Physical Therapy Clinics, Plan of Care Completion & Insurance Authorization Tracker

Independent outpatient physical therapy, occupational therapy and sports rehab clinics with 1 to 6 clinicians and 150 to 600 active patients. The decision maker is the owner clinician, who is also treating patients 30 hours a week, which is exactly why nobody is watching the visit counts. Find them through state APTA chapter member lists, PT specific Facebook groups, the referral networks of orthopaedic practices, and local Google Maps searches filtered to clinics with fewer than 3 locations.

Hospital owned and private equity backed chains are the wrong target, they already have a revenue cycle team and a 9 month procurement process. The best single qualifying question is 'what percentage of your patients complete their full plan of care?' Most owners cannot answer it, and the ones who can usually quote a number under 60%. Clinics with a heavy HMO or workers comp mix are the strongest fit, because those payers authorize in small blocks and demand the most paperwork.

Cash pay only clinics are a weak fit, there is no authorization to track.

The clinic exports its active patients and recent visits from its EMR each night, usually a scheduled CSV. The app matches that against the authorization rules for each payer, which you load once from the clinic's own contracts: how many visits per block, how long that payer takes to answer an extension, whether they need a progress note every 6 visits, and whether extensions go by portal, fax or email. From there it does three things every weekday morning at 6am.

It counts attended billable visits against each episode's authorized block and works out the hard date of the first visit that would be unauthorized, then tells the biller which requests have to be filed today based on that payer's actual turnaround rather than a generic reminder. It scores every active episode 0 to 100 for drop out risk, weighted heaviest on first 4 week attendance (missing more than 20% of early appointments makes a patient roughly 3.5 times more likely to drop out), plus the gap since the last attended visit, whether a next appointment exists at all, home exercise compliance, pain trend and progress against the outcome measure, and it shows the named drivers rather than a bare number. And it sends the front desk one digest email listing the authorization actions due today, the red risk patients with a recommended action each, and the week's revenue at risk.

When the biller opens an extension request, the app pulls that patient's visit count, outcome measure baseline and current score, pain trend and functional notes, then drafts the medical necessity narrative from only those fields, with the source data shown beside the draft so the clinician can check every claim before signing. Approved packets render to PDF and go out by the route that payer uses. Patients get automated appointment reminders, a rebook message the morning after a no show, and a check in when the gap since their last visit passes double their prescribed interval, all consent gated.

Red risk patients get a call task for a human instead of a text. If an extension gets denied, the self pay visit package appears on that patient's record the same day so the conversation is 'here is what 4 more visits costs' rather than 'your insurance said no'.

The authorization half pays for itself fastest, usually inside 6 weeks, because it stops work the clinic was doing for free and stops cancellations the clinic was causing itself. Expect to find 3 to 8 live problems in the first import: patients being treated past an expired authorization, episodes sitting at visit 9 of 10 with no extension filed, and a handful of patients with no next appointment that nobody had noticed. That first import is the real sales moment, and it is worth doing it in front of the owner.

The retention half moves slower. Healthy clinics run 65% to 75% plan of care completion, the industry generally sits around 55% to 60%, and a realistic first year move is 8 to 15 percentage points, which on a 40 patient caseload is roughly 4 to 6 extra completed episodes a month. It will not get to 90%, and you should say so out loud, because some patients genuinely get better and stop early and that is a good outcome rather than a leak.

Two things will slow you down. First, the EMR export: a few systems make scheduled exports awkward and you end up training the front desk to run it manually each morning, which works but needs a named person responsible. Second, A2P 10DLC approval for SMS commonly takes several days and gets rejected for vague use case descriptions, so start it on day one of the build rather than the week you go live.

Budget 2 to 3 weeks from signature to live caseload, with a 2 week supervised pilot on one therapist before switching the whole clinic on. The HIPAA work is real and you should charge for it: BAAs with the clinic and with each vendor that touches patient data, the clinic on a paid Supabase plan rather than free, and patient names stripped before any call to the drafting model. Clinics that ship this through AppBuild.DIY as an actual app see it used properly, because an authorization expiring in 2 days on a lock screen at 7am gets handled, and the same alert in an email opened at 11am does not.