Provider Credentialing and Network Optimization: 17 Strategic Ways to Build High-Performance Healthcare Networks

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Provider credentialing and network optimization are foundational processes that determine how efficiently healthcare organizations operate. Although often working behind the scenes, these functions directly influence patient access, payer participation, regulatory compliance, and revenue stability. In today’s U.S. healthcare environment, where networks are expanding and regulations are tightening, provider credentialing and network optimization are no longer administrative tasks—they are strategic imperatives. This guide explains how healthcare organizations can strengthen provider credentialing and network optimization while reducing operational strain. It also highlights how medical billers and coders  help organizations streamline these processes and maintain compliant, high-performing provider networks. What Is Provider Credentialing and Network Optimization? Provider credentialing is the process of verifying a healthcare provider’s qualifications, education, licensure, and pro...
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Getting Paid for Telehealth Physical Therapy

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Basics of Telehealth Physical Therapy

Medicare covers three types of telehealth physical therapy services i.e., telehealth services, e-visits, and virtual check-ins. But physical therapist still needs to follow a few basic practices for getting paid for telehealth physical therapy, let’s discuss them. During the c, the federal government has broadened access to telehealth services including physical therapy. With revised billing guidelines, all beneficiaries can now connect with their healthcare providers online, and providers will get the same reimbursement for these services as they would for in-person sessions.

Verification of Identity

Given that in the telehealth clinical setting, the beneficiary and therapist are not in the same location and may not have established a prior in-person relationship, it is critical, at least initially, that the identities of the physical therapy providers and beneficiaries be verified. Photo identification is recommended for both the beneficiary and all parties who may be involved in the delivery of care to the beneficiary. The photo identification, at minimum, should include the name of the individual; however, personal information such as address or driver’s license number. 

Informed Consent 

Just as PTs must follow state law requirements and professional best practices for acquiring informed consent for in-person encounters, the same requirements should be followed for the delivery of physical therapy services via telehealth technologies. Given the unique nature of the provision of services through telehealth, there are some special considerations including: 

  • Consent to be photographed, recorded, or videotaped and consent to the storage of the encounter data, if applicable. Disclosure should be made as to how long data will be stored. 
  • Consent procedures should include a hold harmless clause for medical or other information lost because of technology failures. Beneficiaries should be informed of the possibility of failure of the technologies used to provide telehealth services.

Standards of Care 

It is the responsibility of the PT to ensure the standard of care required both professionally and legally per the Practice Act is met. As such, it is incumbent upon the PT to determine which beneficiaries and therapeutic interventions are appropriate for the utilization of technology as a component of, or instead of, in-person provision of physical therapy care.

Physical therapy providers shall be guided by professional discipline, the best available evidence, and any existing clinical practice guidelines when practicing via telehealth. Physical therapy interventions and/or referrals/consultations made using technology will be held to the same standards of care as those in traditional (in-person) settings.

To learn more about Getting Paid for Telehealth Physical Therapy, click here: https://bit.ly/3S0BZdJ, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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