Evaluation and treatment billing
Evaluation codes, treatment codes, and the units that support them must match payer expectations and documented services — visit after visit.
Therapy Revenue Cycle Management
Specialized Revenue Cycle Support for Every Therapy Visit.
Therapy practices bill in a rhythm — evaluations, treatment visits, plan-of-care cycles, and visit limits — and each payer enforces its own version of that rhythm. When authorization tracking, documentation, and billing workflows drift out of alignment, revenue follows slowly.
The Capri Collective supports speech-language pathology, occupational therapy, physical therapy, and multidisciplinary practices with revenue cycle services built around how therapy is actually delivered and reimbursed.
Speech-language pathology practices · Occupational therapy practices · Physical therapy practices · Multidisciplinary therapy organizations
Key reimbursement challenges
Where Revenue Gets Stuck in Therapy Revenue Cycle Management.
Visit limits and utilization
Many plans cap visits or apply thresholds that require authorization renewals or progress documentation before services continue.
Plan-of-care requirements
Certification, recertification, and physician or payer signature requirements create timing dependencies that can hold up otherwise clean claims.
Medical necessity documentation
Therapy denials frequently cite documentation rather than coding — the clinical record must support the service on the payer's terms.
Authorization and referral tracking
Referrals, prescriptions, and prior authorizations each carry their own expiration and scope, and gaps surface as denials weeks later.
Denials across varied payers
Therapy practices typically bill a wide mix of commercial, Medicare, Medicaid, and workers' compensation payers, each with distinct rules.
Specialized services
What We Do for Therapy Organizations.
Therapy Claims & Billing Operations
- Evaluation and treatment claims preparation
- Therapy CPT code and modifier workflows
- Claims submission and rejection correction
- Payment posting and reconciliation
- Secondary billing coordination
- Claim status follow-up
Authorization & Visit-Limit Coordination
- Initial authorization requests
- Visit-limit and utilization tracking
- Renewal and expiration monitoring
- Plan-of-care timing coordination
- Authorization-related denial investigation
Denials, Underpayments & A/R
- Denial investigation and appeals support
- Aged receivables workdown
- Underpayment identification
- Payer escalation
- Corrective workflow recommendations
Reporting & Practice Workflow Support
- Collections and denial reporting
- A/R aging visibility
- Supported practice-management revenue workflows
- Front-desk and billing staff education
- Intake-to-billing coordination
Comprehensive RCM connects claims, recovery, authorizations, credentialing and enrollment, patient and family collections, and reporting. We’ll define the functions and responsibilities around your practice’s needs.
Denial recovery & appeals
Denied Doesn't Have to Mean Lost.
Therapy denials often cluster around visit limits, plan-of-care timing, and documentation sufficiency. We look for the pattern across the practice, not just the individual claim.
Denials citing documentation or medical necessity
Visit-limit and authorization denials
Plan-of-care and certification timing issues
Underpaid therapy units
Appeals preparation and follow-up
Aged receivables and payer escalation
Root-cause analysis by payer and therapist
Prevention strategies with your clinical and front-desk teams
You do not have to replace your existing billing department to engage Capri for targeted denial recovery. Routine recovery within the comprehensive agreement is covered by the contracted fee. Standalone projects and material expansions are custom-scoped and approved before additional charges apply.
Payer & operational considerations
Reimbursement Starts Long Before the Claim.
Payer Landscape
- Commercial therapy benefit design
- Medicare therapy thresholds
- Medicaid program differences
- Workers' compensation and personal-injury administrative rules
- Payer-specific documentation expectations
Operational Dependencies
- Referral and prescription intake
- Scheduling aligned with visit limits
- Plan-of-care certification calendars
- Documentation turnaround
- Supported practice-management and EHR revenue workflows
Support is shaped by specific payer requirements, state rules, and available expertise. We do not imply universal payer expertise, guaranteed compliance, or clinical decision-making.
Capri Revenue360 connection
Every Step Accounted For.
This specialty sits within Capri Revenue360 — our connected operating philosophy that links eligibility & benefits, credentialing & payer setup, authorization management, claims, payments, denials, and reporting. Individual components and targeted projects are available without purchasing every service.
Your payer mix, claims volume, existing team, and growth plans shape the support we recommend.
Reporting & revenue visibility
Know Where Your Revenue Stands.
Reporting cadence, format, and indicators are defined by your engagement scope. Typical visibility includes:
Collection rates by payer
Denial rates and categories
Visit-limit and authorization denials
Days in A/R and aging categories
Underpayment and variance trends
Payer-level performance
Complimentary assessment
Where Is Your Revenue Getting Stuck?
Answer a few questions about your organization to receive a response-based Revenue Clarity Snapshot. It is a preliminary starting point for discussion — not a completed professional audit.
Your questions
Frequently Asked Questions
Do you support practices that bill more than one therapy discipline?
Yes. Multidisciplinary practices are common, and we coordinate workflows across disciplines while keeping each payer's requirements distinct.
Can you track visit limits and authorizations for us?
We coordinate authorization requests, visit-limit utilization, and renewal timing as part of the agreed scope. Clinical determinations remain with your licensed clinicians.
Are documentation denials something you can help with?
We investigate why documentation-based denials occur and help align documentation expectations with payer requirements. We do not provide clinical documentation or medical necessity determinations.
Do you require us to change our practice-management system?
No. We work within supported practice-management and EHR systems, and confirm compatibility before an engagement begins.
What if we only need help with aging A/R?
Targeted A/R and denial recovery engagements are available without replacing your existing billing team or processes.
How do we get started?
Request the complimentary Revenue Clarity Assessment on our Revenue Cycle Management page, or contact us directly. We will review your situation and discuss fit.
Let's talk revenue
Your Revenue Deserves a Clearer Path Forward.
Whether you're navigating denials, aging receivables, payer requirements, or an entire revenue cycle that needs stronger oversight, we'd welcome the opportunity to understand your challenges.