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When treating a patient for one condition, such as neck pain, who later returns with a new physician order for a different issue like shoulder pain, your next steps depend on clinical judgment. If the therapist determines the shoulder condition is related to the neck, a reevaluation may be appropriate. However, if the shoulder issue is completely unrelated, a new evaluation should be performed. Keep in mind that whether a second evaluation is reimbursable depends on the specific insurance carrier. For Medicare beneficiaries, your plan of care will vary based on the referring physician(s). If the same physician referred the patient for both issues, you can create an updated plan of care that includes both conditions and obtain a dated signature from that physician. If two different doctors are involved one for the neck and one for the shoulder—you have two options: either one physician agrees to assume responsibility for both conditions and signs a combined plan of care, or you must maintain two separate plans of care, each with the appropriate physician’s certification and recertification. In such cases, it may be helpful to document separate treatment notes if both conditions are addressed during the same visit. Furthermore, if the neck treatment is billed to Insurance A and the shoulder treatment to Insurance B, the shoulder should be considered a separate episode, requiring a new evaluation and separate medical records for each condition. Proper documentation and compliance with insurance policies are essential to ensure accurate billing and optimal patient care.
¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at www.physicaltherapynow/franchise¨
As a private practice owner who has chosen to operate out-of-network (OON) with insurance companies, one of the most important billing decisions you’ll face is whether to submit claims to insurers on behalf of your patients or provide them with a superbill for self-submission. If you decide to submit the claim yourself, you have two options: accept assignment or not accept assignment. Accepting assignment means the insurer pays you directly for the portion they cover, and the patient pays only their cost-sharing amount (copay or coinsurance). However, keep in mind that insurers aren’t required to honor assignment and may still send the payment to the patient. If you choose not to accept assignment, the patient pays your full rate upfront, and the insurer reimburses them directly for the covered portion—this is common with PPO plans but may not apply to Medicare Advantage or TRICARE plans. Alternatively, if you don’t want to submit any claims at all, you can either give the patient a superbill or simply charge your cash rate and provide no documentation for reimbursement. A superbill is an itemized receipt that includes essential details like diagnosis codes (ICD-10), service codes (CPT), charges, provider and therapist information, and patient identifiers. This allows the patient to seek reimbursement directly from their insurance carrier.
¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at www.physicaltherapynow/franchise¨
1. Attend industry-specific conferences or trade shows. 2. Join or create a local or virtual physical therapy franchisee network. 3. Join a professional organization such as the American Physical Therapy Association (APTA). 4. Join a physical therapy franchise-specific association like the International Physical Therapy Franchise Association. 5. Attend webinars and seminars related to physical therapy franchising. 6. Schedule one-on-one meetings with experienced physical therapy franchisees. 7. Participate in online discussion forums and other online communities for physical therapy franchisees. 8. Utilize social media platforms to connect with physical therapy franchisees. 9. Participate in mentorship programs offered by franchisors. 10. Follow industry leaders and key influencers on social media.
