End-of-Year Housekeeping for Rehab Therapy Clinics

What Must Be Done Before January 1 and What Can’t Wait Until February

The calendar turning over is not symbolic in healthcare. It is mechanical.

January 1 flips switches inside payer systems, resets deductibles, expires authorizations, and activates new rules that do not care whether your clinic is ready. The first two weeks of January often determine whether Q1 starts clean or starts buried under rework, write-offs, and uncomfortable patient conversations.

This is your three-phase end-of-year housekeeping checklist. Think of it as revenue protection, not admin work.

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Phase 1: The “Immediate” List

Complete by December 31, 2025

These items directly impact cash flow in the first week of January. Waiting costs money.

1. Prepare for the Deductible Reset

January 1 is the Great Reset.

Patients who had $0 copays in December may walk in on January 2 owing $150 or more per visit until their deductible is met. If this surprises your front desk or your patients, collections suffer and trust erodes.

What to do now

• Run a report of all active patients scheduled in the first two weeks of January.
• Re-verify 2026 benefits. Do not rely on 2025 verifications.
• Train your front desk to proactively set expectations.

The conversation

“Ms. Jones, just a reminder that your insurance year resets next week. Your deductible will likely apply again, so expect a balance due at your next visit.”

Revenue safeguard

• Obtain signed credit card on file (CCOF) authorizations before January 1 whenever possible.

Clinics that skip this step spend January chasing balances that were entirely predictable.

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2. Update Your Practice Management System Values

Your EMR does not magically know it’s a new year.

Federal thresholds must be manually updated to avoid missed modifiers, delayed billing, or denials that only surface weeks later.

2026 Medicare Therapy Thresholds

• KX Modifier Threshold
  • $2,480 for PT/SLP (combined)
  • $2,480 for OT (separate)
  • Approximately a 1.7% increase from 2025
• Targeted Medical Review (TMR)
  • Remains at $3,000

Action

• Load 2026 thresholds into your system.
• Confirm alerts trigger when clinicians approach the KX threshold.
• Ensure the KX modifier is either automatically applied or clearly prompted.

This is quiet work that prevents loud problems.

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3. Load the 2026 Medicare Part B Fee Schedule

This one deserves nuance.

The good news

• The 2026 Medicare Conversion Factor increased to roughly $33.40 for non-APM providers.

The catch

• CMS finalized a -2.5% “Efficiency Adjustment” on non-timed codes, including evaluations and re-evaluations.

What this actually means

• The CF increase is effectively neutralized for eval codes (97161–97163).
• Do not budget for a 3% Medicare revenue bump.
• Expect flat or slightly lower reimbursement on evaluations.

Action

• Load the 2026 Medicare fee schedule effective January 1.
• Set expectations internally so forecasts stay realistic.

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Phase 2: The “Go-Live” List

January 1 to January 15, 2026

These changes hit immediately and affect coding, compliance, and reporting.

1. New CPT Codes for 2026

Remote Therapeutic Monitoring continues to evolve, and CMS’s pattern is familiar.

First comes the carrot. Then comes the stick.

New RTM codes

• 98984 and 98985
• Allow billing for 2–15 day monitoring periods

Why this matters
Previously, RTM required a 16-day minimum. If a patient disengaged early, there was no billable event. Now, shorter monitoring episodes can still generate revenue.

Action

• Update superbills and EMR templates.
• Educate billing teams on correct usage and documentation.

Expect increased scrutiny over time. CMS always watches adoption before tightening requirements.

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2. Watch for Authorization Churn

Commercial authorizations often do not roll over with the calendar year, even when visits remain on the plan of care.

High-risk payers

• BCBS (varies by state)
• UnitedHealthcare
• Aetna

Action

• Check expiration dates on all active authorizations.
• If an auth ends December 31, submit a new request immediately, even if visits remain.

January denials are rarely about clinical care. They are almost always about timing.

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3. MIPS 2026 Strategy

If you are required to report under MIPS, precision matters.

Key requirement

• 75% data completeness across applicable measures

Important change

• CMS removed “Screening for Social Drivers of Health” (Q487) from the PT/OT specialty set for 2026.

If that was your go-to measure, you need a replacement now, not in March.

Alternatives

• BMI screening
• Medication reconciliation
• Functional outcome measures

Action

• Update required fields in documentation templates.
• Alert clinicians immediately so missed fields do not sabotage reporting.

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Phase 3: The “Cleanup”

Late January 2026

This is operational hygiene. Clinics that skip it slowly bleed margin.

1. Review and Update Your Chargemaster

If you are out-of-network or operate under percent-of-charge contracts, your chargemaster still matters.

Action

• Review your standard rates.
• Adjust for inflation and updated Medicare allowables.

Rule of thumb

• Billed charges should generally be 2.5x to 3x Medicare allowable.

An outdated chargemaster quietly limits leverage in negotiations and cash collections.

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2. Check Q1 2026 NCCI Edits

CMS updates the National Correct Coding Initiative (NCCI) edits quarterly.

Action

• Review Q1 2026 edits as soon as they’re released.
• Look for new code pairings that now require Modifier 59 or XS.

Codes that billed cleanly in December may not in January.

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Final Thought

None of this is optional, but none of it is heroic either.

The clinics that start January calm and profitable are not working harder. They are closing loops before the calendar forces their hand. End-of-year housekeeping is how you protect cash flow, reduce denials, and avoid turning January into a recovery mission.

If you want help operationalizing any of the above, StrataPT exists for exactly this moment.

January rewards preparation.