Free OpenClaw Skill for Physical Therapy Clinics: Auth and HEP Compliance Agent (Download)

What this skill does for your physical therapy clinics

• Tracks authorized visit units per patient per payer and flags patients approaching their authorization cap with the recert paperwork drafted for the PT to sign.
• Monitors KX modifier readiness for Medicare patients approaching the therapy threshold and drafts the medical necessity justification.
• Runs the home exercise program (HEP) compliance cadence with check-in texts at 24, 72 hours and weekly thereafter, using MedBridge HEP, HEP2go, or HEP from WebPT.
• Schedules FOTO (or qualified clinical data registry) outcomes survey prompts at intake, 30-day, and discharge with a one-tap link to complete.
• Compiles the weekly plan of care recertification roster (POC due in 7 days) with the PT-signed paperwork drafted and routed for signature.

What's inside this OpenClaw skill

The full file you download, indexed below for search engines and for operators who want to read before they install.

---
name: pt-auth-and-hep-compliance
description: Authorization unit tracking, KX modifier readiness, HEP compliance, FOTO outcomes, and plan of care recertification for outpatient physical therapy clinics. Integrates with WebPT, Raintree, PromptEMR, MedBridge HEP, HEP2go.
version: 1.0.0
author: OpenClaw Consult (Adhiraj Hangal)
license: MIT
url: https://openclawconsult.com/skills/physical-therapy-clinics
---

# OpenClaw Skill: PT Authorization and HEP Compliance Coordinator

## Overview

This skill turns the OpenClaw agent into an authorization, HEP compliance, and
outcomes reporting coordinator for an outpatient physical therapy clinic. It
owns the daily authorization unit count, the recert paperwork drafting, the KX
modifier readiness check, the home exercise program compliance cadence, and the
FOTO outcomes survey prompts.

It is designed for 1 to 15 PT outpatient clinics running WebPT, Raintree
(Systems4PT), PromptEMR, Heno, Clinicient (now Net Health), or TheraPlatform.
Single-location and multi-location practices both work. The skill handles the
authorization-burn-and-recert cycle that defines outpatient PT economics, while
also keeping HEP adherence visible (the single highest-leverage out-of-clinic
factor in patient outcomes).

## What this skill does

1. Daily authorization unit tracking per patient per payer with cap-proximity alerts
2. Plan of care (POC) recertification roster with PT-signed paperwork drafted in advance
3. KX modifier readiness for Medicare patients crossing the therapy threshold
4. HEP compliance cadence with 24h, 72h, and weekly check-ins via MedBridge, HEP2go, or WebPT HEP
5. FOTO (or qualified clinical data registry) outcomes survey prompts at intake, 30-day, and discharge
6. No-show recovery for outpatient appointments with same-day rebook offers

## Triggers

```yaml
triggers:
  - type: heartbeat
    schedule: "0 7 * * 1-5"          # Weekdays 7am
    action: compile_auth_audit_roster

  - type: heartbeat
    schedule: "0 7 * * 1"            # Mondays 7am
    action: compile_poc_recert_roster

  - type: heartbeat
    schedule: "0 9 * * 1-5"          # Weekdays 9am
    action: run_hep_compliance_checkin

  - type: heartbeat
    schedule: "0 7 * * 5"            # Fridays 7am
    action: foto_discharge_prompt_roster

  - type: on_event
    event: emr.evaluation_completed
    action: trigger_foto_intake_survey

  - type: on_event
    event: emr.visit_completed
    action: increment_authorized_unit_count

  - type: on_event
    event: emr.no_show_logged
    action: enter_no_show_recovery_queue
```

## Workflow: authorization audit

Every weekday at 7am the agent:

1. Pulls the active caseload from the EMR
2. For each patient, captures the active payer, authorized visit units, units consumed to date, and POC expiration date
3. Flags patients within 3 visits of their authorization cap as cap-proximity
4. Drafts the recert clinical justification for each flagged patient with: current functional outcome score, change from initial evaluation, remaining impairments, projected number of additional visits to reach goals
5. Routes the drafted recert to the treating PT for signature
6. For patients with no remaining authorized units, holds the next scheduled visit and routes to the front desk

The skill knows payer-specific recert quirks: Aetna requires MNT clinical justification language, UHC has a specific recert form (Naviguard or Optum), Anthem BCBS uses AIM Specialty Health for high-volume episodes, Medicare uses the standard CMS-700 / POC.

## Workflow: plan of care recertification

Every Monday at 7am the agent:

1. Identifies all POCs expiring in the next 7 days
2. For each POC, drafts a recert based on the patient's current outcomes score, the original POC goals, and the remaining impairments
3. Includes the specific physical therapist's documented language style (warm-clinical, concise-clinical, etc.)
4. Routes to the PT for review, edit, and signature
5. Once signed, files in the EMR via the standard write-back or hands to the front desk for manual filing

The Medicare POC recert is required every 90 days for ongoing therapy. The commercial recerts vary by payer but typically every 60 to 90 days. The skill knows the rules and flags patients at the right moment.

## Workflow: KX modifier readiness

Medicare's therapy threshold for 2026 is $2,330 per beneficiary per calendar year. Once crossed, billed visits require the KX modifier with medical necessity justification.

The skill:

1. Tracks each Medicare patient's calendar-year spend on therapy services
2. Flags patients within $250 of the threshold for upcoming KX requirement
3. Drafts the medical necessity justification using the patient's documented impairment, current outcomes, projected episode length, and the standard clinical reasoning template
4. Surfaces the patient to the treating PT one visit before the threshold cross
5. Once crossed, applies the KX flag visible on the patient's daily encounter so the billing team knows to apply the modifier

The skill does not bill claims. It surfaces the right patient with the right paperwork at the right moment.

## Workflow: HEP compliance cadence

When a patient is assigned an HEP, the agent enters them into a compliance cadence:

- Day 1 (24h post-visit): "Did you do the exercises today" check-in with a one-tap response
- Day 3 (72h): "How is the HEP going" with the option to flag any pain or difficulty
- Weekly thereafter: ongoing adherence check with the HEP platform link
- If 3 consecutive missed responses: escalate to the PT for a phone call
- If patient reports pain escalation: same-day flag to the PT

The skill works with MedBridge HEP, HEP2go, and WebPT's built-in HEP. The HEP platform handles exercise delivery. The skill handles the adherence conversation.

## Workflow: FOTO outcomes survey

The skill keys off the EMR's evaluation event to trigger the FOTO intake survey, then schedules the 30-day and discharge surveys:

1. Intake: triggered on initial evaluation completion. Sends the FOTO link via text within 24 hours of evaluation.
2. 30-day status: triggered automatically at visit 8 or week 4, whichever comes first.
3. Discharge: triggered on POC closure or on patient self-discharge.

The skill prompts the patient with a one-tap link to the FOTO PROM (Patient-Reported Outcome Measure) and re-prompts at 24 and 48 hours if not completed. For practices that use OPTIMAL, NDI, ODI, LEFS, or other outcomes tools instead of FOTO, the skill can be reconfigured to point at the alternate URL pattern.

FOTO and other outcomes data drive the practice's MIPS reporting, the payer contracts (some payers tie rates to outcomes), and the internal PT performance reviews. Keeping completion rate above 70% is the typical target. The skill regularly closes the gap from 40% baseline to 75-85% completion.

## Memory keys

```yaml
memory:
  - key: pt.auth_status[{patient_id}][{payer}]
    description: Active authorization state
    schema: { authorized_units: int, consumed_units: int, poc_expires: date, payer_specific_form: string, recert_drafted: bool, recert_signed: bool }

  - key: pt.medicare_threshold[{patient_id}]
    description: Calendar year Medicare therapy spend
    schema: { ytd_spend: number, kx_required: bool, mnt_justification_drafted: bool }

  - key: pt.hep_compliance[{patient_id}]
    description: Active HEP adherence state
    schema: { hep_platform: string, last_checkin_date: date, completion_rate_7d: number, completion_rate_30d: number, escalated: bool }

  - key: pt.foto_status[{patient_id}]
    description: FOTO outcomes survey state
    schema: { intake_sent: datetime, intake_completed: datetime, 30d_sent: datetime, 30d_completed: datetime, discharge_sent: datetime, discharge_completed: datetime }
```

## Message templates

```yaml
templates:
  hep_24h_checkin:
    body: |
      Hi {patient_first_name},

      {pt_first_name} here. How did the exercises go today? Reply with:
      1 - did them all, felt good
      2 - did them, some discomfort
      3 - did some, ran out of time
      4 - missed today

      No judgment, just want to know so we can adjust as needed.

  hep_pain_escalation:
    body: |
      Hi {patient_first_name},

      Thanks for letting me know about the discomfort during the HEP. A few
      quick questions:
      1. Where exactly was the pain (specific joint or muscle)
      2. Pain level 0-10
      3. Which exercise was it on

      Reply when you can. If pain is over 6/10 or radiating, hold the HEP until
      I follow up.

      {pt_first_name}

  poc_recert_clinical_justification:
    channel: drafted_for_pt_signature
    body: |
      Re: Recertification of Plan of Care for {patient_full_name}

      Patient is a {patient_age}-year-old with {primary_dx_icd10} who has
      completed {visits_completed} of an authorized {visits_authorized}.

      Initial evaluation findings: {initial_eval_summary}
      Current findings: {current_status_summary}
      FOTO/outcomes score change: from {initial_score} to {current_score}
      Remaining impairments: {remaining_impairments}
      Projected visits to reach functional goals: {projected_remaining_visits}

      Medical necessity for continued skilled therapy: {medical_necessity_text}

      Recommend recertification for an additional {recert_visits} visits over
      {recert_duration_weeks} weeks.

      {pt_full_name}, {pt_credentials}
      {pt_npi}

  authorization_cap_proximity:
    channel: pt_internal_alert
    body: |
      AUTH CAP ALERT
      Patient: {patient_full_name}
      Payer: {payer_name}
      Visits used: {visits_used} / {visits_authorized}
      Visits remaining: {visits_remaining}
      POC expires: {poc_expiration_date}
      Recert paperwork: {recert_drafted_status}
      Suggested action: review and sign recert by {sign_by_date}

  foto_discharge_survey:
    body: |
      Hi {patient_first_name},

      Today is your discharge from {practice_name}. One last quick survey to
      capture how you are doing now compared to when we started. It takes about
      2 minutes:

      {foto_discharge_link}

      Thanks for the work you put in. Keep up the HEP and reach out if anything
      flares.

      {pt_first_name}
```

## Required integrations

| Integration             | Purpose                                              | Read | Write |
|-------------------------|------------------------------------------------------|------|-------|
| WebPT                   | EMR, scheduling, authorization, visit log            | yes  | optional |
| Raintree (Systems4PT)   | EMR, scheduling, authorization                       | yes  | optional |
| PromptEMR               | EMR, scheduling, authorization                       | yes  | optional |
| Heno                    | EMR, scheduling                                      | yes  | optional |
| MedBridge HEP           | HEP delivery and completion data                     | yes  | yes   |
| HEP2go                  | HEP delivery                                         | yes  | yes   |
| FOTO                    | Outcomes reporting                                   | yes  | yes   |
| Payer eligibility feeds | Active authorization confirmation                    | yes  | no    |
| Twilio (or similar)     | Outbound SMS                                         | no   | yes   |
| Email provider          | Outbound email                                       | no   | yes   |
| OpenClaw Memory         | Cross-run state                                      | yes  | yes   |
| OpenClaw Heartbeat      | Scheduled cadence triggers                           | yes  | yes   |

Write-back to the EMR is optional. Most clinics start read-only and have the
front desk commit any EMR changes manually. After two weeks, flip write access
on for recert filing and visit-note appends.

## HIPAA notes

By default this skill operates on patient identifiers, appointment metadata,
authorization counts, and HEP compliance status. We deliberately avoid putting
diagnosis codes, specific impairment detail, or therapy notes into outbound SMS.
For stricter PHI handling, set `phi_mode: identifier_only` and the agent
tokenizes patient identifiers.

Confirm your BAA covers the cloud AI provider you point OpenClaw at. The skill
itself is local; the model inference is not. MedBridge, HEP2go, and FOTO have
their own BAA terms which the practice should review.

## Configuration

```yaml
config:
  practice_name: "Your Practice Name"
  pts:
    - last_name: "Morales"
      first_name: "Daniela"
      voice: warm-clinical
    - last_name: "Patel"
      first_name: "Ravi"
      voice: concise-clinical
  approval_mode: front_desk_approves_all  # or "autonomous_after_2_weeks"
  phi_mode: standard                      # or "identifier_only"
  payer_recert_forms:
    Aetna: MNT_clinical_justification
    UHC: Naviguard_recert_form
    Anthem_BCBS: AIM_specialty_health
    Medicare: CMS_700_POC
  medicare_2026_threshold: 2330
  hep_platform: MedBridge_HEP             # or "HEP2go", "WebPT_HEP"
  outcomes_tool: FOTO                     # or "OPTIMAL", "NDI", "ODI", "LEFS"
  cadences:
    hep_compliance: [24h, 72h, weekly]
    poc_recert_lead_days: 7
    auth_cap_proximity_visits: 3
    foto: [intake_24h, visit_8_or_4w, discharge_24h]
```

## Quick install

```bash
mkdir -p ~/.claude/skills
mv physical-therapy-clinics.md ~/.claude/skills/pt-auth-and-hep-compliance.md
# Edit the config block to match your clinic
```

Launch OpenClaw and the skill is live. Run `compile auth audit roster` or
`run hep compliance checkin` on demand, or wait for Heartbeat to fire it.

## Want it wired to your stack?

This SKILL.md is the starting point. If you want it plugged into your specific
EMR, your specific payer mix, your specific HEP platform, and your specific
outcomes reporting, on a fixed-price two-week clock, with the founder writing
every line of the build, the door is at
https://www.adhirajhangal.com/work

Install in 60 seconds

1. 1

   Drop the file into your OpenClaw skills directory

   Save the downloaded physical-therapy-clinics.md as ~/.claude/skills/pt-auth-and-hep-compliance.md. OpenClaw picks up new skill files on next agent launch.

2. 2

   Wire in your EMR and HEP platform

   Edit the integrations block to point at your WebPT, Raintree, PromptEMR, or Heno export. Connect your MedBridge HEP, HEP2go, or built-in WebPT HEP. Read access to authorization data and the daily appointment schedule is enough to start.

3. 3

   Start in front-desk approval mode, validate, then move to autonomous

   Run for two weeks with the front desk approving every outbound message. The skill defaults route any authorization denial, any pain escalation reported by the patient, and any insurance benefit change to a human. After two weeks, flip HEP check-ins and FOTO survey prompts to autonomous.

Example conversation

Common questions

Related free skills