Rehab medical billing services for
PT, OT, and rehab clinics

Rehab billing is its own discipline. The codes are narrower, the documentation rules are stricter, and the payers know it. A claim that would sail through for a primary care visit gets kicked back for a physical therapy session because the modifier was wrong or the plan of care expired three days ago. That is where most rehab practices lose money, and it is where Mediflows works.

We are a US-focused medical billing company built around the workflows that physical therapy, occupational therapy, speech therapy, and multi-disciplinary rehab clinics actually run. Flat monthly pricing. No percentage of your collections. No long contracts.

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What rehab medical billing actually involves

Rehab medical billing is the full revenue cycle for a therapy or rehab practice: verifying benefits before the patient walks in, coding the visit with the right CPT and ICD-10 combinations, submitting clean claims to commercial payers and Medicare, working denials, posting payments, billing patient balances, and reporting on what the clinic is actually collecting versus what it billed.

What makes it specifically rehab billing is the rule set. Therapy claims live inside CMS therapy threshold rules, plan-of-care documentation requirements, the 8-minute rule for timed CPT codes, and a thicket of modifiers that determine whether the claim gets paid or denied. A general medical biller can technically process these. Most do not catch the rehab-specific issues until the denial shows up 30 days later.

Why rehab billing breaks where general medical billing works

Three patterns cause most rehab denials we see when we audit a new clinic’s AR.

Therapy threshold and KX modifier issues.

Medicare Part B has a soft annual threshold for outpatient therapy. Above it, claims need the KX modifier and documentation of medical necessity. Miss the threshold, miss the modifier, and miss the payment.

The 8-minute rule applied wrong.

Timed codes like 97110 (therapeutic exercise) and 97140 (manual therapy) are billed in 15-minute units, but the math is not 15 = 1 unit. CMS uses the 8- minute rule to decide how many units are payable. Billers who learned in primary care often round the wrong way.

Modifier 59, GP, GO, GN confusion

Modifier 59 distinguishes separate procedures. GP, GO, and GN designate the discipline (PT, OT, SLP) on the claim. Commercial payers and Medicare apply these inconsistently. A clinic running PT and OT under one tax ID can lose claims for weeks before catching the pattern.

The result is the same in every case: claims paid late, claims paid short, or claims written off because the appeal window closed before anyone noticed.

What changes when you outsource rehab medical billing?

The clinics we onboard usually see three changes within the first 90 days.

Denial rates drop. Most rehab practices we audit start with denial rates between 8% and 15%. Industry benchmark is closer to 5%. After we clean up coding, modifier use, and front-end eligibility, denial rates land in the 3% to 5% range for most clients.

Days in AR shrink. When claims go out cleaner the first time, money comes in faster. A clinic that was sitting at 45 to 60 days in AR typically moves to 28 to 35 days within a quarter.

Your front desk stops doing two jobs. The person who was checking patients in is no longer also fighting with Anthem on the phone for an hour every afternoon. That alone changes how the clinic feels to work in.

Our rehab medical billing services

Eligibility and benefits verification.

Before the first visit, we verify coverage, deductible status, visit limits, prior authorization requirements, and copay. Verification goes back into your EHR or front desk system so the patient gets the right number at check-in

Denial management and appeals.

Every denial gets worked. We track the root cause by payer and CPT so the same denial does not happen twice. Appeals go out within the timely filing window with documentation pulled from the chart.

Charge entry and CPT coding.

We code therapy visits using current CPT, including the 97000 series, evaluation codes (97161–97163 for PT, 97165–97167 for OT), and re-evaluation codes. ICD-10 selection is matched to the plan of care. Modifiers are applied per payer policy.

Patient billing and payment posting.

Patient statements go out on your schedule. ERAs and EOBs are posted daily. Payment variances are flagged.

Claim submission and clearinghouse management.

Claims are scrubbed and submitted electronically through our clearinghouse. Rejections come back to our team, not yours.

Provider credentialing and re-credentialing.

New hires get credentialed with your existing payer panel. Re-credentialing calendars are tracked so therapists do not fall off panels mid-quarter.

Monthly performance reporting.

You get a report that actually means something: collections versus charges, denial rate by payer, days in AR, top denial reasons, and what we are doing about each one.

Why rehab clinics choose Mediflows

We work with rehab practices. That is not a tagline. It shapes the team you talk to, the audits we run, and the playbooks we apply to your AR.

A few specifics:

HIPAA compliance built into every workflow.

Encrypted transmission, role-based access, signed BAA, audit logs.

US-based account management.

Your account manager is reachable, by name, by phone.

EHR and PM system integration.

We work inside WebPT, Raintree, TheraOffice, Practice Perfect, Kareo, AdvancedMD, Athena, and most major rehab platforms

How onboarding works

Week one: discovery call, AR audit on your current book, payer contract review, EHR access setup, signed BAA. Week two: data migration, fee schedule loading, clearinghouse enrollment, transition plan for in-flight claims. Week three onward: live billing under Mediflows.

You keep working through transition. We pick up new claims while your existing AR gets worked down in parallel.

Q1.What is rehab medical billing?

Rehab medical billing is the process of coding, submitting, and collecting payment for therapy services. It covers physical therapy, occupational therapy, speech therapy, and other rehab disciplines. It uses specific CPT codes, modifiers (GP, GO, GN, KX, 59), and documentation rules that general medical billing does not.

Q2.How much do rehab medical billing services cost?

Rehab billing companies charge either a percentage of collections (usually 4% to 9%) or a flat monthly fee. Mediflows uses flat pricing, starting at $499 per month for solo practices, $999 for group practices, and $1,499+ for larger rehab groups. No setup fees.

Q3. What is the 8-minute rule in rehab billing?

The 8-minute rule is the CMS formula for billing timed therapy CPT codes in 15-minute units. A therapist must provide at least 8 minutes of a service to bill 1 unit. Misapplying the rule is one of the most common causes of denied and underpaid rehab claims.

Q4. Can you bill PT and OT under the same provider on the same day?

Yes, but the claim has to use the GP modifier for physical therapy services and GO for occupational therapy, and the documentation has to support both plans of care. Modifier 59 may be needed if the codes are typically bundled. Payer policies vary.

Q5. How long does it take to outsource rehab billing?

Most rehab clinics are live on Mediflows billing within two to three weeks. Week one is discovery, AR audit, and BAA. Week two is data migration and clearinghouse enrollment. Week three is live claim submission while we work down existing AR in parallel.

Q6. Do you handle Medicare therapy threshold and KX modifier compliance?

Yes. We track each patient's running Medicare Part B therapy total against the annual threshold, apply the KX modifier when the threshold is exceeded with documented medical necessity, and flag charts for therapist sign-off on the medical necessity statement.

Q7. Is Mediflows HIPAA compliant?

Yes. We sign a Business Associate Agreement with every client, use encrypted data transmission, restrict access by role, and log every record touch. HIPAA compliance is documented and available on request.

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At Mediflows, we are dedicated to delivering exceptional billing support for over 20 years, we have been a offering comprehensive medical services in USA

Rehab medical billing services forPT, OT, and rehab clinics