Eligibility gaps and missed authorizations are preventable.
Physical therapy runs on visit limits, benefit caps, and prior authorization. One missed authorization or exhausted benefit and the visit isn't payable, and manual teams can't verify every patient's coverage and track every re-auth across the plan of care. Ember verifies eligibility and manages authorization before the patient is on the table.
Trusted by specialty groups and health systems
Where physical therapy revenue leaks
The denial patterns Ember was built for
Physical therapy lives and dies on eligibility and authorization. Visit caps, benefit limits, and prior-auth requirements vary by payer and reset on their own schedules, and a single missed authorization or exhausted benefit makes the visit unpayable. Ember verifies coverage and manages authorization before the patient is on the table.
01 · Visit limits & authorization
Benefits run out and authorizations lapse mid-plan.
Most plans cap therapy visits and require prior authorization, with re-auth needed partway through the plan of care. Manual teams can't track every patient's remaining visits and auth expirations, so claims deny for exhausted benefits or missing authorization. Ember verifies limits up front and manages every authorization and renewal.
Auth · Visit cap · 9716102 · Therapy threshold & KX modifier
Crossing the threshold without the right documentation.
Once a patient passes the Medicare therapy threshold, the KX modifier and supporting medical necessity are required or the claim denies. Missed thresholds and absent KX modifiers are a recurring write-off. Ember tracks each patient's accumulated spend and applies the KX modifier with documentation when the threshold is crossed.
KX · GP · 9711003 · Timed-code units & the 8-minute rule
Unit miscounts and missing distinct-service modifiers.
Timed codes billed under the 8-minute rule are easy to miscount, and manual therapy paired with therapeutic exercise needs modifier 59 to be paid separately. Wrong unit counts and missing modifiers leak revenue on nearly every visit. Ember calculates units and applies the correct modifiers before submission.
97110 · 97140 · Mod 59 · 8-minThree engines.
One source of truth.
Ember connects clinical documentation, live benefit and authorization status, and contract terms into a single intelligence layer. Built for the visit limits and prior-auth tracking physical therapy billing depends on.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies the plan of care, coding decisions, and contracts with live benefit, visit-count, and authorization status for every patient.
R. Alvarez
Case #PT-44820 · Plan of care
02 · Audit
Coding Engine
Reviews 100% of visits against coding standards, each payer's authorization and visit-limit rules, your internal guidelines, and your contracts. Every flag carries a rule citation.
Re-authorization required before this visit bills
Payer auth policy · confidence 0.98
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the authorization and plan-of-care terms in play, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #PT-44913 · Denial CO-197
Services were rendered under valid authorization #AUTH-7741 and an active plan of care certified through visit 12; the attached re-authorization extends coverage…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for physical therapy practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the eligibility gap before the claim leaves.
Ember reviews every visit against coverage, authorization, coding standards, and your contracts. Visit limits, the KX modifier, timed-code units, and modifier 59 are validated before submission.
- 1
Verify before the visit
Confirms active coverage, remaining visit count, and authorization status from the payer before the patient is seen, not after the claim denies.
- 2
Validate the visit
Checks timed-code units under the 8-minute rule, GP and KX modifiers, distinct-service modifier 59, and plan-of-care certification against each payer's policy.
- 3
Recommend with citation
Returns the suggested correction or re-auth trigger tied to the exact authorization, visit-limit rule, or contract term.
- 4
Educate the team
Authorization lapses and coding patterns drive team-level coaching, so verification and modifier accuracy improve across every therapist and location.
Append modifier 59 · trigger re-auth before next visit
Payer auth + coding policy · confidence 0.97
+23%
Clean-claim rate
100%
Visits reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves the plan of care and authorization records, references the payer's visit-limit and contract terms, drafts the appeal, and tracks it through adjudication.
Auth required
Benefit max
Medical necessity
Mod 59 / units
Re-auth appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per visit
The full revenue cycle
From eligibility to adjudication. Covered.
Eligibility and authorization are where physical therapy revenue is won or lost, but Ember protects it at every stage of the cycle.
Eligibility Verification
Confirms active coverage, therapy benefits, and remaining visit count before every visit, so exhausted benefits and inactive coverage never turn into denied claims.
Prior Authorization
Initiates, tracks, and renews authorizations across payers, flagging the visit a re-auth is due, so the plan of care never lapses out of coverage mid-treatment.
AI Medical Coding
Reviews 100% of visits, timed-code units under the 8-minute rule, GP and KX modifiers, and modifier 59, against current payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching unauthorized visits, missing modifiers, and unit miscounts before they generate write-offs.
Denial Management
Full appeal lifecycle for every PT denial type, authorization, benefit max, medical necessity, and modifier disputes, tracked to adjudication.
Underpayment Recovery
Parses contracts and fee schedules to model what each visit should pay, then surfaces timed-code and modifier underpayments at scale.
Physical therapy revenue, protected visit to visit
-57%
denial rate
-45%
cost to collect
100%
visits audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your physical therapy practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.