Physical, Occupational and Speech Therapists Business Guide
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We documented 21 challenges in Physical, Occupational and Speech Therapists. Now get the actionable solutions — vendor recommendations, process fixes, and cost-saving strategies that actually work.
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- All 21 documented pains
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All 21 Documented Cases
Risk of recoupments and penalties from billing outside payer therapy coding policies
$10,000–$100,000 per audit cycle in recouped payments and non-payments for out-of-policy codes for a multi-location practice.Payers issue detailed bulletins specifying which PT, OT, and ST codes are payable, telehealth-eligible, or capped, and services billed outside these rules are subject to denials, audits, and potential recoupment of previously paid claims. Provider alerts explicitly instruct therapists to follow code lists and benefit limits and to request extensions when necessary, indicating an enforceable compliance expectation.
Unpaid therapy visits when pre-authorization is missed or mishandled
Commonly 10–20 denied visits per month in a small practice; at ~$100–$150 per visit this is ~$1,000–$3,000/month ($12,000–$36,000/year) in preventable lost revenue.Physical, occupational, and speech therapy often require pre-authorization; if it is not secured or renewed correctly, insurers are under no obligation to pay and the practice or patient is left with the full bill. This leads to services already rendered that are either written off or never collected.
Claim denials and rework due to pre-authorization errors
If 5–10% of therapy claims are denied for authorization/medical-necessity issues and half require 15–30 minutes of staff rework, a clinic submitting $100,000/month could see several thousand dollars delayed and 20–40 staff hours/month in rework cost.Incorrect CPT/diagnosis codes, incomplete documentation, or failure to prove medical necessity at the pre-auth stage leads to denials that must be appealed with corrected information. This creates rework in billing, delayed revenue, and sometimes permanent nonpayment if appeals fail.
Delays in starting therapy and prolonged time-to-cash from slow payer approvals
For a clinic with $80,000–$120,000 in monthly insurance revenue, adding even 10–15 AR days due to pre-auth delays can lock $25,000–$50,000 in working capital at any time, raising borrowing needs and interest costs.Therapy pre-authorization decisions frequently take several business days to weeks, and clinics often delay treatment or billing until authorization is confirmed, stretching the time between service and cash. Follow-up work on pending requests further drags the revenue cycle.