HealthSpark Blog
The business side of PT/OT practice, explained
Medicare, billing, and the operations of running a PT/OT practice — written by the team building the AI back office that handles them.
All articles
Medicare audit letters: what PT/OT practices need to gather for each claim
The evaluation, the signed plan of care, recertifications, progress reports, and daily notes, checked for missing signatures and gaps. What to gather for every letter in a batch, and how we turned the pile into a few minutes of review.
Medicare crossover claims: why the secondary never gets billed, and how to catch it
Accepting Medicare doesn't mean the secondary pays the rest. How crossover works, how to tell whether Medicare forwarded a claim, and how to send the secondary claim yourself when it didn't.
The four Medicare traps that cost new PT/OT practices the most money
Open home health episodes, Medicare Advantage hiding behind a Part B card, plan of care dates, and the secondary claim that never gets sent. What each one is, why it costs money, and how to handle it by hand.
Medicare home health overlap recoupments: why PT/OT clinics keep getting hit
The episode was not in Medicare's system the day you checked. Why an intake check is not enough, why the agency's answer cannot be trusted, and how the day-of-visit record turns a recoupment into an appeal.
Medicare secondary billing for PT/OT practices: who pays first, crossover, and the secondary claim
Medicare pays first, always. What a supplement is, why not being contracted with its carrier does not make the patient out-of-network, how crossover works, and how to build the secondary claim yourself when it fails.
The Medicare Advantage card trap
Patients hand you a red-white-blue Medicare card and may actually have Medicare Advantage. How to catch it in the eligibility check before the claim denies.
The KX modifier and the Medicare therapy threshold, explained
When the KX modifier applies, what your note needs to say, and where PT/OT practices get in trouble attesting without the documentation to back it.
Medicare plans of care: the requirements and the renewal trap
What Medicare actually requires on a PT/OT plan of care, when signatures need to be collected, and how practices lose revenue to expired POCs they never noticed.
Out-of-network billing: do you charge your rate or the payer's?
Your rate. The payer's out-of-network allowed amount only sets what the patient gets back. How the money moves, why the claim goes out non-assigned, and the one benefits check to run before the first visit.
How to verify PT/OT benefits before the first visit
A call script and checklist for benefits verification — what to ask, what to confirm, and the questions PT/OT practices routinely forget that cost them later.
The 10 PT/OT denial codes that cause the most lost revenue
The denials that show up repeatedly on PT/OT remittances, what each one actually means, and the upstream fix that stops them from coming back.
How to appeal a denied PT/OT claim without burning time you do not have
Not every denial is worth appealing. Here is how to decide, the information the payer actually needs, and the timelines that can make a denial unrecoverable.
Setting up ERA and EFT: getting paid electronically
Electronic remittances and electronic funds transfer cut weeks out of your payment cycle. Here is what the setup actually involves and why most practices skip it.
Getting credentialed with commercial payers in California
A realistic timeline, the documents you need before you start, and the mistakes that add 60 days to your credentialing calendar.
California PT direct access: what you can and cannot do without a referral
California lets patients see a PT without a referral, but the 45-day and 12-visit rules still apply. Here is what direct access actually covers and where PTs get caught.