Going into business for yourself means financial freedom and the ability to be your own boss. Of course, being in charge means contending with all the ongoing logistical challenges of running a therapy practice—including ensuring that all of your treating therapists are credentialed with all of your major payers. Otherwise, you leave your practice vulnerable to denied claims—and thus, reduced cash-flow. With that in mind, here’s the 4-1-1 on credentialing.

The PT’s Guide to Billing - Regular BannerThe PT’s Guide to Billing - Small Banner

Earning Those Credentials

Getting credentialed (i.e., enrolling in an insurance company’s preferred provider network) requires more than merely filling out paperwork. It’s actually a fairly involved process. And it’s an important one, too: credentialing helps insurance companies and government entities like Medicare determine whether you’re qualified to serve on their panels as an in-network provider. Why is that so important? Mainly because it could impact your ability to continually attract patients to your clinic. The majority of prospective patients base their care provider decisions on the answers to a few simple questions:

  • Are you good?
  • Can I trust you?
  • Do you take my insurance?

Credentialing can also afford therapists leverage and protection if they end up leaving a specific company—that is, of course, if they’ve earned credentials as sole practitioners and aren’t working under a group contract. Now, there are plenty of things to consider when it comes to the credentialing process, but here are some initial steps you can take to get the ball rolling, as adapted from this resource:

  • Secure your own tax ID number.
  • Obtain malpractice insurance.
  • Get an NPI number.
  • Have a license to provide services in your state.
  • Find a clinic location in which to practice.

Some payers also require you to submit annual updates and reapply after a certain time period to further prove your legitimacy as a provider. In other words, credentialing doesn’t always stop after you’ve submitted the initial forms.

Jumping Through Other Hoops

When a new therapist joins your practice, you’ll need to investigate his or her credentialing status with your insurance carriers. Now, even if you or your other therapists aren’t credentialed with a specific insurance company, you still have the option of billing as out-of-network providers. This could prove risky, though, as there’s no guarantee the insurance company will accept or pay those claims in full. Furthermore, if you’re not credentialed with Medicare, you cannot treat—or collect payment from—Medicare patients for any Medicare-covered services. Still, that doesn’t mean your clinic can’t see Medicare patients at all (check out this blog post to learn about your options for treating Medicare patients without being credentialed).

Today’s insurance companies may seem more limited and selective compared to years past, and that’s partially because, thanks to reform legislation like the Affordable Care Act, more patients are insured and, thus, able to access covered care. Furthermore, there are fewer insurance restrictions on patients with pre-existing conditions. Thus, to contain costs—and possibly to prevent overuse of benefits—payers are limiting the number of in-network providers available to their beneficiaries.

Contending with “Closed” Insurance Panels

Credentialing is not only time-consuming, but also—in the eyes of PTs, OTs, and SLPs—seemingly arbitrary and full of uncertainties. It generally takes three to four months to hear back from insurance panels once you’ve submitted documentation to verify your experience, expertise, interest, and willingness to provide therapy services. Then there’s the very real possibility that certain insurance companies will deny you based on selectivity or because the panels are “closed” (i.e., they’re not accepting any new providers). Knowing how to position your experience can go a long way when it comes to getting into “closed” panels—but that’s easier said than done. So, what are some of your best options for overcoming these barriers? Beyond applying to specific insurance companies every six months, you should sign up for the CAQH ProView™, a universal provider database that makes credentialing a little easier to manage—and stomach.


As the saying goes, “Nobody said that it’d be easy; they just promised it’d be worth it.” This adage definitely applies to insurance credentialing. After all, you can’t expect to attract many patients if your admitting privileges aren’t up to snuff. That’s why it’s vital that you make credentialing a priority. While it can be fraught with frustration and uncertainty, the eventual payoff means more money in your pocket—and greater business success.

  • 3 Common Rehab Therapy Credentialing Mistakes Image

    articleJul 18, 2018 | 6 min. read

    3 Common Rehab Therapy Credentialing Mistakes

    Proper credentialing is a crucial step in running a successful physical therapy clinic. If your clinic and therapists aren’t properly credentialed with insurance providers from the get-go, your bottom line might suffer. And it’s not just new clinics that are susceptible to making credentialing mistakes; in fact, any clinic that has gone through a change in ownership, rapid growth phase, or any other transition might find itself mired in credentialing headaches. But before we get to the …

  • How to Negotiate Payer Contracts (Part 1): Making a Plan Image

    articleJun 23, 2014 | 7 min. read

    How to Negotiate Payer Contracts (Part 1): Making a Plan

    In today’s healthcare payment landscape, every dollar counts—especially in the physical therapy realm, where increasing regulations and decreasing reimbursements seem to be the name of the game. That’s why now, more than ever, it’s crucial that you get the most out of your private payer contracts—and to do that, you’ve got to negotiate. To help you make a case for the rates you deserve, I’ve put together a two-part guide to successfully negotiating payer contracts. Today, I’ll …

  • articleMar 16, 2011 | 4 min. read

    5 Steps to Jump Start Your PT Private Practice Collections

    There is just no getting around the fact that reimbursement and collections is as much a part of running a successful PT private practice as is providing quality physical therapy care for your patients. Nobody goes into physical therapy as a career with the hopes of becoming a bill collector, but getting paid for services rendered is a dilemma for every business across the board and a PT private practice is no different. Collections and reimbursement is …

  • Negotiating Payer Contracts (Part 2): Taking Action Image

    articleJun 24, 2014 | 6 min. read

    Negotiating Payer Contracts (Part 2): Taking Action

    You’ve done all of your research and amassed a wealth of supporting data. Now you’re ready to make a super strong case for increasing your reimbursement rates with a particular private payer. (If you missed my post about preparing for payer contract negotiations, you can check it out here .) But this isn’t your average business negotiation; making a deal with a health plan representative is a little more complex than, say, haggling over the price of …

  • 4 Keys to Keeping a Steady Cash Flow Image

    articleMay 18, 2016 | 5 min. read

    4 Keys to Keeping a Steady Cash Flow

    As a private practice clinic owner, you’re probably familiar with the cold sweat-inducing struggle to keep a steady cash flow. Claims management muck-ups, inefficient processes, staff issues, and lack of insight into your clinic’s financial health can leave you feeling like you’re riding a revenue rollercoaster. So, whether you’re trying to maximize reimbursements , combat employee theft , or optimize patient payments , these four keys to maintaining a steady cash flow will help you even out …

  • 7 PT Billing Software Deal Breakers Image

    articleMay 24, 2017 | 6 min. read

    7 PT Billing Software Deal Breakers

    I don’t know about you, but for me, it’s hard to put a price on a good cup of coffee. For some, it’s not merely a beverage to be sipped with eggs and toast—it’s an integral part of a morning ritual. For these folks, the difference between a stellar cup of joe and a subpar one can mean the difference between a productive day and one they struggle to push through. Much like a hot cup of …

  • Founder Letter: 3 Ways Your Practice is Losing Money Image

    articleMay 5, 2016 | 7 min. read

    Founder Letter: 3 Ways Your Practice is Losing Money

    Much like the patients you treat, your practice can appear healthy on the outside despite significant internal issues. And when those issues are money-related, the consequences can be deadly. If your practice already is in the red, you know you’ve got some pretty serious cash flow problems. But even if you’re in the black every month, you may still be washing dollars down the drain. While there are myriad ways your practice might inadvertently be losing revenue, …

  • articleMar 19, 2013 | 3 min. read

    Get Your Life Back: Billing Best Practices for Rehab Therapists, Part 5

    Billing is one of the most important aspects of running a rehab therapy clinic, aside frompatient care. But it can also be one of the most challenging, especially if you’re working with a billing process that doesn’t suit your clinic. The right billing method should streamline your workflow, increase your profitability, and free up some much needed bandwidth. Just think, what could you do with some extra time. With that in mind, we’re going to devote the next …

  • Billing for Dry Needling Image

    articleAug 8, 2016 | 6 min. read

    Billing for Dry Needling

    It’s safe to say that trigger point dry needling has been getting under our skin (pun very much intended). That’s because we get a lot of questions about billing for dry needling—specifically, about whether physical therapists are actually allowed to bill for the practice—and there isn’t an easy answer. In fact, there isn’t an answer at all. Here’s why: The Scope-of-Practice Problem Dry needling has taken some heat. Back in 2009, the American Academy of Orthopedic Manual …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.