Physical Therapy revenue cycle management
Visit caps, plan-of-care recerts and the 8-minute rule are where PT revenue leaks. AI agents track every authorized visit, validate every timed unit, and run claims and collections behind it.
Physical therapy is recurring, authorization-limited and easy to under- or over-bill. AI agents track authorized visits, validate timed-code units and threshold modifiers, remind on plan-of-care recertification, and keep the schedule and the cash flowing.
Authorization & visit tracking
- Auth request & renewal - Requests and renews authorizations before visits run out.
- Visit & recert tracking - Tracks authorized vs. used visits and reminds on plan-of-care recertification.
- Plan-of-care signature tracking - Chases physician signatures on the plan of care before they cost a claim.
- Continued-authorization requests - Prepares continued-auth requests as visit counts run down.
Coding & claims
- Timed-unit & modifier validation - Validates units under the 8-minute rule and checks modifiers (GP, KX, 59).
- CCI edit check - Checks timed vs. untimed code pairs against CCI edits.
- Evaluation-complexity coding - Supports the correct evaluation-complexity level from the note.
- Recurring claim scrubbing - Scrubs and submits recurring visit claims automatically.
Eligibility & therapy caps
- Benefits & cap tracking - Verifies PT benefits and visit limits, and tracks the KX-modifier threshold.
- Secondary coverage detection - Detects secondary plans and coordinates benefits.
Claims & submission
- Claim submission - Submits scrubbed claims through the clearinghouse.
- Claim status follow-up - Polls status and chases stuck claims.
Payments, denials & AR
- ERA auto-posting - Posts remittances and adjustments automatically.
- Cap & auth denial recovery - Auto-appeals therapy-cap and authorization denials.
- Underpayment detection - Flags payments below contracted rates.
Patient collections
- Point-of-service copay collection - Collects copays and coinsurance at each visit.
- Statements & payment plans - Sends statements and offers payment plans.
Scheduling & plan of care
- No-show & waitlist backfill - Reminds patients and backfills cancellations.
- Booking & recurring series - Answers calls and sets up recurring visit series in the EMR.
- Digital intake & insurance capture - Collects intake and captures the insurance card up front.
Analytics
- Visits-per-case & cancellation dashboards - Tracks utilization, cancellations and cap risk.
What you get
- Never bill past an authorized visit count
- Get the 8-minute rule right on every timed code
- Track the KX-modifier threshold automatically
- Stay ahead of plan-of-care recertification dates
- Automate recurring visit claims
- Recover cap and authorization denials
Frequently asked questions
What is the 8-minute rule?
It determines how many timed treatment units can be billed based on total minutes of direct one-on-one therapy. Miscounting units either loses revenue or creates an overbilling exposure, so unit calculation should be validated on every visit.
What is the KX modifier in physical therapy?
The KX modifier attests that therapy above the annual threshold is medically necessary and supported by documentation. Without it, services above the threshold are denied; with it, the documentation must genuinely justify continued care.
What is plan-of-care recertification?
The physician-certified plan of care must be recertified at defined intervals for therapy to remain billable. An expired certification invalidates otherwise legitimate visits, which is why recert dates need active tracking.
Why are physical therapy claims denied?
The most common reasons are incorrect timed-code units, exceeding authorized visits, an expired plan of care, and missing the KX modifier above the therapy threshold - all of which are preventable with up-front tracking.