Revenue Cycle Solutions for Physical & Occupational Therapy Providers

Tech-enabled patient access and revenue cycle management solutions tailored to physical and occupational providers to increase staff efficiency and patient satisfaction, reduce denials, and improve profitability.

FULL-SERVICE PATIENT ACCESS RCM SOLUTIONS

Customized RCM solutions for physical & occupational therapy practices

Physical and occupational therapy groups (PT/OT) understand the challenges of the payment lifecycle. From automating patient access tasks like prior authorizations and eligibility checks to streamlining EHR and billing workflows or bridging staffing gaps with skilled billing professionals, our customized solutions tackle these common pain points:

  • Prior Authorization
  • Insurance Discovery
  • Eligibility Verification and Benefits Checks
  • Referral Management and Document Capture
  • Medical Coding
  • A/R Recovery and Denials Management
  • Denials Prevention

Powered By Artificial & Human Intelligence

Despite progress AI and automation are making in automating patient access and revenue cycle processes, there remains a need for staff with RCM, clinical and compliance expertise to ensure patients are financially cleared and services rendered are accurately billed and reimbursed.

We provide our clients with complete technology plus team coverage with deep knowledge of the complicated reimbursement landscape.

INSURANCE DISCOVERY

Maximize reimbursements by uncovering hidden insurance coverage

Insurance discovery is vital for PT/OT practices, where ensuring comprehensive coverage can directly impact revenue and patient satisfaction. Our solutions identify secondary or unknown payers, providing a complete picture of available insurance options.

Identifying Secondary or Unknown Payers

PT/OT services often involve complex payer dynamics, especially for pediatric or long-term rehabilitation patients. Our AI-powered tools uncover secondary or hidden insurance, ensuring no coverage goes unbilled. This is particularly important when primary insurance denies coverage, as practices can proactively verify secondary benefits or explore alternative funding options like charity programs.

Reducing Patient Payment Burdens

By verifying all available coverage, including secondary insurance, practices minimize patient out-of-pocket costs. This reduces financial strain, improves patient satisfaction, and accelerates payment timelines.

AI-Powered Insurance Discovery

Our automated platform scans patient records and payer databases to uncover all coverage options. This ensures PT/OT practices can capture every billing opportunity while reducing revenue leakage and maximizing reimbursements.

ELIGIBILITY VERIFICATION AND BENEFITS CHECKS

Prevent denials with real-time eligibility verification

Quick and accurate eligibility verification and benefits checks are critical for PT/OT practices, where frequent visits, therapy-specific requirements, and high re-verification volumes demand precise coverage confirmation to avoid delays and denials.

Key Coverage Areas to Verify

Infinx automates verification for recurring visits, therapy caps, co-pays, and out-of-pocket limits. During peak re-verification periods at the start of the year, our scalable platform ensures accurate, timely checks to avoid bottlenecks. For pediatric or long-term care cases, the solution also identifies coverage for developmental therapies and progress evaluations, supporting uninterrupted care.

Addressing Therapy-Specific Requirements

Therapy caps and session limits are flagged in real-time, helping practices comply with payer rules and avoid denials. Infinx also verifies prior authorization needs upfront, aligning with payer policies to streamline approvals.

Reducing Rejections and Patient Burden

By confirming active coverage, deductibles, and limits upfront, Infinx minimizes denials and reduces out-of-pocket surprises for patients, improving satisfaction and collection rates.

Real-Time Verification with Infinx

Our AI-powered platform retrieves accurate, payer-specific data in real time, seamlessly integrating with your systems. Even during high-volume periods, it ensures efficient verification, reducing manual effort and keeping patient access smooth.

Intelligent payer mapping enhances this process by ensuring real-time accuracy in coverage details, minimizing re-verification delays, and preventing denials caused by outdated or incorrect information.

PRIOR AUTHORIZATION

Automate PT & OT Prior Authorizations

Managing patient access processes for Physical Therapy (PT) and Occupational Therapy (OT) practices can be overwhelming. Whether you're tackling complex payer policies, high re-verification volumes, or denials from incomplete clinical documentation, our solutions are designed to simplify workflows and increase efficiency.

Automated Prior Authorizations

Infinx automates the entire prior authorization process, from submissions to real-time status checks. By integrating directly with payer portals and EMR systems, our platform eliminates manual tasks, ensuring timely approvals while meeting payer requirements for evaluations, progress notes, and patient histories.

Intelligent payer mapping aligns authorization requests with payer-specific requirements, automating workflows to minimize denials and ensure faster approvals

Denials Reduction

Our technology proactively flags issues like missing documentation, unmet conservative treatment, and medical necessity requirements to reduce denials.

Medicaid and Workers' Comp Expertise

Ensure compliance and efficiency for Medicaid and Workers' Comp claims with tailored workflows, onshore processing, and expert management of payer timelines.

Priority Payer Management

Avoid revenue loss with same-day submissions for priority payers. Our onboarding process ensures these claims are prioritized to prevent denials and write-offs.

REFERRAL MANAGEMENT AND DOCUMENT CAPTURE

Streamline referrals and document capture for seamless PT/OT workflows

Efficient referral management and document capture are essential for PT/OT practices to maintain smooth workflows, ensure timely authorizations, and secure reimbursements.

Ensuring timely referral capture

PT/OT services often require referrals for therapy evaluations, progress reviews, and ongoing treatment. Our system ensures all required documentation is captured and organized correctly, preventing delays in starting patient care or submitting claims.

Improving care coordination

Streamlined referral management enhances collaboration between referring providers, therapists, and payers. This reduces administrative burdens, improves patient satisfaction, and ensures therapy sessions align with authorized treatment plans.

Automated document capture

Our referral management solution automates the capture and storage of all required documentation, including progress notes, therapy plans, and evaluation reports. This ensures compliance with payer requirements and reduces delays in authorization and reimbursement processes.

MEDICAL CODING

Ensure coding accuracy for therapy-specific services

Accurate medical coding is critical for PT/OT practices to secure proper reimbursement for therapy sessions, evaluations, and specialized treatments while avoiding delays or denials.

Specialized PT/OT coding

Certified coders with expertise in therapy-specific coding ensure the correct application of CPT and ICD codes for evaluations, therapy sessions, and treatment plans. This reduces the risk of claim rejections and ensures compliance with payer requirements.

Therapy-specific services, such as pediatric developmental therapy or post-surgical rehabilitation, demand precise coding to capture the full scope of care provided.

Reducing coding errors

Errors in coding therapy services can lead to underpayments or claim denials, particularly for treatments requiring detailed documentation or involving multiple disciplines. Our expert coders ensure accurate submission, optimizing reimbursement and reducing administrative rework.

A/R RECOVERY AND DENIALS MANAGEMENT

Improve cash flow with advanced A/R recovery tools

Effective accounts receivable (A/R) management is vital for PT/OT practices, where frequent and recurring claims require consistent follow-up and denial resolution to maintain cash flow.

Prioritize A/R by propensity to pay

Our AI-powered A/R tools work alongside our expert team to accurately predict propensity to pay and prioritize overdue accounts based on data including claim value, payer behavior, and aging buckets. By automating follow-ups for high-impact claims, we ensure faster recoveries while reducing the burden on your staff.

Resolving denied claims

Denials related to coding errors, eligibility issues, or documentation gaps are resolved efficiently by using our workforce management system to allocate work to our experienced team. Using our analytics, automation, and AI-driven prioritization tools, they identify root causes and implement timely resolutions, improving cash flow and reducing revenue leakage.

AI-powered recovery insights

Practice leaders can access recovery predictions and real-time analytics on denial trends, payer behavior, and aging A/R from our dashboard to keep a close eye on A/R performance. Leaders can also access workforce productivity metrics and prioritized work orders, ensuring complete transparency.

DENIALS PREVENTION

Proactively prevent denials with technology-enabled services

Preventing denials before they happen is crucial for maintaining smooth revenue cycles and reducing administrative burdens.

Flagging potential issues early

Our AI-driven technology and expert team identify potential issues—such as missing documentation or improper coding—before claims are submitted, preventing denials.

By addressing these issues upfront, practices can avoid rework and delays in reimbursement.

Addressing root causes of denials

Common causes of denials, such as eligibility gaps or coding inaccuracies, are flagged and corrected, ensuring smoother claims processing.

Our system tracks denial trends, helping practices identify areas for improvement and training.

Automation to ensure compliance

Automated workflows ensure that all payer requirements are met before submission, minimizing the risk of denials and expediting claims processing.

EDUCATION

Essential resources for your practice

CASE STUDY

Growing Physical Therapy Group Resolves Eligibility And Prior Authorization Bottlenecks Using Automation

WEBINAR

Managing The Pitfalls of ‘Stat’ Authorizations

ARTICLE

Successfully Automating Patient Access Processes in Physical and Occupational Therapy

You asked, we answered

Infinx automation solutions, such as bots for Medicare and other payers, streamline tasks like eligibility verification and benefit determination with high accuracy (e.g., 98%). This reduces manual effort and helps manage increased volumes effectively.

Infinx ensures same-day submission for priority payers, which prevents revenue loss from missed authorizations.

Yes! Infinx offers onshore prior authorization specialists to process Medicaid cases to ensure compliance requirements. Workers’ Compensation cases involve longer follow-up timelines and manual effort, which our specialists can handle for you.

Infinx customizes processes based on payer rules, such as submitting to Medicare Advantage Plans or handling Blue Cross Blue Shield for specific states. The team ensures compliance with varying regulations and deadlines.

Infinx ensures comprehensive documentation management for pediatric cases, including developmental history, progress reports, and extensive medical records required for authorizations.

Infinx can help identify charity fund programs and assist with documentation for patients not covered by primary or secondary payers. This includes proactively verifying eligibility for financial assistance.

Ready to improve your physical and occupational therapy revenue cycle management?

Schedule a consultation with our experts and embark on the path to financial optimization and operational efficiency.