatically updates patient records with the latest codes, reducing the risk of denials. If an issue arises, HelloNote helps you quickly make corrections, and the re-submission process is streamlined.

What to Do to Avoid Denials
Please review your documentation to ensure the updated ICD-10 codes are applied as necessary. HelloNote’s automatic code updates will help you stay ahead, but it’s always a good idea to double-check your billing entries. If there is any delay in your payer’s database updates, HelloNote supports the resubmission process, making appeals and corrections as easy as possible.

Stay Updated with HelloNote
For a full list of ICD-10 code changes, you can visit the CMS website: https://www.cms.gov/medicare/icd-10/2022-icd-10-cm. HelloNote also ensures that your practice stays up-to-date with ongoing ICD-10 revisions, so you don’t miss any important updates.

 

Maintenance therapy focuses on preserving a patient’s functional abilities and preventing decline through skilled physical, occupational, and speech therapy services. It supports individuals with chronic conditions, ensuring safety and maintaining independence while meeting Medicare coverage requirements. Proper documentation and effective care plans are essential for achieving successful outcomes.

For many, many years, there has been this long standing myth in the therapy world that in order for Medicare to reimburse for skilled therapy services, you must show patient improvement. Essentially, it has been thought that maintenance therapy is not reimbursable because as a therapist, you cannot show improvement for certain conditions, but rather you are focusing your treatment on maintaining a patient’s current level of function, which for a long time was seen as a no-no by insurance companies.

However, thanks to the Jimmo vs Sebelius case back in 2011 – 2013, this myth was disproven. According to The Center for Medicare Advocacy, “Jimmo v. Sebelius, was a nationwide class-action lawsuit brought against the Centers for Medicare & Medicaid Services (CMS) on behalf of individuals with chronic conditions who had been denied Medicare coverage on the basis that they were not improving or did not demonstrate a potential for improvement.” In 2013, an agreement was made that Medicare coverage is solely determined by a patient’s need for skilled care, not on a patient’s potential for improvement. This was a significant win for not only patients with Medicare insurance coverage, but therapy providers as well.

Based on the outcome of this lawsuit, maintenance therapy is reimbursable by Medicare if the skilled therapy services are justified for the following disciplines: physical therapy, occupational therapy, and speech therapy. Another key thing to note is that the outcome of this settlement only applies to home health, skilled nursing facilities, outpatient therapy clinics, and inpatient rehabilitation hospitals/facilities.

Since maintenance therapy is reimbursable as long as it is justified, let’s discuss what exactly maintenance therapy is. Typically, skilled maintenance therapy is justifiable and covered in two specific circumstances:

• If the skill and judgment of a physical/occupational/speech therapist is needed to design and educate a maintenance program to be carried out by non-skilled personnel (such as  a personal trainer) or a caregiver. In this situation, Medicare will cover periodic re-evaluations of the patient to determine the efficacy of the plan of care and allow the therapist to make any necessary modifications, if applicable.
• The skills and judgment of the physical/occupational/speech therapist are required to provide skilled maintenance therapy due to the complexity of the services needed to maintain or prevent decline in a patient, or for safety reasons.

Maintenance therapy is often extremely beneficial for patients with neuromuscular disorders, such as ALS, Parkinson’s, Muscular Dystrophies, etc. which result in chronic impairments that impact their mobility and ability to function independently. In these particular cases, patients may likely benefit from ongoing therapy services to slow the decline of their condition, prevent exacerbations, manage pain and maintain their current level of functional independence.

While individuals with neuromuscular disorders will often benefit from maintenance therapy, a patient is not required to have a chronic and/or progressive disease in order for Medicare to cover maintenance therapy services. Medicare also does not require a patient to functionally decline before covering medically necessary skilled therapy. This means that if you are treating a patient with Medicare insurance, who is no longer making improvements but continues to require skilled therapy services, you can reassess the patient and develop a new plan of care which reflects the new maintenance therapy goals.

Below are some documentation tips you should consider to correctly document and show justification for skilled maintenance therapy:

• The patient’s medical condition and/or complexity of the therapeutic treatment requires the skills of a physical/occupational/speech therapist.
• Treatment cannot be safely and effectively carried out by the patient individually, or by a non-skilled person, such as the caregiver.
• The patient has the potential to functionally decline without skilled therapy services.
• The therapeutic treatment itself is reasonable and necessary, in relation to the patient’s condition, to maintain, prevent or slow down further functional decline.
• Frequency and duration of services are appropriate and match that patient’s goals.
• Make sure you are updating the status of that patient’s goals, especially as they are being achieved. Documentation should support and show the treatment’s effectiveness of achieving the maintenance therapy goals.
• Continue to utilize objective tests and measures for assessments and goals, such as BERG, 10 meter walk test, TUG, etc.
• Make sure your goals are appropriate for maintenance therapy. These goals should emphasize preventing unnecessary and avoidable complications, such as: deconditioning, muscle weakness, reducing fatigue, muscle contractures, promoting safety, and maintaining strength and/or flexibility.

Oftentimes, maintenance therapy is forgotten about, especially in outpatient clinics, resulting in patients being discharged and experiencing a functional decline, either rapidly or over time. Thanks to Jimmo v Sebelius, patients who would benefit from maintenance therapy now no longer have to worry about their therapy services being taken away or having to pay out-of-pocket for potentially life saving therapy. Remember to always consider whether or not the patient is appropriate for maintenance therapy before you discharge them so that there is no discontinuity in their plan of care! Whether you are providing documentation for progressive therapy services or maintenance therapy services, HelloNote is a therapy EMR software that will provide you with all of your documentation and billing needs.

Payment tracking and billing reconciliation are vital for financial success in healthcare practices. This article highlights the importance of these processes and how automating them through EMR software can streamline operations. Discover how accurate billing reconciliation reduces errors, improves cash flow, and ensures timely payments, contributing to the financial health of your clinic.

Owning a healthcare practice involves more than just providing excellent patient care; it also requires managing finances effectively to ensure sustainability and growth. Among the most critical aspects of financial management in healthcare is payment tracking. Proper payment tracking, combined with efficient billing reconciliation, forms the foundation for understanding your clinic’s financial health.

For healthcare professionals who may not have accounting expertise, these tasks can seem daunting. Fortunately, tools like EMR software streamline the process, saving time and reducing errors. This article explores why payment tracking in healthcare is vital and how automation can revolutionize your practice’s financial management.

What Is Payment Tracking in Healthcare?

Payment tracking is the process of monitoring billed amounts, payments received, and outstanding balances. It enables clinic owners to have a clear picture of their financial performance and helps prevent revenue loss. Here’s what payment tracking allows you to do:

• • Monitor Billed vs. Paid Amounts: Understand the gap between what’s billed and what’s received from patients and insurance companies.
  • Identify Bad Debt: Track unpaid or partially paid invoices to recognize bad debt early.
  • Manage Partial Payments: Ensure transparency by identifying and addressing incomplete payments from insurance companies or patients.
  • Prevent Misunderstandings: Maintain clear communication with patients and insurers regarding outstanding balances.
  • Understand Cash Flow Trends: Recognize patterns that might indicate financial issues, allowing for timely interventions.

Efficient payment tracking supports better organization, improved cash flow, and a deeper understanding of your practice’s financial wellness.

What Is Billing Reconciliation?

Billing reconciliation involves matching incoming payments, particularly from insurance companies, with open invoices to ensure accuracy. This process helps confirm that your clinic is receiving the correct payment for services rendered.

Traditionally, billing reconciliation was a manual process, requiring hours or even days to compare records, address discrepancies, and calculate revenue. This method was not only time-consuming but also prone to errors.

The introduction of Electronic Remittance Advice (ERA) in 2014 simplified this task. ERA automation, often integrated with EMR software, allows clinics to reconcile payments with a few clicks. This advancement reduces manual labor, ensures accuracy, and saves valuable time.

Why Is Payment Tracking Essential in Healthcare?

Healthcare practices face unique financial challenges. Mismanaged payment tracking and reconciliation can lead to revenue loss, poor financial health, and even patient dissatisfaction. Here’s why prioritizing payment tracking is crucial:

• • Improved Financial Transparency: Payment tracking provides a clear overview of your revenue streams, helping you understand your clinic’s financial standing at any given moment.
  • Enhanced Organization: A well-structured payment tracking system keeps patient accounts up-to-date, preventing billing errors and confusion.
  • Reduced Revenue Loss: Identifying outstanding balances and bad debt promptly minimizes financial losses.
  • Streamlined Operations: Automating payment tracking frees up staff time, allowing them to focus on patient care and other essential tasks.
  • Compliance with Billing Standards: Automated systems ensure compliance with payer requirements, reducing the risk of claim denials.

Steps for Effective Payment Tracking and Billing Reconciliation

While automation simplifies the process, incorporating the following steps ensures accuracy and efficiency:

• • Organize Patient Records: Maintain consistent and accurate records for every patient. This includes billing details, insurance information, and payment history.
  • Perform Weekly Reviews: Regularly review patient accounts to identify discrepancies, outstanding balances, and denied claims.
  • Allow Time for Adjustments: Resubmit denied claims promptly, ensuring all required information is included within the payer’s time limits.
  • Track Key Metrics: Monitor cash flow, average reimbursement time, and the percentage of denied claims to identify trends and areas for improvement.=

The Role of EMR Software in Payment Tracking and Billing Reconciliation

Integrating payment tracking and billing reconciliation with EMR software is the simplest way to streamline financial management in healthcare. EMR systems automate these tasks, reducing human error and enhancing efficiency.

Here’s how EMR software supports payment tracking and reconciliation:

• • Automation: EMR software automatically tracks billed and paid amounts, ensuring accuracy.
  • Data Insights: Generate detailed revenue reports to analyze trends and make informed decisions.
  • ERA Integration: Match payments with invoices seamlessly using ERA automation.
  • Real-Time Access: Access financial data from anywhere, allowing you to manage billing even when away from the office.

For example, HelloNote’s EMR software offers a built-in payment reconciliation tool, enabling clinic owners to track payments and generate revenue reports effortlessly.

How Automation Benefits Healthcare Practices

Investing in automation through EMR software offers several advantages:

• • Time Savings: Automated systems eliminate the need for manual tracking and reconciliation, freeing up time for other priorities.
  • Error Reduction: Automation minimizes discrepancies, ensuring accurate billing and payments.
  • Improved Patient Experience: Efficient billing processes reduce misunderstandings and enhance patient satisfaction.
  • Increased Revenue: By identifying and addressing payment gaps promptly, clinics can optimize their income.

Conclusion

Effective payment tracking in healthcare is critical for maintaining the financial health of your practice. By automating payment tracking and billing reconciliation with EMR software, you can improve organization, reduce errors, and focus more on providing exceptional patient care.

For healthcare practices looking to simplify financial management, HelloNote’s EMR software offers the tools you need. From seamless payment tracking to automated reconciliation, HelloNote ensures your clinic runs efficiently while achieving financial success.

If you’re ready to take control of your clinic’s financial health, schedule a free demonstration of HelloNote today!

EMR software simplifies therapy practice management by streamlining documentation, enhancing patient care, ensuring billing compliance, and providing easy accessibility. With features like personalized care plans, secure cloud storage, and patient portals, EMR software helps physical, occupational, and speech therapists deliver effective care while managing their practices efficiently.

Starting a physical, occupational, or speech therapy practice comes with unique challenges, one of which is efficiently managing patient care and administrative tasks. A reliable electronic medical record (EMR) software is an essential tool to help you grow and streamline your practice. Gone are the days of paper records; today, EMR systems provide numerous benefits for both clinics and patients. Here are six key advantages of using EMR software in your therapy practice:

1. Personalized Patient Care

An EMR system allows therapists to access detailed patient records instantly, making it easier to understand medical histories and develop comprehensive treatment plans. This ensures that care is tailored to the individual needs of each patient. By having all relevant information in one place, therapists can provide well-rounded and effective interventions.

For practices with multiple clinicians, EMR software enhances collaboration by allowing seamless information sharing, ensuring continuity of care even when therapists are unavailable.

2. Streamlined Documentation

EMR software centralizes all patient notes and documentation in one secure location, making it easier to maintain accurate records. This feature is especially useful when a therapist is on leave, as other clinicians can continue providing goal-oriented treatments without interruptions.

By simplifying the documentation process, EMR systems help therapists save time while ensuring compliance with industry standards. Accurate and organized records also improve coordination among team members and facilitate better patient outcomes.

3. Insurance Billing Compliance

Billing can be one of the most complex aspects of running a therapy practice, especially when dealing with insurance claims. EMR systems, like HelloNote, simplify the process by automating claim submissions and flagging missing information or incorrect codes.

With built-in features for adding necessary modifiers and ensuring accuracy, an EMR system significantly reduces claim rejections and denials. This not only saves time but also ensures consistent cash flow for your practice.

4. Enhanced Patient Engagement with Portals

EMR systems store patient records securely in the cloud, allowing therapists to access data from virtually any location with an internet connection. Whether you’re working from home, at a clinic, or on the go, you can easily retrieve and update records without disruption.

For instance, if you need to finalize a treatment note while traveling, you can quickly log into the EMR system and complete the task. This flexibility eliminates barriers to productivity and ensures that your practice runs smoothly, no matter where you are.

5. Accessibility Anytime, Anywhere

EMR systems store patient records securely in the cloud, allowing therapists to access data from virtually any location with an internet connection. Whether you’re working from home, at a clinic, or on the go, you can easily retrieve and update records without disruption.

For instance, if you need to finalize a treatment note while traveling, you can quickly log into the EMR system and complete the task. This flexibility eliminates barriers to productivity and ensures that your practice runs smoothly, no matter where you are.

6. Environmentally Friendly and Cost-Effective

Switching to EMR software supports eco-friendly practices by reducing the need for paper documentation. All patient information, including intake forms, care plans, and exercise handouts, can be securely uploaded and stored digitally.

By going green, your clinic not only contributes to sustainability but also saves on expenses like paper, ink, and storage space. Additionally, digital storage reduces the time and effort required for manual filing and retrieval, freeing up staff for more critical tasks.

Why EMR Software Is Essential for Your Practice

EMR software is more than just a tool; it’s a cornerstone for improving patient care and optimizing administrative processes. With features that centralize documentation, simplify billing, and enhance accessibility, EMR systems enable therapists to focus on what matters most—helping their patients achieve their goals.

For physical, occupational, and speech therapy practices, an EMR solution like HelloNote offers a comprehensive platform for managing patient records, scheduling, billing, and more. Whether you’re a new clinic owner or transitioning from paper records, now is the time to invest in an EMR system that supports your practice’s growth and success.