How Automation Can Protect your Reimbursement
As with most healthcare services, payers limit the amount of coverage available for outpatient physical and occupational therapy and speech-language pathology services. There are circumstances under which patients can quality for additional coverage beyond the established therapy caps, but there are limits, or thresholds, for this coverage as well.
So how do you keep track of each patient’s therapy and ensure it stays under the cap? Many practices use automated systems. However, to achieve a competitive advantage, you will need a system that captures referral and authorization data and dynamically manages the process. For example, your system should link appointments to the related referral and authorization information and alert schedulers and therapists when patients are nearing their limits—whether dollars, days, or visits. This is a critical feature that helps protect your practice and ensures that you get reimbursed for the services you provide.