Highlighting coding and documentation rules specific to occupational therapy claims  Occupational therapy billing is often treated as a smaller variation on physical therapy billing, and that assumption is where a lot of avoidable denials start. OT has its own coding logic, its own documentation expectations,

A look at where automation actually helps billing teams, and where human review still matters  AI has moved from a buzzword in healthcare billing to a working part of the revenue cycle for a growing number of outpatient PT, OT, and SLP practices. But the

A coalition of more than 200 healthcare organizations, including over 30 health systems, is asking CMS to reconsider its proposed remote patient monitoring policies in the 2027 Medicare Physician Fee Schedule.  In an August 24 letter to CMS Administrator Dr. Mehmet Oz, the coalition warned

Payers are not waiting for your appeal. They are processing your claims in real time, flagging inconsistencies before a human ever touches the file, and issuing denials at a pace that most outpatient PT and OT practices are not built to match.  This is not

A new survey from the Healthcare Financial Management Association and Guidehouse is making rounds in healthcare trade media. The headline: payer denials are getting worse, AI adoption in the revenue cycle is lower than most executives admit, and outsourcing is accelerating.  The survey was built

The settlement resolves allegations that the Humana-owned provider submitted unsupported diagnosis codes that increased federal payments.  The Villages Health System has reached a $541.5 million settlement over claims that it used unsupported diagnosis codes to boost Medicare Advantage payments. The provider group, owned by CenterWell Senior Primary Care (a

Insurers are rapidly automating claims processing with artificial intelligence to boost efficiency – but experts warn this “AI arms race” is driving denial rates sharply higher. Recent data show denials climbing nationwide (16% increase from 2018 to 2024). For example, one analysis found UnitedHealthcare’s post-acute care prior-authorization denial rate

Key Official Weighs Two Alternatives to Fee-for-Service Default Chris Klomp, who serves as director of Medicare and deputy administrator at the Centers for Medicare & Medicaid Services, disclosed to STAT that his team is actively studying the viability of models that would place beneficiaries by

CMS Is Weighing Automatic Medicare Advantage Enrollment. Here Is What PT/OT/SLP Practices Need to Understand. CMS is actively exploring a policy that would flip the Medicare enrollment default, moving new beneficiaries out of traditional fee-for-service Medicare and into Medicare Advantage plans automatically, unless they opt