Claims Management Services for Therapy Practices
Clean claims. Faster payments. Fewer denials.
Claims management is where revenue is won or lost. Even small errors in documentation, coding, or timing can delay payments for months or result in avoidable denials. Our claims management services are built specifically for therapy practices, ensuring every claim is accurate, compliant, and aggressively followed through to resolution.
Claims Management Matters for Therapy Billing
Therapy billing comes with unique challenges, including unit-based services, ongoing authorizations, multiple disciplines per child, and payer-specific rules that change often. Without a proactive claims strategy, practices experience delayed payments, rising accounts receivable, and unnecessary write-offs.
Our team manages the entire claims lifecycle, from submission to final payment, with a focus on accuracy, speed, and accountability.
Who We Support
Keeping Therapy Insurance Claims Moving and Revenue Flowing
Managing Claims Without Delays or Guesswork
We manage the full lifecycle of therapy claims, from pre-submission review through final payment. Each claim is actively monitored, corrected when needed, and followed up with payers to reduce denials and accelerate reimbursement.
We Stay Ahead of Payer Rules So Claims Don’t Stall
Claims Management Built for Therapy Billing Accuracy
Claims requirements change constantly, especially for therapy services. Small updates to payer rules, modifiers, or documentation standards can lead to denials if they’re missed. Our claims process is designed to stay aligned with current payer expectations so claims move smoothly from submission to payment.
Claims Management Services FAQ's
Underpaid claims are reviewed, corrected, and disputed with the payer to recover the remaining reimbursement owed.
After the primary insurance pays, the claim must be sent to the secondary payer with the primary EOB attached. Many “crossover” claims happen automatically, but we manually audit these to ensure the patient is only billed for the true remaining deductible or co-insurance.
An ERA is the digital version of an EOB (Explanation of Benefits). It allows for Automated Payment Posting, which reduces manual data entry errors and ensures your accounts receivable (AR) reflects the exact balance owed by the insurance vs. the patient.
We track “unit utilization” and expiration dates in real-time. By alerting your clinical team 30 days before an authorization expires, we ensure a new “Request for Continued Care” is submitted, preventing “gap days” where therapy cannot be billed.
Yes, but it often requires “CCI Edit” modifiers (like modifier -59) to prove the services were distinct and not “unbundled” components of the same treatment. We monitor these edits to ensure you are paid for the full scope of care provided.
A rejection happens at the clearinghouse level due to data errors (like an invalid NPI or ID number) and never reaches the payer. A denial occurs after the insurance company processes the claim but refuses payment due to policy or clinical reasons. Both must be resolved within 48 hours to protect cash flow.
If services exceed authorized units or expire, claims are often denied, making authorization tracking critical to successful billing.
Timed codes (like 90834 or 97110) are billed in 15-minute increments based on the duration of the session. Untimed codes (like 90791 or 92523) are flat-rate codes for evaluations or assessments and are billed once per session, regardless of how long the appointment lasts.
Payment posting is applying insurance and patient payments to the correct accounts, dates of service, and procedures after claims are processed.
The 8-Minute Rule is a Medicare standard used to determine how many units of “time-based” CPT codes can be billed. To bill one unit, you must provide at least 8 minutes of therapy. While common in PT, OT, and Speech, many private payers also adopt this logic for other behavioral therapies.
A/R (accounts receivable) follow-up involves tracking unpaid claims and contacting payers to resolve delays, denials, or underpayments.
Denial management is the process of identifying why claims are denied, correcting errors, appealing when necessary, and preventing repeat issues.
The top reasons include: 1) Expired Authorizations, where therapy was provided without a valid approval on file; 2) Missing Modifiers, such as failing to indicate the specific discipline (GN, GO, GP); and 3) Coordination of Benefits (COB) errors where the primary insurance was not billed first.
Most electronic claims for commercial insurance are reimbursed within 14 to 21 days. Medicaid and state-funded programs typically pay within 7 to 14 days, while out-of-network claims or those requiring manual review can take 30 to 45 days.
A “Clean Claim” is one that is processed and paid upon the first submission without errors. Industry leaders maintain a rate of 98% or higher. Achieving this requires rigorous “scrubbing” of session notes against CPT code requirements and payer-specific modifiers before the claim is sent.
A clean claim is a claim submitted correctly the first time, with accurate coding, documentation, authorizations, and payer-required details.