Revenue Cycle Management · Medical Billing & Coding · Revenue Intelligence

Kitronixe Solutions

Physiotherapy & chiropractic

Revenue cycle management for physiotherapy and chiropractic

Therapy and chiropractic practices, where visit limits, plans of care and modifier rules decide whether a claim is paid.

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Visit utilizationEpisode A · Patient Example AIllustrative episodeNo patient data
Authorized visits
12
Completed
7
Remaining
5
  1. Visit 01: completed
  2. Visit 02: completed
  3. Visit 03: completed
  4. Visit 04: completed
  5. Visit 05: completed
  6. Visit 06: completed; plan-of-care review after this visit
  7. Visit 07: completed
  8. Visit 08: scheduled
  9. Visit 09: scheduled; authorization checkpoint after this visit
  10. Visit 10: scheduled
  11. Visit 11: scheduled
  12. Visit 12: scheduled
  13. Visit 13: not yet authorized
  14. Visit 14: not yet authorized
  • Completed
  • Scheduled
  • Beyond authorization: not yet authorized
  • Plan-of-care review, after Visit 06
  • Authorization checkpoint, after Visit 09

Illustrative episode with invented counts. No patient data, not a payer’s rule, and not a Kitronixe result or a client’s figures. Authorization requirements vary by payer and plan; some plans require none.

How therapy claims behave

Every repeat visit depends on what happened before it.

A later visit can be correct, necessary care and still come back unpaid if an earlier step left the authorization, the plan of care or the documentation out of date.

Therapy billing is governed by rules that sit outside the visit itself: how many visits a plan allows, whether a plan of care is current, how many units the documented minutes support. A claim can describe correct, necessary care and still be denied because one of those conditions lapsed.

One setup issue, many claims

A mistake made once can repeat on every visit that follows.

Most therapy claims inherit their details from the episode set up at the start: the authorization on file, the plan-of-care dates, the visit count. Choose an issue and see where it travels, then see what changes when it is caught at setup.
One setup issue, many claimsFour sample visits in one episodeIllustrative example

Episode setup

Wrong authorization details

The authorization entered at setup does not match what the payer approved: a different number, date range or service scope.

Carried into 4 of 4 sample claims

Flows into each claim that uses the episode’s details

  1. Visit 1 claim

    Claim may not match the payer’s authorization on file

  2. Visit 2 claim

    Claim may not match the payer’s authorization on file

  3. Visit 3 claim

    Claim may not match the payer’s authorization on file

  4. Visit 4 claim

    Claim may not match the payer’s authorization on file

Why a setup control matters

Each later claim copies the same episode details, so one wrong setting can repeat on every visit until someone notices, often only when the first denial arrives. By then several more visits may already have been billed the same way.

Illustrative example with sample visits, not a client’s claims. Whether a payer denies, holds or pays a claim depends on the payer, the plan and the documentation.

Authorization window

An authorization is a window, not a single approval.

Where a payer or plan requires one, an authorization usually approves a number of visits or units within a period of time. Both run out. Move the Today control through a sample window to see how the picture changes week by week.
Authorization windowSample authorization · Payer A · 12 visits approvedSample authorization
  1. Authorization startThe date the approval begins. Visits before it are generally not covered by it.
  2. Approved visit or unit windowWhat was approved: a count of visits or units, within a period set by the payer.
  3. Visits used (current)Each completed visit draws down the approved count.
  4. RemainingWhat is left of the approved count, and how much of the period is left to use it.
  5. ExpirationThe end of the approved period. Unused visits do not normally carry past it.
  6. Reauthorization / follow-upWhere care is continuing, a new or extended approval is requested with current documentation.

Today: choose a week

Visits used
7 of 12
Remaining
5
Weeks to expiration
4

Where this sample window stands · Week 4

On track

Visits used and time elapsed are both comfortably inside the approval.

Authorization requirements vary by payer and plan, and some plans require none. This sample window is not any payer’s rule: approved counts, periods and reauthorization steps are set by each payer.

Illustrative data for a fictional episode. Not a Kitronixe result or a client’s figures.

Plan of care

The plan of care sets the dates the claims live inside.

A sample episode, week by week. Choose an event to see what it is and why billing depends on it. Timing depends on the payer and the plan of care; the positions here are illustrative.
Plan-of-care calendarEpisode A · sample week positionsSample episode
  1. Week 1
  2. Week 2Treatment visits continue
  3. Week 3Treatment visits continue
  4. Week 4Treatment visits continue
  5. Week 5
  6. Week 6Treatment visits continue
  7. Week 7Treatment visits continue
  8. Week 8Treatment visits continue
  9. Week 9
  10. Week 10Treatment visits continue
  11. Week 11Treatment visits continue
  12. Week 12Treatment visits continue

Week 1 · sample position

Plan of care

The treatment plan: goals, the kind of treatment, and how often and for how long it is expected to run.

Why billing depends on it

Many payers expect visits to fall within a current plan of care, and some require it to be signed or certified before claims are paid.

Timing depends on the payer and the plan of care. The week positions are illustrative, not a payer’s interval.

Illustrative episode with no patient data. Not a Kitronixe result or a client’s schedule.

Before each visit is billed

Eight things each visit’s claim has to agree with.

A therapy claim draws on more than the visit note. Choose a cell to see what each component means, and what “review needed” or “missing” would look like for it.
Claim component matrixThree example visits, eight components eachIllustrative visitsNo patient data

  • Example Visit A

    Ready to submit

  • Example Visit B

    Hold for review

  • Example Visit C

    Hold: information missing

Plan of care · Example Visit C

Missing information

Whether the date of service falls inside a current plan of care, where the payer requires one.

Ready
Nothing outstanding for this component on this visit.
Review needed
The plan is close to its end date, or its signature or certification is still pending.
Missing information(this cell)
No current plan of care covers this date of service.

Illustrative visits with invented statuses and no patient data. Which components apply, and what each payer requires, varies by payer and plan. Not a Kitronixe result or a client’s claims.

The conditions around the visit

The rules a therapy claim is judged against.

Each condition below sits outside the treatment itself, and each can decide whether a correct claim is paid. The right-hand column is what it means for the claim.
Visit limits and authorization counts
For the claimMany plans cap therapy visits or authorize a fixed number at a time. Care that continues past the approved count without re-authorization goes unpaid.
Plans of care and re-certification
For the claimPayers commonly require a certified plan of care and periodic re-certification. A lapsed date turns otherwise correct claims into denials.
Timed services and units
For the claimTimed therapy services are billed in units derived from documented treatment minutes. Inconsistent minute documentation produces the wrong unit count, in either direction.
Chiropractic medical necessity
For the claimMany payers cover manipulation only as active, corrective treatment and require the claim to identify it as such. Maintenance care billed the same way is denied, and often cannot be recovered from the patient without prior notice.

How Kitronixe works

Controls before the claim goes out.

Each checkpoint is run ahead of submission, so a problem is found while it can still be fixed once rather than denied many times.

  1. Checkpoint 1

    Visit counts tracked per patient

    Authorized and used visits are tracked so re-authorization is requested before the limit, not after the denial.

  2. Checkpoint 2

    Plan-of-care dates monitored

    Certification and re-certification dates are watched ahead of time, so a lapse is caught before claims are affected.

  3. Checkpoint 3

    Units checked against minutes

    Billed units are compared with the documented treatment time before submission.

  4. Checkpoint 4

    Modifiers and notices reviewed

    Claims are checked for the modifiers and patient notices each payer requires to distinguish active treatment from maintenance care.

Questions

Questions therapy and chiropractic practices ask

All FAQs
How do you keep track of authorized visits?

Where a payer or plan requires authorization, the approved count, the approved period and the visits used are recorded for each episode and checked as visits are billed. The aim is to see the limit coming and request a reauthorization in time, rather than find out from a denial. Authorization requirements vary by payer and plan; some plans require none.

What happens when an authorization expires mid-treatment?

Visits after the approved period generally need a new or extended approval where the payer requires one. We flag the approaching end date, confirm with the practice whether care is continuing and what documentation the payer asks for, and track the request. Whether visits before a decision are covered depends on the payer, so we raise it before they happen.

Do you monitor plan-of-care and recertification dates?

Yes. Plan-of-care start and end dates, and any recertification the payer requires, are tracked per episode so an update can be requested before the date passes. The timing depends on the payer and the plan of care, so we work from each payer’s requirements rather than a single rule.

How do you check units against documented time?

Before submission, billed units for timed services are compared with the treatment time documented in the visit note. Units are derived from documented treatment time according to the applicable payer’s rules, and those rules differ, so a mismatch is sent back to the practice for review rather than adjusted on the claim by us.

Do you handle chiropractic maintenance versus active care distinctions?

We review claims for how each payer expects active or corrective treatment to be identified, and whether the payer requires a patient notice before care it may not cover. Those requirements are payer-specific. The clinical judgement of which kind of care was given stays with the treating provider and their documentation.

Can you work with both physiotherapy and chiropractic in one group?

Yes. The disciplines often follow different payer rules for the same patient population, so we keep their requirements apart: separate authorization and plan-of-care tracking where it applies, and each discipline’s claims checked against its own payer conditions.

What do you need from our team to start?

Access to your practice management or billing system, your payer mix, how authorizations and plans of care are recorded today, and a contact for clinical documentation questions. Please do not send patient information through this website; that is arranged securely during onboarding.

Other practice settings

Talk to us about your therapy and chiropractic claims

Tell us how visits, authorizations and plans of care are tracked today. We will look at where repeat-visit settings could be checked earlier.

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