Electronic Health Reporter

By John Wallace, PT, MS, FAPTA, chief compliance officer, WebPT.

Being efficient doesn’t mean cutting every cost. In rehab therapy, it means knowing where lean systems are enough and where targeted investments pay off. Many practice owners take pride in their resourcefulness, but avoiding necessary spend can be just as damaging as overspending. True efficiency requires discernment, not deprivation.

Invest in Prevention, Not Just Cleanup 

Many compliance challenges are preventable and often come down to education. Annual CPT coding refreshers, documentation training, and payer-specific updates help teams avoid the most common reasons for denials. Fortunately, these resources are widely available and affordable.

Associations like APTA, AOTA, and ASHA offer low- or no-cost defensible documentation checklists. Some EMRs also include built-in CPT code training modules that therapists can complete on demand. Even one annual training session can prevent dozens of costly mistakes and appeals.

A practice that spends wisely on education avoids far more costly cleanups later.

Know the Limits of Internal Fixes

Internal reviews, peer audits, and checklists can resolve most routine issues. But when audit denial rates spike, especially over the 50% mark, it’s time to rethink the DIY approach.

If you’ve already submitted records and received a wave of denials, don’t rush into appeals without backup. Bring in someone who can review your submissions, flag weak points, and ensure the full documentation story is being told. Even one overlooked missing element can tank an otherwise appropriate episode of care.

Waiting too long to get help can turn a manageable problem into a financial crisis.

Reevaluate Your Payer Strategy

Some of the most expensive mistakes rehab practices make don’t come from what’s in the documentation but from who they sign contracts with. It’s common for new owners to accept every payer agreement offered, thinking more plans means more patients. But each payer adds administrative overhead. If the reimbursement doesn’t offset the documentation burden, denials, and audit risks, that contract might be a liability, not an asset.

There are large commercial payers known for aggressive takeback audits. Talk to peers, evaluate patterns, and think critically about which payers are worth the work.

Out-of-network models, while not for everyone, offer more control and less regulatory friction. They require more patient communication and claim support but can protect clinical autonomy and reimbursement consistency in the long term.

When You Do Need Help, Get the Right Kind

Not every challenge requires outside support, but some absolutely do. If a payer is demanding a multi-year takeback or you’re staring down potential legal action, you need a healthcare attorney, not the business lawyer who helped set up your LLC. These legal experts specialize in payer appeals and regulatory defense, often working alongside compliance consultants to prepare defensible documentation reviews.

Start your search through professional associations, peer groups, or online rehab therapy communities. Platforms like Facebook and LinkedIn host active forums where practice owners regularly recommend experienced consultants and attorneys.

It’s not about bringing in an expensive expert for every small hiccup. It’s about knowing who to call when the stakes get high and acting early enough to protect your practice.

Efficiency with Intention

Running a low-cost practice doesn’t mean cutting corners or taking on every responsibility yourself. The most resilient clinics are the strategic ones, whose leaders are intentional with their budgets, prioritize staff training, protect themselves from risk, and avoid contracts that aren’t in their best interests.

Lean doesn’t mean minimal. It means strategic. Knowing when to pull in help or walk away from risk is one of the smartest moves a practice owner can make.