Physical therapy billing services, from the visit to paid.

It handles the insurance side of your clinic, from the check before the first visit to the payment after the last. That means verifying coverage and visit limits, checking timed codes, units and modifiers, sending claims, following each one until the payer decides, posting EOBs and working denials. At Valian, our team does that work in our software, or your own team does it there, and either way you see every claim.

It depends on the company. Many charge a share of what they collect, and others charge per claim or by the month. Valian sets your price with you after the discovery call, based on how many claims you send and which parts of billing you want our team to run. Nothing is charged until you agree to it.

It is how Medicare turns treatment minutes into 15-minute units. When a visit has one timed code, it needs at least 8 minutes for one unit. When a visit has several timed codes, Medicare adds up all their minutes: 8 to 22 is one unit, 23 to 37 is two and 38 to 52 is three. The units then go to the codes that took the most time. Untimed codes, like evaluations, are one unit.

KX tells Medicare that therapy past its yearly threshold is still medically necessary and that the record shows why. Medicare sets one threshold amount each year for physical and speech therapy combined. Lines past it without KX are denied. KX belongs only on claims that may pass the threshold, and Medicare can review the records of patients who pass a higher amount.

GP marks a service as given under an outpatient physical therapy plan of care. Medicare wants it on every therapy code a physical therapist bills, evaluations included, and some other payers ask for it too. In Valian, GP is saved as each therapy service's usual modifier, so every line starts out with it.

Physical therapy evaluations are billed by complexity: 97161 for low, 97162 for moderate and 97163 for high. The level comes from the patient's history and other health problems, the exam, how stable the patient's condition is and how complex the decisions are. 97164 is a re-evaluation of an existing plan of care. Each is billed as one unit, and a therapist bills only one of them a day.

Only when the record shows a need. Medicare pays for a re-evaluation, 97164, for reasons such as new clinical findings, a significant change in the patient's condition, or no response to the treatment in the plan of care. It is not a routine visit on a schedule. Progress reports are a separate duty, due at least once every 10 treatment days.

The plan lists the diagnoses, the long-term goals, and the type, amount, frequency and duration of therapy, and it is written before treatment starts. A physician or a practitioner such as a nurse practitioner certifies it with a dated signature within 30 days of the first visit. The plan is certified again at least every 90 days, or sooner when it changes in a big way.

It depends on the state and the payer. Every state lets patients see a physical therapist without a referral in some form, but many states add time or visit limits or other conditions. Medicare needs no referral, but a physician or a practitioner such as a nurse practitioner must certify the plan of care. Some plans have their own rules, so check each contract.

The insurance check shows them. When a plan sends a visit limit, Valian shows it with the visits left, next to the deductible and coinsurance. Your front desk runs the check in one click before the first visit, or our team checks each patient before the visit when we run your billing. A patient near the limit is caught before the visit, not on a denial.

Often, yes. Many plans want approval before the first visit or after a set number of visits, and each plan sets its own rule. With Valian, our team files the request from the patient's verification page, with the visit notes and from your clinic's own fax number, and follows up until the payer decides. The approval number stays on the visit.

CQ marks a Medicare therapy service that a physical therapist assistant gave in whole or in part. On a private practice's claims, it goes on the line next to GP, and Medicare pays those lines at a lower rate. A line with CQ but without GP is sent back unprocessed. The treatment note names everyone who took part in the treatment.

Yes. Car insurers and workers' compensation carriers take no online coverage check, so Valian saves the card under the right company and sends no check. Each claim marks the visit as a car accident or a work injury, with the date, and our team follows it up with the carrier like any other claim. In New Jersey, PIP usually pays first after a car accident.

Medicare wants a claim within 12 months of the date of service, and a claim denied for late filing cannot be appealed. Commercial plans set their own deadlines, often from 90 days to a year, and your contract can set it too. Valian checks every claim against its payer's deadline before it goes and warns you when one is close.

No. Valian does not do payer credentialing, the work of getting a provider into a payer's network. We do file the sign-ups a clinic needs to send claims and get EOBs electronically, such as Medicare's claims sign-up, which runs inside the dashboard one step at a time. Credentialing stays with your clinic or the company you use for it.

Yes. HIPAA treats a billing company as a business associate, so a Business Associate Agreement is signed before any patient data moves. Data is encrypted in transit and at rest, and access is logged. Every carrier answer is kept exactly as it was sent, and each claim keeps its own history from the visit to the deposit.