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REVENUE CYCLE MANAGEMENT

Your revenue cycle, run by people who speak PT.

Billing, denials, and compliance for outpatient PT, OT, and SLP — handled daily, reported monthly, and built around the rules as they change. You keep treating patients.

Get a revenue cycle assessment
CLAIM LIFECYCLE
  1. SUBMITTED
  2. CODED
  3. BILLED
  4. DENIED
  5. APPEALED
  6. COLLECTED

12.3% workers’ comp denial rate Next-Wave Niches strategy brief, 2025

What we handle

The 8-minute rule, KX, GP/GO/GN — that's the whole job, not a footnote. Here's what runs behind your practice once you hand it to us:

  • Charge entry and claims — clean, coded, and out the door on your schedule, not ours.
  • The 8-minute rule — timed-code units calculated correctly, every visit, so you're not over- or under-billing.
  • KX threshold tracking — the $2,480 PT + SLP combined threshold for CY2026 (CMS CY2026 PFS), flagged before it bites.
  • GP / GO / GN modifiers — the right discipline modifier on every line.
  • CO / CQ modifiers — PTA and OTA services billed at the Medicare differential correctly.
  • Plan-of-care recertification — POC recert tracked so a lapse never voids a claim.
  • Prior authorization — submitted, tracked, and followed up, including the payers expanding it.
  • Denial management — every denial worked, appealed where it should be, and counted.
  • Patient balances and statements — handled with the same care as the payer side.

You see the numbers.

We don't ask you to trust a clean-claim percentage you can't verify. Every month you get the three numbers that prove the work — reported, not asserted:

DENIAL RATE

Tracked by payer, so you can see where the leak is.

DAYS IN A/R

How long your money sits before it lands.

NET COLLECTION RATE

What you actually keep of what you're owed.

These are your practice's reported figures, measured monthly — not an industry benchmark or a guarantee.

One specialist roof for PT, OT, and SLP

OT and SLP share the mechanics that make therapy billing its own discipline — the KX threshold, the 8-minute rule, the GP/GO/GN modifier logic, and the same prior-auth playbooks. That's why they belong under one specialist roof, not split across a generalist biller who treats therapy as one vertical among many. If you run a combined practice, your billing runs the same way ours does: specialist, and only therapy.

How we run your revenue cycle.

  1. We learn your practice

    The assessment maps your payer mix, your current denial rate, your days in A/R, and where claims get stuck — inside the EMR you already use. You keep your system; we work in it.

  2. We set up billing inside your system

    Charge entry, coding, the 8-minute rule, KX tracking, and the GP/GO/GN modifier logic are configured to your state's rules and your payer set. The people who set it up are the people who run it.

  3. We run it daily

    Claims go out on your schedule. Prior authorizations are submitted and followed up. Every denial is worked — appealed where it should be, corrected and resubmitted where that's faster — and counted.

  4. We report it monthly

    You get the three numbers that prove the work — denial rate by payer, days in A/R, and net collection rate. Reported, not asserted. The leak is visible, so you can see where the money is.

Questions practices ask

How is revenue cycle management priced?

Pricing depends on your collections volume, payer mix, and which services you need. Most outpatient therapy RCM is priced as a percentage of collections. We quote after a short assessment so the number fits your practice — book one and we'll walk through it.

Do I have to switch my EMR or billing software?

No. You keep the EMR you already have. You're hiring a service, not moving onto a platform. We work inside your system.

How do you handle denials?

Every denial is worked — appealed where it should be, corrected and resubmitted where that's faster, and counted so the pattern shows up in your monthly denial rate. You see the rate by payer, so the leak is visible, not buried.

What is the 8-minute rule, and how do you bill it?

The 8-minute rule is how Medicare decides how many timed-treatment units you can bill in a visit. We calculate units per the rule on every visit, so you're not leaving units on the table or over-billing into audit risk.

What is the KX threshold for 2026?

For CY2026, the KX threshold is $2,480 for PT and SLP services combined, and $2,480 for OT separately (CMS CY2026 Physician Fee Schedule final rule). We track each patient against it and apply the KX modifier when continued care is medically necessary and documented.

Do you handle workers' comp and state-specific billing?

Yes. Workers' comp and state rules differ everywhere, and the industry-wide workers' comp denial rate runs around 12.3% (Next-Wave Niches strategy brief, 2025). We bill to your state's rules — we've worked in all 50.

Credentialing is part of the relationship — new hire, new payer, new location, handled.

See credentialing & enrollment

When you're ready to open a clinic, add a location, or renegotiate your rates, the consulting is there.

See consulting services

Find out where your revenue is leaking.

The assessment looks at your denials, your days in A/R, and where claims get stuck. It's a conversation — you decide what happens next.

Get a revenue cycle assessment