Patient Access
Primary metric affected by referral dalays
DTA
Patient payment before coverage starts
Deductible
Modifier added to show medical necessity after a patient has reached their threshold amount
KX Modifier
What does DTA have to be within?
5 days
Maximum amount a patient is responsible for each year.
Form used when the patient receives a letter stating their PT benefits will no longer be covered.
ABN form
What does CX rate have to be below to be passing?
15%
A referral is received but not contacted same day. Explain at least 3 downstream risks.
Increased DTA. Patient's health continues declining. Patient dissatisfaction. Reduced conversions. Lost Referrals.
Approval required before treatment
Authorization
What is the 2026 Deductible for MCR patients?
$283
Capture Rate Goal
70% or above
A patient has exhausted their PT benefits. What are three things you should offer the patient?
Charity Care, ANNC or ABN form, Self-Pay with a GFE form for costs.
Proof that services are justified
Medical Necessity
What is the 2026 threshold amount for MCR patients?
$2480
Hours to response includes what 3 categories added together in Leading Reach?
New, Received, and Pretext Sent
A patient switches insurance mid–plan of care. Walk through the required operational steps in Soarian to update the insurance.
What do you have to do before sending a Patient Dismissal Letter due to attendance non-compliance?
Partner with the treating therapist first because it is their decision.
What is the new Smarthealth Plan called?
Health Alliance
DAILY DOUBLE
When is an active MCR not considered primary for a patient?
When a patient has an ACTIVE GHP from an employer with 20 patients or more with MCR based on age. OR When a patient has an ACTIVE GHP from an employer with 100 patients or more when MCR based on disability.
What is the Utilization Goal for therapists to be considered passing?
85% or higher