Looking for the best EMR software with customization? Discover top solutions designed for therapy clinics, offering flexible templates, automated billing, and seamless scheduling to enhance documentation and compliance.

Why Therapists Need EMRs That Work for Their Specific Needs

Therapists know that their workflows, documentation needs, and billing processes are very different from those of general healthcare providers. Yet, many Electronic Medical Record (EMR) systems are built with a one-size-fits-all approach, often designed for broader healthcare use rather than for therapy-specific workflows. 

To provide efficient, high-quality patient care while maintaining compliance and financial stability, therapists need the best EMR software with customization options for therapy practices. These solutions allow them to tailor documentation templates, billing features, scheduling, and reporting to match their specialized therapy needs. 

Why Customization Matters for Therapy Practices

Unlike general medical fields, rehabilitation therapy requires detailed, goal-oriented documentation, progress tracking over time, and insurance compliance for therapy-specific billing rules. Without an EMR that offers customization options, therapists may find themselves wasting time on workarounds, leading to inefficiencies, documentation errors, and claim denials. 

Key Benefits of Customizable EMRs for Therapy Practices: 

• • Specialized Documentation Needs – PTs, OTs, and SLPs require evaluation templates, functional assessments, and goal-tracking tools that general EMRs may not provide. 

• • Efficient Billing & Insurance Support – Therapy billing involves unique CPT codes, modifiers, and compliance rules, such as the 8-minute rule and Medicare therapy cap tracking. 

• • Custom Scheduling & Session Types – Therapy clinics often schedule recurring appointments, group sessions, and family-linked visits, requiring flexible scheduling tools. 

• • Outcome Tracking & Reporting – Value-based care models demand customizable progress reports that align with patient goals and payer requirements. 

With a customizable EMR system, therapists can streamline their practice operations, spend less time on paperwork, and focus more on delivering quality patient care. 

Best EMR Features for Therapy Documentation & Compliance

1. Custom SOAP Notes & Progress Tracking

A therapy-focused EMR should include: 

• • Pre-built therapy templates with customizable fields for PT, OT, and SLP specialties. 

• • Goal tracking and outcome measures that align with Medicare, insurance, and compliance standards. 

• • Voice dictation and mobile access for on-the-go documentation. 

2. How Custom EMRs Improve Therapy Billing & Insurance Compliance

A customizable EMR should offer: 

• • Automated CPT coding and modifier suggestions, including Medicare 8-minute rule compliance. 

• • Seamless claim submissions with built-in insurance verification. 

• • Reporting dashboards for denial tracking and revenue cycle insights. 

Best EMR Scheduling Features for Therapy Clinics

Therapy clinics require flexible scheduling tools that support: 

• • Automated scheduling for recurring therapy sessions. 

• • Group therapy and multi-provider scheduling. 

• • Integration with telehealth and patient reminders. 

Best Customization Features in EMR Software for Therapy Practices

1. Specialized Documentation Templates

Therapists need customizable templates that align with their clinical workflows, including: 

• • Evaluations tailored for PT, OT, and SLP assessments (e.g., ROM testing, cognitive assessments, swallowing evaluations). 

• • SOAP notes designed for therapy-specific interventions rather than generic medical charting. 

• • Functional outcome measures tracking patient progress over time. 

Example: A pediatric occupational therapist can create a custom evaluation template that includes sensory integration assessments, fine motor skill tracking, and parent-reported concerns, ensuring thorough and relevant documentation. 

2. Flexible Billing & Insurance Compliance

Billing in therapy practices requires more than just basic coding. The best EMR software with customization options should include: 

• • Auto-population of therapy-specific CPT codes and modifiers to prevent errors. 

• • Automated 8-minute rule calculations to ensure compliance with Medicare billing guidelines. 

• • Integrated insurance verification tools to check patient coverage before appointments. 

Example: A physical therapist using a customized EMR billing system can automatically apply CPT code time-based calculations to avoid underbilling or claim rejections. 

3. Adaptive Scheduling for Therapy Workflows

Unlike traditional medical offices, therapy clinics require more advanced scheduling capabilities, such as: 

• • Recurring appointment settings for patients with long-term therapy plans. 

• • Group therapy scheduling with shared or individual documentation. 

• • Family-linked records to manage pediatric and multi-member therapy sessions. 

Example: A speech therapist working with pediatric patients can use custom scheduling tools to link parent contacts, school-based therapy sessions, and home-based visits all under one patient profile. 

4. Automated Progress Tracking & Goal Management

Therapists rely on goal-based treatment planning, which means EMRs should support: 

• • Objective goal tracking (e.g., mobility improvements, speech articulation scores). 

• • Automated progress reports that adjust based on patient improvements. 

• • Built-in clinical outcome measure templates to meet payer and regulatory requirements. 

Example: A PT tracking post-surgical recovery can generate automated progress reports showing range of motion improvements over time, ensuring insurance compliance and accurate patient monitoring. 

5. Custom Reporting for Data-Driven Decisions

Therapy clinics need custom reporting tools that provide valuable insights into both patient care and business performance, including: 

• • Patient progress reports for payers and referring physicians. 

• • Billing and revenue tracking for financial planning. 

• • Compliance and authorization tracking to ensure documentation meets payer standards. 

Example: A therapy clinic owner can customize reports to monitor insurance claim trends, authorization limits, and revenue cycle efficiency, ensuring financial stability. 

How HelloNote Supports Customization for Therapy Practices

At HelloNote, we understand that therapists need an EMR that adapts to their workflows, not the other way around. Our platform is built specifically for PT, OT, and SLP professionals, offering: 

• • Customizable therapy documentation templates – Prebuilt SOAP notes, evaluations, and functional assessments that can be tailored to your specialty. 

• • Integrated billing tools with therapy-specific compliance features – Automatic 8-minute rule calculations, CPT code optimization, and seamless insurance claims management. 

• • Flexible scheduling designed for therapy practices – Recurring sessions, family-linked scheduling, and group therapy support. 

• • Goal-based progress tracking and automated reporting – Helping therapists measure patient outcomes efficiently. 

• • Comprehensive business and compliance reporting – Making it easy to track financial performance, manage authorizations, and meet payer documentation standards. 

The Future of EMRs: A More Adaptive Approach for Therapists

As therapy practices continue to evolve, EMR systems must become more flexible and customizable. The days of generic, one-size-fits-all platforms are fading, as specialized therapy practices demand solutions tailored to their unique workflows. 

Key Takeaways: 

• • Therapists need EMRs with customization options for documentation, billing, and scheduling. 

• • Flexibility in EMRs improves compliance, efficiency, and patient outcomes. 

• • Specialized EMRs like HelloNote are designed to support therapy professionals without unnecessary workarounds. 

By choosing the best EMR software with customization options for therapy practices, therapy clinics can improve efficiency, enhance patient care, and streamline practice management—ensuring long-term success in an increasingly complex healthcare landscape. 

Get Started Today! 

Discover how HelloNote can transform your therapy practice. Book a Free Demo Now! 

Get the latest updates on the ICD-10 code for low back pain, including important changes for 2025 and their impact on diagnosis and treatment. Stay informed and compliant with these essential coding revisions.

Keeping up with medical coding changes is essential for healthcare providers to ensure proper documentation, accurate diagnosis, and optimized reimbursement. With the updated ICD-10-CM codes for low back pain, which took effect on October 1, 2024, understanding and implementing these changes has become more important than ever. As we move into 2025, here’s a breakdown of the updates and what healthcare professionals need to do to stay compliant. 

Decoding the New Codes for Low Back Pain

The widely-used M54.5 code for low back pain has been retired and replaced by more specific codes that provide greater clarity in diagnosis and treatment. These new codes are: 

• • M54.50 – Low back pain, unspecified 
    This code is used when the cause of low back pain is not documented, serving as a general category for nonspecific pain without a defined pathology. 

• • M54.51 – Vertebrogenic low back pain 
    A highly specific code for low back pain originating from vertebral endplate changes. This type of pain is often associated with Modic changes, which can be detected through MRI scans and are linked to degenerative alterations in the vertebral endplates and adjacent bone marrow. Vertebrogenic pain often requires more specialized treatments like biologic injections, spinal fusion, or interventional therapies. 

• • M54.59 – Other low back pain 
    This code is for conditions not classified as vertebrogenic but still requires differentiation from unspecified pain, such as muscular strain, facet joint dysfunction, or sacroiliac joint pain. These cases still need clear documentation to differentiate them from broader low back pain diagnoses. 

These updates allow healthcare providers to document low back pain with higher precision, ensuring that patients receive the most appropriate treatment and care. More detailed coding also means that therapists, physicians, and specialists can develop more targeted care plans, optimizing treatment outcomes and patient satisfaction. 

Impacts of Accurate Coding on Healthcare Providers and Patients

Accurate documentation and proper coding are essential for both the clinical and administrative sides of healthcare practice. Implementing the new low back pain codes will improve patient care, streamline treatment planning, and ensure that reimbursement claims are more likely to be approved. Healthcare providers can avoid costly delays in payments and reduce the risk of claim denials, which can disrupt a practice’s financial flow. 

For patients, precise coding helps clinicians to more effectively pinpoint the cause of pain, leading to more effective and tailored treatments. For example, a patient diagnosed with vertebrogenic low back pain may benefit from specialized imaging studies or biologic treatments that wouldn’t be prescribed if their pain was misclassified under the older M54.5 code. 

Moreover, as back pain is one of the most common reasons for medical visits, these code changes impact a wide range of specialties: from physical therapists and orthopedic surgeons to chiropractors and pain management specialists. 

Updating Clinical Practices: A Step-by-Step Guide

Continuing to use outdated codes such as M54.5 can lead to claim denials, disrupt the revenue cycle, and hinder proper patient management. To optimize revenue and improve patient outcomes, healthcare providers should take the following steps: 

1. Revise Clinical Documentation 
   Ensure that patient records are updated to reflect the new codes. This includes incorporating detailed histories, diagnostic findings, and imaging results to substantiate the use of M54.51 for vertebrogenic pain or M54.59 for other categorized low back pain conditions. Clinicians should specifically note whether vertebrogenic changes like Modic changes are present. 
2. Update Billing and EMR Systems 
   Work with coding specialists to integrate these updates into Electronic Medical Records (EMR) and billing software. This will streamline the billing process and reduce the risk of claim denials or delays. Furthermore, auditing existing templates and workflows is essential to ensure the new codes are correctly applied in practice. 
3. Educate the Healthcare Team 
   Conduct training sessions for physicians, therapists, nurses, and administrative staff. Ensure all team members understand when and how to apply the new codes, and provide real-life examples of proper documentation scenarios. The training should also emphasize the importance of collaboration across different specialties to ensure comprehensive care and accurate documentation. 

Leveraging Technology for Seamless Transition

With the constant changes in medical coding, having an advanced EMR system can make a significant difference. Tools like HelloNote help integrate the latest coding updates, minimizing errors, ensuring compliance, and enhancing workflow efficiency. This technology ensures that providers can stay ahead of regulatory changes and focus on providing high-quality care without being bogged down by administrative burdens. 

HelloNote and similar EMR solutions offer features like automatic code suggestions, direct integration with diagnostic tools like MRI and X-ray results, and real-time updates to billing templates. This integration not only reduces human error but also helps practices stay compliant with evolving coding standards. 

Case Study: The Importance of Correct Coding

Consider a case where a patient is diagnosed with low back pain following a car accident. If the physician continues using the old M54.5 code for “unspecified low back pain,” the treatment plan may not fully reflect the patient’s condition. With the updated codes, they could document M54.51, identifying it as vertebrogenic low back pain associated with degenerative changes seen on MRI. This more specific diagnosis would guide appropriate treatment options, such as injections or referrals to specialists, which would be crucial for the patient’s recovery. 

On the other hand, if the patient had muscular strain or facet joint dysfunction, the provider could use M54.59, ensuring that the correct therapeutic strategies are implemented without unnecessary procedures. 

Industry Trends: The Future of Medical Coding

The transition to more precise ICD-10 codes for low back pain is part of a larger trend in healthcare to embrace artificial intelligence and machine learning for coding accuracy. These technologies are increasingly being integrated into EMR systems to reduce human error and improve workflow efficiency. 

Looking ahead, we can expect further refinements in coding systems as medical research and technology evolve. As more is understood about conditions like low back pain, we may see even more nuanced classifications emerge to guide clinicians toward the best treatment options. Additionally, healthcare practices must stay adaptable to these changes, ensuring their documentation and coding practices evolve alongside the latest standards. 

Conclusion

The transition from M54.5 to the more specific codes M54.50, M54.51, and M54.59 marks a critical shift in how low back pain is classified and documented in 2025. This update not only improves diagnostic accuracy but also helps providers develop more targeted treatment strategies, enhancing patient outcomes. 

To ensure continued compliance and avoid billing disruptions, healthcare providers must update their clinical practices, train staff, and integrate updated codes into their systems. By doing so, they will be better equipped to navigate the evolving healthcare landscape, ensuring optimal reimbursement and high-quality care for patients. 

If you haven’t updated your clinical documentation and billing systems yet, now is the time to act! Consider integrating an EMR system like HelloNote, which automatically updates with the latest ICD-10 revisions, ensuring your practice stays compliant and efficient. 

Stay up to date with the latest Medicare 8-Minute Rule 2025 updates. This article covers essential changes in billing, documentation, and compliance that impact therapy practices. Learn how to navigate these updates, ensure accurate billing, and stay audit-proof with expert tips and tools like HelloNote.

The Medicare 8-minute rule has been a cornerstone in therapy billing, ensuring that therapists are reimbursed for the time spent with patients. As of 2025, Medicare has issued clarifications that impact how therapists document, bill, and manage their therapy sessions. These updates aim to improve transparency, reduce errors, and ensure compliance with the ever-evolving regulatory landscape. Understanding these changes is crucial for therapy clinics to stay compliant and avoid denied claims. 

Key Changes in the 2025 Medicare 8-Minute Rule

1. Clarifications on Group and Concurrent Therapy Billing 

The 2025 updates bring more clarity to billing for group and concurrent therapy sessions. Here’s how the changes affect therapists: 

• • Concurrent Therapy: When treating two patients simultaneously under separate care plans, therapists must now document each patient’s session separately. This means differentiating concurrent care time to avoid billing mistakes. 

• • Group Therapy: For group therapy sessions, it is now necessary to document the time spent on individual needs within the group. This ensures that patients are receiving the appropriate level of attention and that the services are reimbursed fairly. 

How HelloNote Helps: HelloNote’s automated timers and customized templates help therapists accurately track and document both concurrent and group therapy time, making it easier to comply with these new requirements. 

2. Enhanced Reporting and Documentation Requirements 

The 2025 updates require more detailed documentation for every therapy session. Therapists are expected to break down the time spent on: 

• • Direct patient care (billable) 

• • Rest periods or patient breaks (non-billable) 

• • Non-clinical activities, such as patient education or administrative tasks 

For example: 

• • 10 minutes: Manual therapy (97140) 

• • 15 minutes: Therapeutic exercise (97110) 

• • 5 minutes: Patient rest (non-billable) 

This level of detail helps ensure compliance and reduces the likelihood of audits. 

How HelloNote Helps: With HelloNote’s structured templates, therapists can easily document time allocations and meet Medicare’s reporting standards without the risk of oversight. 

3. Updated Rules for Therapy Assistants (PTAs and OTAs) 

Medicare’s 2025 updates emphasize the importance of clear documentation when therapy assistants (PTAs and OTAs) are involved in patient care. Therapists must now: 

• • Clearly document the time and tasks completed by assistants during a session. 

• • Apply modifiers like CQ (for PTA) and CO (for OTA) to indicate assistant involvement. 

• • Account for reduced reimbursement rates (85% of the standard rate) for services provided by assistants. 

How HelloNote Helps: HelloNote’s modifier integration automatically suggests and applies the correct modifiers, reducing the risk of denied claims or payment reductions. 

Impact of the 2025 Updates on Therapy Practices

These updates significantly impact the administrative workload for therapy practices. Therapists and clinic owners must allocate more time and resources to ensure compliance with Medicare’s new documentation and billing requirements. Without the right tools, this could lead to increased administrative burdens and costly mistakes. 

Solution: By using an EMR system like HelloNote, therapy clinics can streamline documentation processes, reduce errors, and stay compliant with Medicare’s regulations. 

Practical Steps to Stay Compliant with the 2025 Updates 

1. Refine Your Documentation Practices 

Therapists should: 

• • Include detailed time breakdowns for each service. 

• • Use clear language to justify the medical necessity of interventions. 

• • Ensure the roles of all providers (therapists, PTAs, OTAs) are clearly documented. 

How HelloNote Helps: Preloaded templates and customizable fields help therapists meet all reporting standards efficiently. 

2. Train Your Team 

Ensure your staff understands the 2025 updates and how they impact documentation and billing practices. Regular training sessions will help improve accuracy across the practice. 

How HelloNote Helps: The platform offers training materials and expert support to ensure your team stays up to date on regulatory changes. 

3. Leverage Advanced EMR Technology 

Adopt an EMR system designed specifically for therapy practices. Look for systems that automate time tracking, documentation, and billing processes, so your team can focus more on patient care. 

HelloNote Features: 

• • Automated time tracking for group and concurrent therapy sessions. 

• • Built-in prompts for compliance with PTA/OTA billing. 

• • Real-time audit alerts to catch errors before submission. 

4. Conduct Regular Audits 

Regular audits help identify discrepancies before they result in denied claims. It’s essential to have a system that highlights potential errors quickly. 

How HelloNote Helps: HelloNote offers built-in audit reports that allow you to quickly identify documentation errors and inconsistencies to maintain compliance. 

Looking Ahead: Preparing for Future Changes

The 2025 updates reflect Medicare’s growing emphasis on accountability and transparency in therapy billing. These updates are part of a broader initiative to improve the quality and accuracy of therapy services. Therapists and clinic owners should stay proactive by investing in the right technology to streamline workflows and ensure compliance with future regulatory changes. 

How HelloNote Helps: By using an advanced EMR system like HelloNote, therapy clinics can be confident they’re equipped to handle upcoming regulatory changes while maintaining the highest standards of patient care. 

Conclusion

The 2025 updates to the Medicare 8-minute rule bring significant clarifications that therapists must incorporate into their billing and documentation practices. By using tools like HelloNote, therapy clinics can navigate these updates more efficiently and reduce the risk of compliance issues. The key to success is accurate, detailed documentation, and by streamlining these processes with the right technology, therapists can continue to focus on delivering excellent patient care. 

Simplify therapy billing with this comprehensive guide to the KX Modifier. Learn how it ensures compliance, supports medical necessity, and streamlines reimbursements.

January marks the beginning of a new year and a fresh opportunity to optimize your therapy practice’s billing and compliance processes. Therapy modifiers, including Medicare’s KX modifier and state-imposed limits, are essential tools for ensuring accurate billing and securing reimbursement. While some modifiers, like the KX modifier, may not be immediately relevant at the start of the year, preparing for their eventual use can help avoid disruptions and ensure a smooth workflow as the year progresses. 

This article explores why therapy modifiers matter, the challenges they present, and how you can set your practice up for success in 2025. 

Why Modifiers Matter in Therapy Billing

Modifiers provide additional context for therapy billing, helping payers understand the specifics of the services being provided. Proper use of these codes ensures accurate claim processing, minimizes the risk of denials, and keeps your practice compliant. 

Common Therapy Modifiers 

• KX Modifier: Indicates therapy services exceeding Medicare’s annual threshold are medically necessary. 

• GA Modifier: Signifies that an Advance Beneficiary Notice (ABN) was issued to notify the patient of potential non-coverage. 

• 59 Modifier: Prevents claim bundling by identifying distinct services provided on the same day. 

• CQ Modifier: Identifies physical therapy services delivered by a physical therapist assistant (PTA). 

• GP Modifier: Specifies services delivered under a physical therapy plan of care. 

• CO Modifier: Applies to occupational therapy services provided by an occupational therapy assistant (OTA). 

• GN Modifier: Reflects speech-language pathology services under a therapy plan of care. 

Accurate application of these modifiers is critical for compliance and securing timely reimbursement. 

State-Imposed Therapy Limits: Staying Ahead

State-imposed limits on therapy services add another layer of complexity for providers. These restrictions, such as session limits or coverage criteria, vary widely and require close monitoring to avoid issues. 

Common Challenges with State-Imposed Limits 

• Variable Rules: Different states and payers have varying therapy limits, making it challenging to stay updated. 

• Patient Disruptions: Exceeding limits can lead to denied claims, forcing patients to pay out-of-pocket or delay care. 

• Administrative Burden: Tracking usage against limits while managing a busy caseload adds complexity. 

How to Stay Ahead 

• Verify Benefits Early: At the start of the year, confirm patient benefits and therapy limits to plan treatment effectively. 

• Monitor Usage: Use EMR tools to track therapy sessions and ensure they remain within allowable limits. 

• Proactive Communication: Keep patients informed about their coverage and discuss alternative options if their benefits may run out. 

The KX Modifier: Preparing for Its Use Later in the Year

The KX modifier is a crucial tool for Medicare billing, allowing services to continue beyond Medicare’s annual therapy thresholds. However, it’s typically applied later in the year when patients begin to exceed these thresholds. For 2025, the Medicare therapy thresholds are: 

• $2,230 for combined physical therapy and speech-language pathology services. 

• $2,230 for occupational therapy services. 

Why the KX Modifier Isn’t Relevant in January 

At the beginning of the year, therapy services rarely exceed the annual thresholds, so the KX modifier is not immediately required. Instead, January is an ideal time to focus on: 

• Understanding Thresholds: Familiarize yourself with Medicare’s limits and ensure your documentation supports claims that may require the KX modifier later in the year. 

• Setting Up Tracking Systems: Establish systems to monitor cumulative therapy costs and identify when patients are approaching their thresholds. 

Using the KX Modifier Effectively 

When thresholds are reached later in the year: 

Document Thoroughly: Justify the medical necessity of continued therapy with clear and comprehensive notes. 

Monitor Progress: Ensure that ongoing therapy aligns with patient goals and Medicare’s guidelines for medical necessity. 

Automate Compliance: Use an EMR system to apply the KX modifier accurately and eliminate manual tracking. 

A Time for Preparation and Process Optimization

Now is the time to prepare for its eventual use and ensure your practice is ready for the year ahead. 

Steps to Take in January 

Review 2024 Trends: Analyze last year’s claim denials and modifier-related issues to identify areas for improvement. 

Train Your Team: Ensure that everyone on your staff understands how and when to use modifiers, including the KX modifier. 

Implement Monitoring Tools: Use tools like HelloNote EMR to track therapy thresholds and modifier usage seamlessly. 

How HelloNote EMR Simplifies Modifier Management

Navigating therapy modifiers like the KX modifier can feel overwhelming, but HelloNote EMR makes the process manageable and efficient. 

Key Features of HelloNote EMR 

Automatic Alerts: Receive notifications when patients approach Medicare thresholds, allowing you to prepare for KX modifier application. 

Integrated Modifier Tools: Apply modifiers like KX, GA, and 59 with ease using guided prompts that reduce errors. 

Comprehensive Reporting: Track therapy sessions, modifier usage, and compliance, making audits and appeals straightforward. 

Team Collaboration: Share updates with your team to ensure everyone is aligned on patient progress and compliance requirements. 

With HelloNote, you can eliminate unnecessary steps and focus on what matters most: providing exceptional care to your patients. 

Set the Tone for Success in 2025

While the KX modifier won’t be needed early in the year, understanding its purpose and preparing your processes will save you time and stress as thresholds are reached later on. By leveraging tools like HelloNote EMR, you can streamline billing, maintain compliance, and focus on delivering quality care. 

Ready to simplify modifier management and improve your practice’s efficiency? 
Schedule a demo with HelloNote today to learn how our platform can help you stay ahead of billing challenges and achieve your goals in 2025. Let’s make this your best year yet! 

Learn about the key procedures of re-evaluation, re-certification, and progress notes in therapy to ensure effective, compliant care across PT, OT, and SLP practices.

What is Re-Evaluation?

Re-evaluation is a key part of therapy that ensures the care provided meets the patient’s changing needs. Patient progress is often unpredictable; some patients improve quickly, while others may experience setbacks or reach plateaus. Re-evaluation helps therapists reassess the treatment plan, adjust goals, and make changes to keep therapy on track. 

When Do You Need to Re-Evaluate? 

Re-evaluations are necessary whenever a patient’s condition changes significantly. If a patient is not making expected progress, hits a plateau, or shows new symptoms, it’s time to reassess. Re-evaluation is also important if therapy extends beyond the original plan of care to ensure treatment continues to meet the patient’s evolving needs. 

Adjusting Frequency of Care 

After a re-evaluation, the frequency of therapy sessions may need adjustment. For example, if a patient is not improving as expected, you may decide to add an extra session each week or extend the therapy duration. Sometimes, extending therapy for a few more weeks may be needed to reach the patient’s goals and address any new challenges. 

Revising Goals 

Re-evaluation is also an opportunity to revisit a patient’s goals and ensure they remain realistic and achievable. If necessary, new short- and long-term goals can be set that reflect the patient’s current status. For example, a focus might shift to improving functional goals, such as walking longer distances, regaining balance, or performing more complex tasks. 

Why Re-Evaluations Matter 

Re-evaluations are crucial for ensuring therapy is relevant and effective. They allow therapists to adjust the treatment plan and goals based on the patient’s progress. This process ensures that therapy continues to be responsive to the patient’s changing needs, maximizing their potential for success. 

What is Re-Certification?

Re-certification ensures that continued therapy is still necessary for a patient’s progress. It’s required when the Plan of Care (POC) expires and often involves approval from a referring physician or specialist, rather than directly from Medicare. 

When is Re-Certification Needed? 

Re-certification typically occurs when the POC expires. This may happen before the standard 90-day mark, depending on the goals and frequency set. If long-term goals (LTGs) are established with specific durations, such as 60 or 90 days, and progress is slower than expected, re-certification allows therapy to continue without interruption. It ensures the treatment plan remains aligned with the patient’s needs. 

Adjusting Frequency of Care and Goals 

Like re-evaluation, re-certification can also involve adjustments to the frequency of therapy. For example, the number of therapy sessions per week may need to be increased, or the treatment duration may be extended if progress is slower than expected. Based on the results of the re-assesment, therapists can modify the POC, set new goals, and develop an updated treatment plan in the recertification note. 

The Role of ICD-10 and CPT Codes 

ICD-10 and CPT codes are crucial during re-certification. These codes are used to justify the ongoing need for therapy, ensuring that the diagnosis and treatment align with the patient’s progress. When submitting for re-certification, be sure to review and update these codes as needed to reflect any changes in the patient’s condition or treatment approach. 

Why Re-Certification Matters 

Re-certification ensures that therapy remains necessary and appropriate for the patient. It provides an opportunity to review goals, adjust treatment plans, and modify the frequency or duration of therapy. This ensures that therapy remains effective and compliant with regulatory guidelines. 

What are Progress Notes?

Progress notes are essential for documenting a patient’s progress and the effectiveness of their treatment. Unlike daily notes, which are written after each session, progress notes are completed at specific intervals. For Medicare patients, progress notes are done at least once every 10 sessions, while for insurance patients, they are written when the authorization expires, and the new one is needed. 

Progress notes summarize a patient’s achievements, document any progress made towards the treatment plan, and outline future goals. These notes play a key role in ensuring compliance with insurance requirements and facilitating communication with insurance providers. 

Progress notes are also essential for tracking long-term progress. They help assess whether therapy goals are being met and if the treatment plan needs adjustment. 

Conclusion

Re-evaluation, re-certification, and progress notes are all essential parts of therapy. Re-evaluation ensures that therapy remains effective by adjusting goals and frequency to meet the patient’s changing needs. Re-certification ensures therapy continues to be medically necessary and compliant with Medicare guidelines. Progress notes provide a clear record of the patient’s progress and ensuring compliance with insurance companies. 

By following these processes in platforms like HelloNote, therapists can provide the best possible care, keeping therapy relevant, effective, and compliant across all practices, whether PT, OT, or SLP. With HelloNote, therapists can efficiently track and document these essential elements, streamlining their workflow while maintaining high standards of care.

Discover how Hellonote is simplifying SOAP and daily notes for therapists, making documentation efficient, accurate, and stress-free. Learn how to navigate therapy documentation challenges with ease.

Imagine being a therapist wrapping up a long day at the clinic. You’ve guided clients through gait training, worked on improving shoulder mobility, or focused on refining speech clarity. Now, as you sit down to document those sessions, you’re left wondering: Did I capture the key details? Is this the right format? 

For busy therapists and clinic owners, effective documentation is both a necessity and a challenge. While crucial for tracking client progress, guiding treatment, and ensuring compliance, it often feels overwhelming when time is limited. With HelloNote, the dilemma of choosing between SOAP and daily notes is eliminated. By merging these formats into one streamlined process, HelloNote simplifies documentation without sacrificing depth or quality, helping therapists focus on what matters most—their clients. 

The Role of Documentation in Therapy

Documentation is the foundation of quality therapy care. It tracks the client’s journey, providing measurable insights into progress, treatment effectiveness, and the next steps in care. Whether treating mobility deficits, fine motor challenges, or communication issues, well-documented notes are essential for monitoring outcomes, maintaining care continuity, and supporting clinical decisions. 

Therapists rely on documentation to adapt interventions based on trends and measurable results. It ensures that if a client transitions to a new provider, revisits therapy after a break, or participates in multidisciplinary care, there is a clear and accessible record of their history and progress. 

Accurate documentation also serves a legal and ethical purpose. Notes must withstand scrutiny during audits, insurance reviews, and legal proceedings. Incomplete or inconsistent records can lead to denied reimbursements, compliance issues, or ethical concerns. For example, failure to document progress in a client’s mobility or functional independence could undermine the case for continued care or insurance approval. 

Ultimately, documentation does more than fulfill administrative requirements—it enhances client care. By identifying progress, stagnation, or areas needing adjustment, therapists can make informed decisions, measure outcomes, and empower clients with visible evidence of their achievements over time. 

Simplifying SOAP and Daily Notes with HelloNote

Therapists traditionally rely on two documentation styles: SOAP notes for comprehensive, detailed records and daily notes for brief updates. While SOAP notes provide a structured, in-depth approach, they can feel time-consuming when managing a busy caseload. On the other hand, daily notes may lack the detail necessary for audits, clinical reviews, or insurance submissions. 

HelloNote eliminates this challenge by unifying SOAP and daily notes into a single, streamlined format. Therapists no longer have to choose between brevity and thoroughness. The system retains the essential SOAP structure—Subjective, Objective, Assessment, and Plan—but adapts it for practical, everyday use, ensuring both efficiency and completeness. 

Subjective 

The subjective section captures the client’s experience and feedback during a session, serving as the foundation for understanding their perspective. Whether a client reports discomfort during specific activities, improvements in their movement, or ongoing challenges, this input guides treatment and provides context for measurable observations. 

Objective 

The objective section focuses on measurable and observable data gathered during the session. For example, changes in range of motion, balance during gait assessments, improvements in grip strength, or speech intelligibility are documented here. By including quantifiable metrics, therapists can track progress over time and demonstrate the effectiveness of interventions. 

Assessment 

The assessment synthesizes subjective and objective findings into a clinical interpretation. This is where therapists document their professional insights, identifying patterns, challenges, and progress. For example, improved functional mobility or increased independence with specific tasks highlights the success of ongoing interventions, while stagnation may indicate a need for adjustments to the treatment plan. 

Plan 

The plan outlines the next steps in treatment, ensuring a clear direction for future sessions. Whether introducing new exercises, adjusting therapeutic goals, or incorporating adaptive strategies, this section provides a roadmap for continued progress. 

By combining these components into one streamlined note, HelloNote makes documentation practical without sacrificing the details required for quality care and compliance. Therapists can efficiently record sessions while maintaining thorough, professional standards. 

Improving Efficiency Without Compromising Quality

For therapists, time spent on paperwork often feels like time taken away from client care. Managing extensive caseloads while ensuring documentation remains accurate and compliant can lead to stress and burnout. HelloNote addresses these challenges by making documentation seamless and efficient, reducing administrative burdens without compromising quality. 

The platform’s intuitive design provides customizable templates, automated prompts, and secure digital storage. These features ensure that notes include all necessary details, whether for routine sessions, comprehensive evaluations, or audits. By streamlining this process, HelloNote allows therapists to document quickly and accurately while adhering to clinical and regulatory standards. 

Therapists can confidently rely on HelloNote to: 

• • Ensure all critical information is captured without redundancy. 

• • Simplify the process of reviewing notes for audits, insurance submissions, or team collaborations. 

• • Reduce errors or inconsistencies in documentation, improving overall compliance. 

By improving efficiency, HelloNote empowers therapists to spend more time where it truly matters—helping clients achieve their goals. 

Supporting Client Outcomes Through Technology

In modern therapy practices, technology plays an increasingly important role in enhancing both clinical efficiency and client care. Tools like HelloNote simplify documentation, making it easier to track progress, analyze trends, and adjust interventions as needed. 

For example, tracking measurable changes in mobility, functional independence, or communication skills over time provides therapists with clear insights into treatment effectiveness. By centralizing this information, HelloNote ensures records are organized, accessible, and easy to retrieve for multidisciplinary reviews or client updates. 

For clinic owners, this consistency across staff documentation improves operational efficiency and enhances care quality. For therapists, it means less time spent navigating administrative hurdles and more time focusing on meaningful interactions with clients. 

Enhancing Therapy Through Clear, Effective Documentation

Effective documentation is not just about meeting requirements; it’s about supporting the therapeutic process. Comprehensive and organized records provide therapists with a framework for identifying progress, analyzing challenges, and communicating goals clearly. 

HelloNote’s unified approach to SOAP and daily notes ensures that documentation remains manageable, thorough, and clinically valuable. By streamlining this essential process, therapists can confidently deliver high-quality care, adapt interventions to meet evolving client needs, and measure outcomes over time. 

With tools designed to simplify documentation, HelloNote enables therapists to make every session count—helping clients regain mobility, improve independence, and enhance their quality of life. 

 In an industry where every minute matters, effective documentation shouldn’t feel like a burden. HelloNote empowers therapists to balance efficiency and quality, allowing them to focus on what truly matters: guiding their clients’ progress, one session at a time. 

In Medicare-compliant physical therapy, accurate documentation and adherence to criteria are essential for successful outcomes and appropriate remuneration.
Here’s a brief overview of essential themes for maintaining compliance and efficacy in your electronic medical records (EMR) system:

1. Understanding Dx Codes and Their Importance

The Medicare billing procedure relies heavily on diagnostic codes (Dx codes). They offer a consistent approach for documenting patient diagnoses, which directly impacts claims processing and compensation. Accurate Dx coding ensures that the services given are appropriately justified and reimbursed, thus avoiding claim denials and delays. Misuse or inaccuracies in coding might result in compliance concerns and financial losses. As a result, knowing and using Dx codes appropriately is critical to preserving Medicare compliance.

2. Past Medical and Surgical History: Why It Matters?

Documenting a patient’s past medical and surgical history is critical for developing a comprehensive treatment plan. This information assists therapists in understanding underlying problems that may influence present therapy demands and prospective complications. Accurate and complete history documenting promotes better clinical decision-making and validates the need for therapeutic services. It also assures Medicare compliance by providing a precise overview of the patient’s health status, thereby justifying continued therapy under Medicare guidelines.

3. Medication Management in Physical Therapy

Medication management is an important element of physical therapy, especially when working with patients who are taking numerous medications. Drug documentation helps to analyze their impact on therapy, avoid interactions between medications, and ensure patient safety. Medicare-compliant EMR systems should have extensive sections for recording medication history and current prescriptions to ensure that treatment plans are consistent with the patient’s medication regimen and overall health goals, in line with Medicare regulations.

4. Addressing Functional Deficits and ADLs

Functional impairments and Activities of Daily Living (ADLs) are important aspects of therapeutic evaluations and planning. Documenting these factors assists in assessing the patient’s functioning skills and customizing therapy interventions accordingly. Medicare compliance necessitates precise records of how therapy tackles specific deficiencies and promotes ADL improvements, ensuring that therapy goals are relevant and attainable depending on the patient’s needs, all in line with Medicare’s requirements.

5. Tracking Functional Transfers and Objective Measurements

Effective recording of functional transfers and objective assessments is critical for determining patient progress and therapeutic success. Objective measurements provide quantitative information about a patient’s functional skills, which is critical for assessing progress and altering treatment strategies. Medicare-compliant EMR systems should make it easier to accurately record and monitor these indicators in order to justify therapy services and outcomes for Medicare billing.

6. Effective Goals Tracking and the 8-Minute Rule for Billing

Setting and tracking objectives for therapy are critical for assessing patient progress and ensuring effective treatment. The 8-minute rule, which applies to billing for time-based therapy services, requires exact verification of the time spent on therapy activities. Proper goal monitoring and adherence to this rule aid in accurate billing and compliance with Medicare requirements, ensuring that services are properly billed and reimbursements are received as expected. This is crucial for maintaining Medicare-compliant billing practices.

7. Navigating the Auto KX Modifier and Cap Tracking

The Auto KX modifier is used to indicate that therapeutic services have exceeded the Medicare cap but are medically essential. Accurate use of this modifier and effective cap tracking are essential for Medicare compliance and avoiding claim denials. To guarantee that all services are properly documented and billed, EMR systems should support the seamless application of the Auto KX modifier as well as good therapy cap tracking, which is essential for Medicare-compliant billing.

8. Plan of Care (POC) Tracking for Better Patient Outcome

The Plan of Care (POC) is an important document that details a patient’s therapeutic goals, interventions, and expected outcomes. Tracking the POC ensures that therapeutic services are in line with the patient’s needs and progress. Medicare compliance necessitates regular updates and comprehensive records of the POC to verify the therapy’s medical necessity and effectiveness, ultimately leading to better patient outcomes and satisfaction. This continuous documentation ensures that therapy stays aligned with Medicare’s requirements.

Conclusion

Adherence to Medicare regulations in physical therapy entails a full understanding of Dx codes, extensive documentation of medical history, cautious medication management, and accurate tracking of therapy goals and outcomes. By concentrating on these critical areas, you can ensure Medicare compliance, improve patient care, and simplify the billing process. The proper usage of your EMR system in these areas will help to maintain the integrity and efficiency of your physical therapy business, keeping it Medicare-compliant and financially secure.

Re-evaluation, progress visits, and accurate PT documentation are essential for tracking patient progress, adjusting treatment plans, and ensuring compliance with regulations.

Keeping up with patient records and documentation can be a time-consuming task. As a physical therapist (PT), you understand the importance of meticulous documentation. But differentiating between re-evaluations and progress visits can be a murky area for both you and your patients. A clear understanding is crucial, not just for accurate billing and reimbursement, but for ensuring the highest quality of care.

Imagine a patient recovering from a knee injury. The initial evaluation establishes the baseline for their treatment plan. However, a few weeks in, they report significant improvements in strength and flexibility. This scenario necessitates a re-evaluation (CPT code 97164). A re-evaluation allows you to assess their remarkable progress, potentially adjust their goals, and ensure exercises remain relevant. Think of it as a strategic recalibration to maintain their recovery momentum.

On the other hand, let’s say a patient’s progress has plateaued or even regressed. Perhaps they’ve encountered a new setback, or the initial plan wasn’t quite the right fit. This is where progress visits come into play. These regular check-ins involve reviewing progress notes, monitoring their response to treatment, and fine-tuning the plan accordingly. Progress visits are like consulting a roadmap during a rehabilitation journey – they ensure you stay on track and make adjustments as needed to get them to their destination (pain-free movement) as efficiently as possible. 

So, how do you navigate this distinction for accurate billing and optimal care? Here’s where Medicare, a major player in therapy reimbursements, provides specific guidelines. A re-evaluation is generally considered a separately billable service when there’s a significant change in a patient’s condition – a substantial improvement, a worsening of symptoms, or an unforeseen development. This includes changes to the plan of care, such as Diagnosis, Long Term Goals, Frequency/Duration, and/or CPT codes.

So, how do you navigate this distinction for accurate billing and optimal care? Here’s where Medicare, a major player in therapy reimbursements, provides specific guidelines. A re-evaluation is generally considered a separately billable service when there’s a significant change in a patient’s condition – a substantial improvement, a worsening of symptoms, or an unforeseen development. This includes changes to the plan of care, such as Diagnosis, Long Term Goals, Frequency/Duration, and/or CPT codes.

Progress notes, however, are routine documentation completed after most visits. They track a patient’s progress, address any concerns they raise, and document adjustments made to the treatment plan. These notes are not typically billed separately; they’re considered an integral part of the standard PT service.

Now, let’s ensure proper billing for efficient reimbursements. When a re-evaluation is warranted, use the specific CPT code (97164) to bill for it separately. Sometimes, a re-evaluation might coincide with another service, like a treatment session. In those cases, utilize the 59 modifier to indicate that the re-evaluation is a distinct service from the treatment itself.

The key takeaway? A clear understanding of re-evaluations and progress visits is essential for therapists to ensure optimal care and accurate billing. By proactively clarifying these distinctions and adhering to proper billing practices, you can foster clear communication with your patients and pave a smooth path towards their recovery. Remember, transparency is key! Don’t hesitate to explain the purpose of each visit to your patients. After all, you’re a team working towards a common goal – their return to optimal health and function!

Managing these re-evaluations, progress notes, and all your other documentation can become time-consuming, especially with traditional paper methods. HelloNote, a user-friendly EMR system, can help! With HelloNote, you can easily document patient progress, track treatment plans, and generate accurate reports – all electronically, saving you valuable time and reducing the risk of errors

Streamline Your Documentation with HelloNote

Managing these re-evaluations, progress notes, and all your other documentation can become time-consuming, especially with traditional paper methods. HelloNote, a user-friendly EMR system, can help! With HelloNote, you can easily document patient progress, track treatment plans, and generate accurate reports – all electronically, saving you valuable time and reducing the risk of errors. Ready to streamline your documentation and focus on what matters most – your patients? Schedule a free demo of HelloNote today and see how it can transform your practice!

Understanding the differences between Therapeutic Exercise (97110) vs Therapeutic Activity (97530) is crucial for accurate documentation and billing. Learn when to use each CPT code, key documentation requirements, reimbursement guidelines, and how to avoid claim denials. Optimize your therapy practice with proper coding strategies to ensure compliance and maximize reimbursement.

Understanding the Differences for Accurate Documentation and Billing

Therapeutic activities and exercises play a crucial role in patient recovery, but proper documentation is essential for ensuring accurate care and reimbursement. In this guide, we’ll explore the differences between therapeutic exercise (97110) and therapeutic activity (97530) and how correct documentation can enhance patient outcomes and streamline therapists’ workflows.

Why Choosing the Right CPT Code Matters

Billing can be one of the most confusing parts of a therapist’s job. Selecting the right CPT code is critical to ensure clinics receive proper reimbursement from insurance providers. Therapeutic exercise (97110) and therapeutic activity (97530) are often confused because they share common goals. However, each code is unique and should be billed appropriately.

If you struggle with deciding whether to bill CPT code 97110 or 97530, here is a detailed breakdown of their differences:

CPT Code 97110: Therapeutic Exercise

What Is It?

Therapeutic exercises involve movements designed to improve strength, flexibility, endurance, and range of motion after an injury or surgery. These exercises are structured and must directly contribute to a patient’s functional improvement.

Key Documentation Requirements

When billing and documenting for therapeutic exercise (97110), therapists must include:

• • Body part(s) treated (e.g., shoulder, knee, spine).

  • Specific muscles and/or joints targeted to avoid confusion.

  • The functional goal of each exercise in relation to the patient’s overall progress.

Examples of Therapeutic Exercises Billed Under 97110

• • Active, active-assisted, or passive range of motion (ROM) exercises.

  • Resistance exercises (isometric, isotonic, isokinetic) to improve muscular strength.

  • Aerobic or cardiopulmonary endurance exercises (e.g., treadmill, bicycle, NuStep).

  • Active stretching to improve flexibility.

Therapeutic exercises typically target a single parameter, such as improving ROM or increasing strength. While they contribute to better functional movements (e.g., ADLs, work tasks, sports), if the focus is on real-life movement improvement, the correct code to use is CPT 97530 (therapeutic activity).

CPT Code 97530: Therapeutic Activities

What Is It?

According to Optum 360° and APTA, therapeutic activities involve the use of dynamic activities to improve functional performance. These activities are task-specific and simulate real-world tasks that a patient needs to perform in daily life.

Key Documentation Requirements

When determining whether an intervention qualifies as a therapeutic activity (97530), consider the following:

• • Is this a functional activity, such as climbing stairs or lifting objects?

  • Will this improve performance in daily life, work, or sports?

  • Are multiple parameters (strength, coordination, endurance) being addressed?

  • Does this activity directly relate to a specific real-world task (e.g., lifting a box onto a shelf)?

Examples of Therapeutic Activities Billed Under 97530

• • Lifting and carrying objects to improve work-related strength.

  • Squatting, bending, or reaching overhead for functional mobility.

  • Simulated car transfers for improved daily independence.

  • Stair climbing for increased lower body strength.

  • Balance exercises while performing a reaching task (e.g., standing on one leg while grabbing an item).

Billing Guidelines and Reimbursement Considerations

Billing Differences Between 97110 and 97530

• • 97110 is billed in 15-minute increments and focuses on single-parameter therapeutic exercises.

  • 97530 is also billed in 15-minute increments but involves real-world functional movements.

Using Modifier 59 for 97110 and 97530

When billing 97110 and 97530 together, Modifier 59 must be used to indicate distinct, separately identifiable services:

Correct Example: “Patient completed resistance training (97110) to improve quadriceps strength. Additionally, the patient performed functional stair climbing (97530) to enhance independence in household mobility. Modifier 59 applied to differentiate services.”

Avoid Overuse: Modifier 59 should only be used when documentation clearly supports separate treatment purposes. Improper use can trigger audits or payment rejections.

Medicaid and Private Insurance Reimbursement

• • Medicaid covers 97530 but does not cover 97110—therapists must verify coverage before treatment.

  • Private insurance plans may reimburse both codes but require distinct documentation for each session.

Billing Rates for CPT 97110 and 97530

Billing rates for CPT codes vary based on location, payer contracts, and Medicare rates. On average:

• • CPT 97110 reimburses approximately $30–$40 per 15-minute unit through Medicare.

  • CPT 97530 generally reimburses at a slightly higher rate since it involves more dynamic activities.

For the most accurate reimbursement rates, therapists should check the Medicare Physician Fee Schedule (MPFS) or consult with specific insurance payers.

Common Reasons for Claim Denials and How to Avoid Them

Insufficient Documentation

• • Vague Entry: “Patient performed strengthening exercises.”

  • Detailed Entry: “Patient performed 3 sets of 10 reps of resisted shoulder abduction with a theraband to improve strength for independent dressing.”

Billing 97110 and 97530 Together Without Justification

• • If both are billed, documentation must clearly differentiate them (e.g., one focuses on isolated muscle training, while the other applies strength to a real-world task).

Incorrect Use of Time-Based Billing

• • Ensure that each 15-minute unit meets the 8-minute rule for Medicare compliance.

How HelloNote EMR Simplifies Therapy Documentation

With HelloNote EMR, therapists can:

• • Streamline documentation for therapeutic exercises and activities.

  • Automatically apply modifiers to ensure reimbursement.

  • Reduce billing errors and improve claim approvals.

  • Track patient progress with real-time documentation.

Sign up for a free HelloNote demo today to see how easy it is to document and bill for CPT codes 97110 and 97530!

Final Thoughts on CPT Code 97110 vs. 97530

Understanding when to bill 97110 (therapeutic exercise) vs. 97530 (therapeutic activity) is essential for accurate documentation and proper reimbursement.

By implementing best documentation practices, using Modifier 59 when necessary, and leveraging an efficient EMR like HelloNote, therapists can improve claim approvals, maximize reimbursement, and avoid costly denials.

Mastering these distinctions helps ensure your therapy practice remains compliant, financially stable, and focused on quality patient care.

Learn how to confidently navigate cash-based sales conversations with this guide on creating an effective cash-based sales script for PT, OT, and SLP practices.

The scariest part of starting a therapy private practice, is selling yourself. We’ve spent our careers using insurance either as employees or practice owners, but what if we wanted to pivot to cash pay – what will patients say? In this guide, we’ll walk you through the conversation you’ll have with patients if you want to charge cash for PT, OT or SLP services.

The Cash Based Sales Script for PT, OT and SLP Practices

Reframe Your Mindset:

Before we go into the sales flow, it’s important to reframe the conversation you’ll have with your patient, caregiver, or family member.  Instead of thinking of this as a sales call, which when we think this way can make us feel scared, slimy, and not why we started our practice, we should instead just focus on the call on the following:

Answer any of our potential patient or their loved ones questions to the best of our abilities

Guiding this potential patients care, making sure they are appropriate for therapy and that you are the best provider for them

Learning about their care and providing care, advise, and recommendations based their diagnosis and aliments

If you treat this consultatory phone call with your therapist hat on, then usually people recognize your passion, your knowledge, and your ability to help them. And this attitude can really help make you feel more comfortable on these sales calls as well as help close more bookings. 

Prepare For Common Questions:

There are going to be some frequent questions that you’ll likely receive on every or at least most phone calls. Having prepared answers to these questions will greatly improve your confidence and comfort and success with your sales calls just like reframing your mind will.

Common questions may include: 

Why choose you vs the other practices?

Prepare this answer by looking at what your competitors are doing and how you are different? Is it the time you spend with the patient? Is it your credentials or extra certifications? Is it your demeanor and personality? Is it your background/experience? Is it the tools or technology you use? Is it the extra accountability or apps or education your provide included in your services?

There are a number of things you ask yourself to help prepare for this question but think about the hard and soft skills that make you special. 

There are a number of things you ask yourself to help prepare for this question but think about the hard and soft skills that make you special. 

Why should I pay cash vs using insurance?

How long have you been practicing, what have you treated (this may also be said in a way where they ask if you’ve seen their diagnosis), what is your experience? In this question, just be prepared to say how many years you’ve been a practitioner for, what settings and diagnosis you’ve seen, and if you know the prospective  client’s diagnosis ahead of time then you can prepare an answer about the experience with their diagnosis. 

Keys for these common questions is to, within HIPAA, provide patient success stories and real examples. This helps patients visualize how you’ll treat them and feel more confident that you’ve had success with their diagnoses. 

Sales Script Template for PT, OT, and SLP clinics

Welcome them:

YOU: Hi ___name_______, thank you so much for your interest in our practice! I’d love to know what is causing you to reach out for our _____PT,OT,SLP___therapy services? 

PATIENT: Patient will talk about his pain, diagnosis, aliments. You’ll simply listen and take notes.

Review what they said:

YOU: Thank you for sharing that information. Let me just summarize so that we are on the same page and then we’ll talk about how I can help you, as I really feel like we could make a dramatic impact on your ___pain, quality of life, walking etc______________________.

Perform brief summary. Then ask, is that correct?

PATIENT: Yes, that’s correct! Finally, someone who is listening!

Now impress them with patient example and what you would do to help:

YOU: Great, I’m glad we are on the same page and we have treated a lot of people in your same situation! In fact _____share patient success story (brief story)__________________________.  We would focus on address __briefly cover how you would help them, what the issue is______________________. 

PATIENT:  Wow, that sounds like that is what I need!

Now schedule them: 

YOU: Oh good, I’m so glad – we really try hard to make sure we can help and that everyone is in the best place to feel better! 

I would love to schedule you for your evaluation – we are a cash only clinic and the evaluation is $150. Included in the evaluation is a full hour one on one with one of our highly skilled therapists who will answer all your questions, perform a detailed evaluation of diagnosis, and give you several things you can do that very same day to make you feel much better.  Although we accept only cash, we’ll also provide you with what’s called a “superbill” that you can take to get reimbursement back from your insurance. 

This is the hardest part of the call. You have built repour, made sure the prospective patient is the right fit, and proven your knowledge level. This point in the call is where the prospective patient may have some hesitations. 

PATIENT: I’m not sure I can afford that…….

YOU:  This is where you could talk about results, perhaps you get patients better in less visits that other clinics. That’s at least a $20 co pay savings each time. So they can make up that savings in co pays.  

You can also talk about that you have had direct experience and that they have been trying to have help for years with no avail, this is that chance to really get better. 

You can also explain the superbill and how that will offset their costs and so really the end cost could likely be 50% of that, so only $70. 

Make sure to try to schedule them on the call and take payment on the call. 

Post Call:

Make sure you’ve set up text and email reminders for patient to ensure they show up to their evaluation. 

Make sure you email them a thank you email about how excited you are to see them, parking details, and any other important information they may need to make their visit with you easy and stress free. 

Summary: 

We hope this sales guide has helped to illustrate how you can just be yourself and let best patient care help you in your success.  The more you practice this script the easier it will be as well and you’ll learn the nuances of your particular city and patient population as well. 

Choose HelloNote as your trusted EMR partner for cash-based practices. Simplify scheduling and superbill creation to streamline your workflow. Schedule your free consultation today!