PT Billing Company Worksheet | MedicalBillingSelect

From MedicalBillingSelect: medicalbillingselect.com/physical-therapy-billing-services/ | Medicare figures checked October 5, 2026

Company: ______________________________ Person you spoke with: ______________________ Date: ____________

Part 1. The PT Biller Test

Ask these on the first call. Write down what they say. Mark each answer. The answer key is at the end.

Answers to follow up: ____________________. Ask for written evidence when an answer is unclear, and resolve important gaps before signing. A total score would not prove experience or service quality.

Part 2. Who does what

For each task write: They do it, We do it, Shared (say who does which part), Extra cost (write the price), or Not confirmed.

Task	Need it? (Y/N)	Quote A	Quote B
1. Benefits and visit limits checked before visits
2. Authorizations: requests, renewals, tracking
3. Credentialing and payer enrollment
4. Charge review and questions back to the therapist
5. Claim submission, rejections, resubmission
6. Denials, appeals, underpayments
7. Payment posting and matching deposits
8. Patient statements and billing calls
9. Old unpaid claims from before the start date
10. Reports, data access, a named contact

Part 3. Get these in writing

Term	Quote A	Quote B
Rate or fixed fee
Which receipts the fee applies to
Monthly minimum, and how it is applied
Required software and its monthly cost
Setup, migration, and other one-time fees
Fee for older unpaid claims
First term and renewal
Notice needed to cancel
Exit fees, open claims, and data export

Answer key for Part 1

#	A good answer sounds like	Be careful if you hear
1	"Three. Add the timed minutes: 47. That is in the 38-to-52-minute band, so three units. Two of 97112 and one of 97110." This is CMS's own example.	"Four," or "whatever the therapist typed in."
2	"In 2026, $2,480 for PT and speech therapy combined. Services above it need KX on the applicable lines and documentation supporting medical necessity. Missing KX causes those services to be denied. $3,000 is a targeted-review threshold, not a cap or automatic review." CMS	"Medicare caps therapy," or they confuse the KX and review thresholds.
3	"We apply CQ with GP under CMS's service- and unit-level rules. Independent PTA time generally triggers CQ above the 10% standard, but timed-unit exceptions matter. Affected services receive 85% of the otherwise applicable Medicare Part B payment. We need the PT and PTA minutes by service." CMS examples	"Same as any other visit," or they apply the percentage to the whole visit without checking the units.
4	"Not necessarily. We check the remittance and expected payment. MPPR cuts the practice-expense portion of eligible additional therapy units or procedures by 50%; the highest practice-expense unit keeps its full practice-expense payment. We challenge errors, not a correctly applied reduction." CMS manual, section 10.7	"We appeal every reduction," or they cannot distinguish a correct adjustment from an underpayment.
5	"Only when documentation supports a distinct service and the current NCCI edit permits a modifier. We use a more specific appropriate modifier instead when available. A different diagnosis alone is not enough." CMS modifier booklet	"Whenever a claim gets denied."
6	A named person, a warning before the last approved visit, and a log of request and decision dates. They track the applicable deadline and escalation process for each payer.	"Your front desk does that," when you were told it was included.
7	A named person and a report. They know when a signed, dated order or referral plus proof of plan delivery within 30 calendar days of the initial evaluation can satisfy initial certification. Continued treatment still needs signed recertification within 90 days, or sooner for a shorter plan or significant change. CMS documentation requirements	"That is on the clinic," with no report offered, or "a referral always replaces certification."
8	"We explain the payment account and any lockbox or agent arrangement in writing. Your clinic keeps control. The BAA is in place before we access protected patient information." HHS	Payments go to the billing company without a clear written arrangement. No BAA offered.
9	A real sample that shows collections by payer, unpaid claims by age, denials by reason, and open tasks. They explain how each number is counted.	One "collection rate" with no definition.
10	A written plan: they work open claims for a set number of days, hand over your data in a format you can use, and say what it costs.	"We can talk about that if it comes up."

For the timed-unit example, combine qualifying 15-minute-code minutes for the same discipline and date of service. Keep untimed services out of that total. The initial-certification exception in question 7 requires the qualifying signed referral and proof of plan delivery to the referring practitioner in the record; it does not replace recertification or apply to comprehensive outpatient rehabilitation facilities (CORFs).

This worksheet combines selected Medicare billing rules and practical questions for evaluating a billing service. It is a buying aid, not a claim-coding guide. Verify the applicable payer's current requirements. Read the complete comparison.