Presented by Rick Gawenda

Session Description:
An accurate understanding of CPT coding and billing is essential for maximizing reimbursement and avoiding costly errors. This session will highlight the top CPT codes that physical therapy, occupational therapy, and speech-language pathology services in private practice need to understand and utilize appropriately to maximize reimbursement. 

Learning Objectives:

✅ Accurately select the appropriate CPT code(s) based on the intervention(s) provided

✅ Recite when you can bill the caregiver training services CPT codes

✅ Charge appropriately for services provided under outpatient therapy benefits for both Medicare and non-Medicare plans

Presented by Rick Gawenda

Session Description:
In these volatile times of declining insurance reimbursements, complex requirements, and wasted time fighting denied claims, private practices must understand the benefits of a hybrid model—deciding strategically which insurance plans to be in-network with or go out-of-network entirely. Navigating the out-of-network landscape can be complex—but with the right knowledge, it can also be a strategic move to increase flexibility and revenue.

This session will help therapy providers understand the key considerations and compliance factors involved in going out-of-network. Participants will learn the critical distinctions between accepting assignment, not accepting assignment, and providing a superbill. The webinar will clarify the correct procedures for billing patients when the provider is not enrolled with the patient’s insurance carrier, including documentation requirements and ethical billing practices—even in the absence of a contractual relationship.

This session also explores balance billing, the financial, clinical, and administrative factors to weigh when deciding whether to stay in-network or operate as an out-of-network provider, and the role of the good faith estimate when charging patients cash for outpatient therapy services.

Learning Objectives:

✅ Differentiate between accepting assignment, not accepting assignment, and providing a superbill

✅ Understand the correct billing process for patients when not enrolled with their insurance

✅ Identify documentation requirements for out-of-network providers

✅ Evaluate key factors in deciding to remain in-network or transition to out-of-network

✅ Explain how and when balance billing is appropriate and compliant

✅ Identify when a good faith estimate is required

✅ List the required elements of a good faith estimate

Presented by Rick Gawenda

Session Description:
Are you getting paid what you’re worth? Many rehab providers accept insurance contract terms without question—often leaving money on the table. This session will empower you with the knowledge and confidence to negotiate or renegotiate insurance contracts effectively, ensuring your reimbursement rates reflect the value of the services you provide.

Participants will learn what to look for in payer contracts, how to prepare for a successful negotiation, and how to leverage your data and outcomes. This session also covers how to request a fee schedule, strategies for approaching payers, and when it may be time to walk away from a contract that no longer serves your practice.

Learning Objectives:

✅ Understand key terms and clauses commonly found in insurance contracts

✅ Request and evaluate payer fee schedules effectively

✅ Prepare data and documentation to support reimbursement rate increases

✅ Implement strategies for negotiating and renegotiating contract terms

✅ Recognize red flags and determine when to terminate or opt out of an insurance contract

Session Description:
Physical therapists, physical therapist assistants, occupational therapists, and occupational therapy assistants are eligible to provide and receive reimbursement for Remote Therapeutic Monitoring (RTM) services through the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage plans, and, in some cases, commercial/private insurance carriers.

This session will provide a deep dive into the six current RTM CPT codes as well as the four new RTM CPT codes set to take effect in 2026. Attendees will gain a clear understanding of what constitutes a medical device, when and how to bill for each code, and the documentation required to support billing. Real-world case scenarios will help illustrate proper code utilization and compliance.

Learning Objectives:

✅ Recite the descriptions of all RTM CPT codes (current and new for 2026)

✅ Understand how therapy thresholds and the Multiple Procedure Payment Reduction (MPPR) policy apply to RTM codes

✅ Identify which RTM codes are subject to the de minimis standard when provided in whole or in part by a PTA or OTA

✅ Distinguish between billing periods for codes defined as “each 30 days” vs. “in a calendar month” (e.g., CPT codes 98976, 98977, 98978, 98980, 98981)

✅ Discuss compliant formats for interactive communication required under CPT codes 98980 and 98981

✅ Accurately calculate when and how many units of CPT codes 98980 and 98981 may be billed

✅ List the types of devices required to bill for CPT codes 98975–98978

✅ Know what documentation is necessary to support each RTM CPT code

✅ Evaluate three models of RTM implementation and determine which is best suited for your practice or organization

Session Description:
Therapy practice owners are increasingly seeking ways to incorporate cash-based services into their practices to improve revenue and sustainability. This panel discussion will explore the growing trend of adding concierge services and additional fees in a hybrid model. It will examine the services and fee structures commonly discussed on social media and contrast them with those that are being ethically and compliantly implemented in real-world practices.

Panelists will share real-life examples, offer insight into compliance considerations, and provide guidance on what to avoid to stay within legal and ethical boundaries while offering high-value, optional services.

Learning Objectives:

✅ Identify common cash-based and concierge service models being explored in hybrid practices

✅ Understand legal and ethical considerations when implementing additional fees

✅ Learn how to distinguish between compliant and non-compliant practices

✅ Gain insights from successful implementation examples

✅ Evaluate which optional service models may be a good fit for your practice