Partnering with us for Medicare Part B therapy allows your non-skilled physical therapy or occupational therapy practice to serve Medicare patients without obtaining your own Medicare certification or building Part B billing infrastructure. Primary benefits include revenue opportunity from patients you currently turn away because you’re not Medicare-certified, client retention by continuing to serve patients who transition to Medicare coverage, expanded service offerings making your practice more comprehensive and competitive, and zero infrastructure investment since we handle all Medicare billing, documentation, and compliance under our provider number. You maintain the therapeutic relationship with patients while we provide the covered services they need. This is particularly valuable for wellness PT practices, sports medicine clinics, cash-based therapy practices, and non-skilled occupational therapy providers who have clients needing skilled Medicare-covered services. Rather than referring these patients elsewhere and losing the relationship, you coordinate with us to provide covered therapy while you continue serving them for non-covered wellness or performance services. Your practice benefits from maintaining patient loyalty and generating referral revenue in some partnership models, while patients benefit from continuity with a practice they already trust. We eliminate the barriers preventing you from serving Medicare patients including the complex Medicare enrollment process requiring extensive documentation and processing time, billing infrastructure and expertise for Part B claims, documentation standards specific to Medicare coverage requirements, and ongoing compliance with changing Medicare regulations and audits.

Several practice types find Medicare Part B partnerships particularly valuable. Sports medicine and performance clinics that serve active adults for injury prevention, performance enhancement, or wellness often encounter patients who develop conditions requiring skilled therapy covered by Medicare. Rather than referring out, you can coordinate covered treatment through our partnership. Cash-based physical therapy practices operating outside insurance models serve many clients who hit a point where skilled, medically necessary therapy is needed and insurance coverage becomes important. Partnering allows you to offer both models. Wellness and prevention-focused occupational therapy practices helping clients with home safety, fall prevention, or aging-in-place strategies often identify skilled needs like post-fall rehabilitation or functional decline requiring Medicare coverage. Non-certified therapy practices in underserved areas where Medicare patients have limited access to certified providers can serve this population through partnership. Boutique or concierge practices maintaining high-touch relationships with clients who need occasional covered therapy can provide this without disrupting your business model. Practices transitioning from purely cash-based to accepting some insurance can test Medicare services through partnership before pursuing direct certification. The common thread is practices with established patient relationships wanting to provide comprehensive care including Medicare-covered services when needed, without the complexity and overhead of becoming Medicare providers themselves. If you’re turning away patients or losing them to Medicare-certified practices when coverage becomes necessary, this partnership model may solve that problem while maintaining your preferred business model for other services.

The billing arrangement is structured to ensure compliance while fairly compensating both parties. We serve as the Medicare-enrolled provider, meaning therapy services are billed under our National Provider Identifier (NPI) and provider number. Medicare reimburses us directly for covered therapy services at standard Medicare fee schedule rates for your geographic area. We handle all aspects of Medicare billing including claims submission with proper CPT codes and modifiers, documentation supporting medical necessity and coverage requirements, prior authorization or therapy threshold notifications when needed, claims follow-up and reimbursement tracking, and appeals if claims are denied. Revenue sharing arrangements vary based on partnership structure but typically involve us retaining a percentage of Medicare reimbursement (typically 30-50%) covering our billing, compliance, and administrative costs, with the remainder going to your practice as compensation for the therapy services actually delivered. Alternatively, some arrangements involve your practice paying us a management or administrative fee (typically 20-30% of collections) to handle Medicare billing while you retain the majority of reimbursement. The specific financial arrangement depends on factors like therapy volume, whether your therapists deliver services or ours do, documentation responsibility, and risk allocation. We’re transparent about costs and revenue splits during negotiations. Payments are typically processed monthly with detailed reporting showing patients seen, services billed, reimbursement received, and net amounts due to each party. This arrangement allows you to benefit financially from serving Medicare patients without directly contracting with Medicare or managing claims processing, while we handle the complex administrative burden that makes Part B billing challenging for practices unfamiliar with the process.

Medicare Part B therapy has specific documentation and compliance requirements that we manage on your behalf, though your involvement is necessary for clinical documentation. Documentation requirements include initial evaluations establishing medical necessity with clear skilled therapy needs, functional limitations requiring therapy intervention, relevant medical history and prior level of function, specific treatment goals with measurable functional outcomes, and treatment plan with frequency, duration, and specific interventions. Daily treatment notes must document skilled interventions provided (not just exercises performed), objective measurements showing progress or lack thereof, patient response to treatment and any changes, and time spent with patient (required for timed CPT codes). Progress reports are required at specific intervals or when therapy thresholds are reached, documenting progress toward goals, continued medical necessity justification, and modified treatment plans as needed. Discharge summaries document outcomes achieved, final functional status, home program, and recommendations. Beyond documentation, compliance involves understanding therapy thresholds and KX modifier usage when medically necessary therapy exceeds caps, functional reporting requirements (G-codes) at evaluation, progress reports, and discharge, medical necessity standards ensuring services are skilled and reasonable, and face-to-face physician requirements ensuring orders are current and appropriate. We provide documentation templates and training ensuring your therapists understand Medicare requirements even if they haven’t billed Medicare previously. We review documentation for compliance before claim submission, providing feedback about deficiencies. Our compliance oversight protects both parties from audit risk and claim denials. While you or your therapists provide clinical treatment and documentation, we handle the Medicare-specific compliance complexity ensuring everything meets CMS standards.

The arrangement can be structured either way based on your preference and practice model. If you have licensed therapists on staff or contract, they can provide the actual patient care with therapy services billed under our Medicare provider number. Your therapists deliver treatment at your facility or in patient homes as appropriate, document services in our system or interface with our documentation platform, and follow Medicare documentation and compliance standards we provide. We handle billing, compliance oversight, and documentation review ensuring Medicare requirements are met. This model allows maximum continuity since your existing therapists maintain patient relationships and provide care consistent with your practice approach. Alternatively, we can provide Medicare-certified therapists from our network who deliver services to your patients. This works well if you don’t have therapists on staff, your therapists lack Medicare experience, or you prefer keeping your practice model completely separate from Medicare services. Our therapists coordinate with your practice regarding patient care plans and keep you informed about treatment progress. A hybrid model is also possible where our therapists handle initial Medicare evaluations requiring extensive documentation, and your therapists provide some treatment sessions under the plan of care. We’re flexible in structuring arrangements that fit your operational model. The key is ensuring whoever provides therapy understands and meets Medicare documentation standards, as this directly impacts reimbursement and compliance. We provide training and ongoing support regardless of whether your therapists or ours deliver services, ensuring quality care and documentation protecting both parties.

Initiating a Medicare Part B therapy partnership begins with a consultation to assess fit and structure an arrangement meeting your practice’s needs. Contact us to schedule an initial discussion about your practice type and current business model, patient population and how many need Medicare coverage, whether you currently turn away Medicare patients or refer them out, your interest in serving Medicare patients, and whether you have licensed therapists available or need us to provide them. We’ll explain how the partnership works including our Medicare enrollment and provider status, how billing and reimbursement flows, documentation requirements and compliance oversight, and financial arrangements and revenue sharing options. We’ll discuss different partnership structures and recommend the model best fitting your situation. If you want to proceed, we’ll develop a partnership agreement outlining scope of services and which therapies are covered, financial terms including revenue splits or fees clearly defined, documentation requirements and responsibilities, compliance and quality assurance processes, patient coordination and communication protocols, and terms for modifying or terminating the partnership. We’ll provide any necessary training for your therapists on Medicare documentation requirements if they’ll be delivering services. We’ll set up operational processes for patient referrals and scheduling, documentation submission and review, billing coordination and reporting, and ongoing communication. Implementation typically takes 2-4 weeks from agreement signing to serving first Medicare patients, allowing time for training, system setup, and workflow coordination. Throughout the partnership, we provide ongoing support, regular reporting on volume and reimbursement, compliance updates when Medicare requirements change, and responsive problem-solving when issues arise. Our goal is seamless integration allowing you to serve Medicare patients effectively without Medicare certification complexity or billing burden. Contact us today to explore whether a Medicare Part B therapy partnership makes sense for your practice.