As is the case for healthcare professionals across the care spectrum, compliance resources for physical therapists are constantly evolving—forcing you, the rehab and remediation specialist, to wear many hats. Not only are you treating patient impairment and injury on a day-to-day basis, but you’re also responsible for ensuring that you and your practice meet a slew of ever-changing regulatory requirements.

Man—and you thought finding treatment slots for your growing Rolodex of patients was a challenge. Don’t worry—you’re certainly not alone, as a number of physical therapy professionals are in the same boat, wondering which resources they need and where they should turn to find the answers to all of their burning compliance questions. So, who you gonna call to make sure your PT practice is meeting various HIPAA, Medicare, and Office of the Inspector General (OIG) standards? There’s plenty to consider before picking up the phone to hire any sort of outside compliance professional, and we’re here to help.

WebPT + Billing Software - Regular BannerWebPT + Billing Software - Small Banner

Contact your MAC with questions about billing and claims.

Medicare’s policies—around coverage, payment, coding, documentation, and billing requirements—are anything but clear (how’s that for the understatement of the year?). CMS offers plenty of resources to help providers navigate the ins and outs of Medicare regulations—as does WebPT—and we recommend educating yourself on those regulations as much as possible. That way, you have the best possible shot of adhering to the rules—and avoiding throwing up any compliance red flags.

Then again, not everything related to Medicare billing and payment is under your control—and that’s where Medicare Administrative Contractors (MACs) enter in the equation. MACs handle a plethora of compliance-related tasks, including probe audits, or prepayment review of claims that target “either particular services or particular specialties.” Essentially, if you meet certain criteria for a probe, auditors will pull a sample of your submitted claims for review prior to payment. From there, MACs will solicit requests for additional billing information, which you must supply to receive proper reimbursement for claims.

So, when would be an opportune time to contact a MAC? Ideally, you’d seek the advice of your MAC before discovering that you’ve been pegged for an audit. Remember, your MAC is your primary point of contact for ensuring accuracy in the receipt, processing, and payment of your Medicare fee-for-service (FFS) claims. So, if you’re ever unsure of whether you are adhering to the Medicare policies that govern these processes—or if you have any related questions—then you’d be wise to get in touch with the MAC serving your region. (Not sure who that is? Visit this CMS page to find out.)

Turn to industry attorneys for customized compliance solutions.

Let’s face it: compliance may not be your forte. Fortunately, you can turn to experts like healthcare attorneys—who can create solutions specifically tailored to the needs of your rehab therapy practice—for help. These specialized lawyers can provide compliance advice, help you draft contracts, and aid in the creation of company policies on compliance. Plus, if your practice were to incur any compliance violations, a healthcare attorney could assist with any resulting investigation or litigation. Now, I’m going to be honest with you: legal services—especially super-niche legal services—can be pricey. But, the cost may be worth the long-term peace of mind, as a healthcare attorney can help you uncover any potential compliance risks, as well as prioritize which issues need to be resolved pronto.

To that end, if you take a proactive approach to getting your legal affairs in order—by enlisting a legal professional to craft company contracts and compliance plans that account for future trends and developments—then you may be able to stave off any potential legal complications (and avoid keeping your attorney on retainer). Sure, the upfront investment might be hard to stomach, but it pales in comparison to the potential cost of a compliance slip-up. Plus, once your attorney does all the heavy lifting, it’ll make it much easier for you—or another designated employee—to confidently handle future compliance-related tasks.

Connect with consultants to cultivate a top-notch compliance program.

One of the keys to a successful compliance program is making it a truly living and breathing part of your organization. Your compliance plan is more than a record of ideas and considerations for the future; it should be a palpitating heartbeat constantly pumping life into everything your organization does and stands for. These plans include evaluation of risk areas in:

  • hiring practices;
  • billing compliance;
  • medical records releases and informed consent;
  • confidentiality and patient rights; and
  • employee safety, rights, and obligations.

Now, you’re probably not an expert in all these areas—which is exactly why you may want to consider enlisting a savvy healthcare consultant to help you develop a compliance program that covers each of these facets. So, whereas a healthcare attorney draws up contracts and policies on already-established compliance protocols, a knowledgeable consultant should be able to strategize and create a plan specific to your practice.

In the market for a compliance expert? You’ll likely find that there are plenty of qualified, eager candidates from which to choose—and their price points may not all be the same. But rather than picking a candidate all willy-nilly, you should make sure your prospective consultant has the credentials, background, referrals, and cost range to satisfy your clinic’s needs. Your consultant’s fees should definitely be on your mind, but it shouldn’t be the be-all and end-all of your negotiations. As PT Compliance Group explains: “Compliance should be your number 1 investment in taking your practice from good to great. Think of compliance as an investment in your business, not a cost.”

Take heed on these final thoughts.

There you have it: these are some of the resources at your disposal for developing a strategy around corporate compliance. There is no one-size-fits-all approach, so make sure to do your homework before deciding which avenue works best for you. Finally, don’t be afraid of no ghosts—err, I mean, don’t be hesitant about contacting fellow rehab therapy colleagues, or joining professional associations or online groups to get some advice on the matter.


What remaining questions do you have about developing a compliance strategy for your practice? Already experienced success in this area? What tips or considerations would you give to rehab therapy professionals looking to hire someone for the first time?

  • 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 …

  • 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 …

  • 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 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 …

  • Maintenance, Medicare, and Medical Necessity: Unpacking the Jimmo Update Image

    articleOct 5, 2017 | 5 min. read

    Maintenance, Medicare, and Medical Necessity: Unpacking the Jimmo Update

    Hey, have you heard the good news? CMS has completed all required action items laid out in the Jimmo v. Sebelius settlement. If you’re scratching your head and wondering why that matters, here’s the rundown: a few years ago, a group of Medicare providers alleged that CMS contractors made determinations on claims for skilled care based on an inappropriate “Improvement Standard.” These providers took CMS to court, and the court determined that CMS needed to clarify and …

  • 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 …

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