We’re all taught at a young age that it’s better to give than to receive. This saying helps children develop perspective, and even as adults, few people would argue against the moral truth of this simple axiom. In fact, I’m betting this statement really speaks to the empathetic nature of rehab therapists. Unfortunately, though, when you’re running a business (for the purposes of this blog, I’m referring to a private practice outpatient therapy clinic), you really need to receive as much as you give, because contrary to Anne Frank’s beautiful and moving words, you can go poor by giving. That’s why doing pro bono work is like walking a tightrope: precarious. Still, there are circumstances in which giving is certainly rewarding—and you can genuinely afford it. So, how do you walk the rope—and is it even worth it?

Suppressing Sticker Shock: How to Handle Your Patients High-Deductible Health Plans - Regular BannerSuppressing Sticker Shock: How to Handle Your Patients High-Deductible Health Plans - Small Banner

The Definition: What is Pro-Bono Work?

In an article titled “Doing Good While Doing Well,” authors Francis Bisagni, PT, and Ron Scott, PT, EdD, JD, define pro bono PT work as “health professional services provided to patients at a reduced fee or no fee, depending on their ability to pay.” It’s a fairly broad definition, which is why the authors later add this caveat: “Professionalism is the key core value at the heart of pro bono service delivery. Health care professionals should routinely evaluate their professional conduct and always strive to be clearly in compliance with legal and ethical mandates.” And for many, that’s where the waters start to get muddy. The most common example of this practice is waiving copays, which is a form of underbilling, or “the conscious process of not billing for all services provided on a given date,” write David O. Lane, PT, MHS, and Peter R. Kovacek, PT, MSA, in an article titled “Money on the Move.”

The Good: How Do You Do Pro-Bono Right?

Two words: Be ethical. According to the American Physical Therapy Association (APTA), the “Code of Ethics for the Physical Therapist and Standards for Ethical Conduct for the Physical Therapist Assistant specify that APTA members provide pro bono physical therapy services and/or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, or underinsured.” The organization has an entire page of resources devoted to educating PT professionals on how to do pro bono work right (and I strongly urge you to read everything on that page and speak to your lawyer before even considering providing pro-bono services), but author Kathleen K. Cianca, OT, provides a nutshell version of the APTA’s stance in her article “A Better Way to Serve”:

“APTA (2009) outlined four ways that therapists could meet their pro bono ethical requirement:

  1. Provide no-cost or reduced-cost professional services to uninsured individuals;
  2. Donate therapeutic services to charitable organizations;
  3. Participate in volunteer activities to improve access to therapy;
  4. Donate money to groups that offer professional services to individuals with limited resources.”

Notice what’s missing? Waiving fees and/or copayments and not billing for all of the services you provide. And that’s how you ensure you’re on the right side of pro-bono work: “The desire to help those in need cannot eclipse the mandate to practice legally,” explain Bisagni and Scott.  

The Bad: Are You Doing Pro-Bono Wrong?

One word: Underbilling. When you provide more units or services than you actually bill for—or worse, waive fees or copays altogether—you lose revenue and leave your practice vulnerable to lawsuits, penalties, or even closure. Why? Because, as Bisagni and Scott explain, “Despite the apparent good intention, this practice violates a contractual agreement between the provider and the [payer], and circumvents the very measure in place to reduce overutilization of health care resources and patient and societal exploitation." Essentially, when you underbill or waive copays and fees, you:

  • Lose revenue. This one is obvious, but what’s less obvious is the way that revenue loss scales: the more you see those patients, the greater financial loss your clinic suffers over time.
  • Diminish the value of yourself, your services, your business, and your profession. And as Brooke Andrus explains in this blog post, “if you do that, how do you ever expect to negotiate for better payer contracts and reimbursement rates?”
  • Risk CMS fraud accusations or investigations. Generally speaking, Medicare and Medicaid prohibit providers from waiving copays. This is because doing so misrepresents the true charge for your services. And although Medicare permits copay waivers in very select circumstances, the exception criteria do not apply to most cases. Sure, the occasional waived copay probably won’t look too fishy, but if you consistently engage in this practice, it’s only a matter of time before CMS takes notice.
  • Risk HIPAA violations with commercial payers due to misrepresentation of charges. “For example,” explains Heidi Jannenga, PT, DPT, ATC/L, in this blog post, “if you waive a $20 copay on a $100 charge, then you’re basically admitting that you value that service at $80. Thus, the carrier should actually owe you only 80% of $80 (not $100).” Furthermore, as John Yodonise details in this PT Billing Services article, “HIPAA concluded that free services are likely to influence a patient to receive some other paid services and should be considered a form of remuneration. Since offering remuneration to patients is illegal, waiving copayments and deductibles are illegal.” There are exceptions to that rule—which Yodonise explains later in the article—but in general, waiving copays/fees and underbilling is a HIPAA violation.
  • Leave your practice vulnerable to discrimination accusations or lawsuits. Whether you’re breaking or bending the rules—or doing everything copacetic—you have to do it consistently and fairly across the board.

Bottom line: If you’re running a business, be an ethical businessperson. No matter how good your intentions are, you must get paid for what you’re worth and adhere to all legal and compliance requirements.

The Billing: How Do You Ensure You Get Right?

First, nip underbilling—and fee and copay waiving—in the bud ASAP. How? Develop procedures for collecting all patient fees (including copays, deductibles, coinsurances, and payment for noncovered services and supplies) at the time of service. Asking for money can be difficult—especially because copays for physical therapy can be so outrageously high. But remember, not collecting the payment you deserve not only diminishes the value of your practice, but also could prevent you from continuing to help your patients. After all, you won’t do them much good if your clinic goes out of business. So, to ensure proper copay collection in your clinic:

  1. Create a copay collection policy and procedure guide, and distribute it to all of your employees.
  2. Provide your staff with all of the resources and tools they need to promptly and accurately collect copays.
  3. Conduct training and role play exercises to get your employees more comfortable with asking for money, and be sure to practice some of the really tricky scenarios (like when patients push back).
  4. Monitor copay collection performance and hold your staff accountable.

Now, regarding genuine pro-bono work, I must again emphasize that you review everything the APTA provides and consult with your lawyer. However, a safe bet—or general rule of thumb—would be to avoid such work with any individual who has insurance. Another safe bet: volunteer work. (You also can investigate community clinic/free clinic models, which Bisagni and Scott define in their article.)


Most physical therapists didn’t get into the business to get rich. The key word in that sentence, though, is “business,” because altruistically speaking, it might be better to give than to receive, but if you want to actually stay in business, you’ve got to make something. More importantly, you’ve got to stay out of trouble. Otherwise you could lose more than just money. So, know the rules, and follow them.

  • The Ultimate ICD-10 FAQ: Part Deux Image

    articleSep 24, 2015 | 16 min. read

    The Ultimate ICD-10 FAQ: Part Deux

    Just when we thought we’d gotten every ICD-10 question under the sun, we got, well, more questions. Like, a lot more. But, we take that as a good sign, because like a scrappy reporter trying to get to the bottom of a big story, our audience of blog readers and webinar attendees aren’t afraid to ask the tough questions—which means they’re serious about preparing themselves for the changes ahead. And we’re equally serious about providing them with …

  • The Complete PT Billing FAQ Image

    articleMay 24, 2016 | 25 min. read

    The Complete PT Billing FAQ

    Over the years, WebPT has a hosted a slew of billing webinars and published dozens of billing-related blog posts. And in that time, we’ve received our fair share of tricky questions. Now, in an effort to satisfy your curiosity, we’ve compiled all of our most common brain-busters into one epic FAQ. Don’t see your question? Ask it in the comments below. (And be sure to check out this separate PT billing FAQ we recently put together.) Questions …

  • The PT’s Guide to Surviving a Medicare Audit Image

    articleMay 30, 2016 | 5 min. read

    The PT’s Guide to Surviving a Medicare Audit

    “How can I avoid being audited by Medicare?” This is one of the compliance questions I hear most frequently, and the honest answer is, quite simply, that you can’t. Just because CMS or one of its auditing entities hasn’t come knocking on your door doesn’t mean you’re not being audited. In fact, every claim you submit undergoes statistical analysis, and Medicare compares your claims data to the data for all other claims submitted. Furthermore, Medicare now analyzes …

  • Dawn of the ICD-10: Life in the Post-Transition World Image

    articleOct 28, 2015 | 5 min. read

    Dawn of the ICD-10: Life in the Post-Transition World

    Some of you might remember all of the hype around Y2K. Rumors and speculation were abuzz, and there were people who thought all hell was going to break loose when the clock struck midnight on January 1, 2000. And then—dun, dun, dun—nothing happened. The Hyperbolic Hype The lead-up to October 1 was similar in many respects, albeit on a much smaller scale. People all over the healthcare community were freaking out about the unknown; some large practices …

  • Denial Management FAQ Image

    articleMay 26, 2017 | 22 min. read

    Denial Management FAQ

    During our denial management webinar , we discussed the difference between rejections and denials, explained how to handle both, and provided a five-step plan for stopping them in their tracks. The webinar concluded with an exhaustive Q&A, and we’ve amassed the most common questions here. Insurance Issues Claim Quandaries Compliance Qualms Documentation Dilemmas Front-Office Frustrations Insurance Issues We’ve had issues with auto insurances denying 97112 (neuromuscular re-education) for non-neuro diagnoses, even in cases when the patient’s medical …

  • Common Questions from Our PT Billing Open Forum Image

    articleAug 18, 2018 | 34 min. read

    Common Questions from Our PT Billing Open Forum

    Last week, WebPT’s trio of billing experts—Dr. Heidi Jannenga, PT, DPT, ATC/L, WebPT President and Co-founder; John Wallace, PT, MS, WebPT Chief Business Development Officer of Revenue Cycle Management; and Dianne Jewell, PT, DPT, PhD, WebPT Director of Clinical Practice, Outcomes, and Education—hosted a live open forum on physical therapy billing . Before the webinar, we challenged registrants to serve up their trickiest PT billing head-scratchers—and boy, did they deliver! We received literally hundreds of questions on …

  • Common Questions from Our Medicare Open Forum Webinar Image

    articleOct 25, 2018 | 43 min. read

    Common Questions from Our Medicare Open Forum Webinar

    Earlier this week, WebPT President Dr. Heidi Jannenga, PT, DPT, ATC, teamed up with Rick Gawenda, PT—President and CEO of Gawenda Seminars & Consulting—to host a Medicare Open Forum . As expected, we received more questions than our Medicare experts could answer during the live session, so we've provided the answers to the most frequently asked ones below. Don't see the answer you're looking for? Post your question in the comment section at the end of this …

  • The 8-Minute Rule Showdown: Medicare vs. AMA Image

    articleNov 25, 2015 | 5 min. read

    The 8-Minute Rule Showdown: Medicare vs. AMA

    The guidelines for using the 8-Minute Rule are kind of like the instructions for building a piece of furniture from IKEA: they appear simple at first, but before you know it, you’ve been struggling for hours, you’ve got a lopsided futon, and there are seven leftover screws of various shapes and sizes scattered around your living room floor (maybe they’re just extras, right?). To make matters even more confusing, not all payers adhere to the same set …

  • Double Duty: How to Bill for PT and OT on the Same Day Image

    articleNov 12, 2018 | 6 min. read

    Double Duty: How to Bill for PT and OT on the Same Day

    In many cases, physical therapy and occupational therapy go together like peanut butter and jelly. PTs and OTs often share similar goals and interventions, treat the same types of patients in the same settings, and get confused by the billing rules that apply to our respective specialties. This confusion leads to quite a few questions, including this head-scratcher: how does one bill for OT and PT provided to a single patient on the same day? While the …

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