HealthSpark Blog
Operational playbooks for insurance-ready independence
Medicare, billing, credentialing, and compliance — written by the team building the infrastructure independent PTs actually need.
Section
Medicare
Enrollment, eligibility, modifiers, thresholds, and the edge cases that cause clawbacks.
The KX modifier and the Medicare therapy threshold, explained
When the KX modifier applies, what your note needs to say, and where PTs get in trouble attesting without the documentation to back it.
The home health overlap: check the episode before you bill Part B
How to catch an active home health episode on eligibility before you bill outpatient PT — and avoid a clawback you will not see coming for months.
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.
Section
Billing
Claims, denials, ERA/EOB, payment posting — the mechanics of getting paid.
The 10 PT denial codes that cause the most lost revenue
The denials that show up repeatedly on PT remittances, what each one actually means, and the upstream fix that stops them from coming back.
How to verify PT benefits before the first visit
A call script and checklist for benefits verification — what to ask, what to confirm, and the questions PTs routinely forget that cost them later.
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 solo PTs skip it.
How to appeal a denied PT 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.
Section
Credentialing
Applications, CAQH, payer contracts, timelines, and what to prepare before you start.
Section
Compliance
Documentation standards, audit preparation, and the workflows that keep records clean.
Section
Practice
Running an independent PT practice: operations, growth, and the financial realities.
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