Brace Health resources
Practical guidance authored by the people who work on billing and practice operations every day.
15 resources
Medicare’s therapy evaluation code families distinguish physical therapy from occupational therapy: commonly, 97161–97163 are PT evaluations and 97165–97167 are OT evaluations. Confirm the code, discipline, documentation, and payer-specific billing rules for the service; a code family alone does not establish coverage or payment.
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An accepted status may confirm receipt by an intermediary, not necessarily that the payer has the claim in its adjudication system. Check the transaction status, payer routing, and required electronic-claim enrollment before treating the claim as received.
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The cost of outsourced PT billing depends on the proposal’s fee basis, included work, exclusions, practice volume, and contract terms. Compare providers using the same scope and period; do not assume a generic “standard” rate applies to every practice.
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A claim rejection generally means the claim was not accepted for adjudication. A denial reflects a payer's decision not to pay all or part of an adjudicated claim. Check the actual response before deciding whether to correct, submit again, or appeal.
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In-house and outsourced physical therapy billing can both work. Compare who will own the full revenue cycle, how work stays covered, and what your practice must still manage. Salary versus a billing fee is only one part of that decision.
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Old accounts receivable does not automatically become the new billing company's responsibility. Before a therapy practice switches, agree who will work earlier claims, who will post later payments, and what access and reporting remain available.
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An outsourced billing team can work within your therapy EMR when access and workflows support it. Before starting, define who prepares claims, posts payments, follows unpaid balances, and supplies missing information. EMR compatibility does not mean every step is automated.
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To investigate a physical therapy claim denial, start with the payer's actual response, compare it with the submitted claim and supporting records, and choose the next action under the applicable instructions. A denial code is a starting point—not a complete root-cause diagnosis.
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Before switching therapy billing companies, agree who owns old and new claims, preserve the access needed to work them, and assign each unresolved item a next action. A documented handoff manages transition risk; it does not guarantee uninterrupted cash flow.
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AI can help rehab billing teams spot exceptions, prepare follow-up, and organize evidence. It cannot replace clinical judgment, payer-specific verification, or a person accountable for approving and resolving the work.
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A physical therapy billing company should show more than a collections total. Evaluate how claims move from submission to payment, what happens when they are rejected or underpaid, and who owns each unresolved issue and next action.
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An AR aging report shows how long balances have been open. For a physical therapy practice, the useful next step is to identify why older balances remain, who owns each one, and what happens next.
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Physical therapy owners can start with five billing measures: submission lag, rejections and denials, AR aging, payment realization, and open exceptions. Each measure needs a consistent definition and a next action.
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A physical therapy billing company should turn completed visits into resolved balances. That includes claim preparation, rejection and denial work, payment posting, unpaid-claim follow-up, patient billing support, reporting, and clear escalation when the practice must act.
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A therapy EMR can prepare and submit a clean claim, but it does not finish the revenue cycle. A billing owner still needs to resolve payer responses, underpayments, secondary claims, patient balances, and recurring workflow failures.
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