For Outpatient physical, occupational, and speech therapy clinics, from a single clinic to a small multi-site group
See therapy claim denial patterns by payer and reason early
Denials get worked one at a time, so the pattern hides. One payer starts denying for a missing modifier, a Medicare patient crosses the therapy threshold without the KX modifier, or a new therapist's claims deny because their enrollment is not active yet. Each is fixable, but only once someone sees it repeating.
What it can cost you
Example: 25 denials a month from one repeat cause x $110 average claim = $2,750 a month in rework.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Groups denials by payer, CPT code, therapist, and reason code each night.
- Flags a reason that is new for a payer or climbing against its recent baseline.
- Flags Medicare patients approaching the yearly therapy threshold so the KX modifier and documentation are ready.
- Flags claims denied because the rendering therapist is not yet enrolled with that payer.
- Lists denials not yet worked as their appeal deadline gets close.
Where it reads from
- WebPT
- Prompt EMR
- Raintree
- Net Health
- TheraOffice
- Waystar
- Medicare therapy threshold and payer policy updates (outside data)
The yearly Medicare therapy threshold amount and published payer policy updates, checked against your active patients and recent denials.
What happens when it fires
Your billing lead gets the cause, the claims affected, and a drafted fix note. A person corrects and resubmits.
Autonomy level: Draft for approval. The system prepares the message or task, and you approve it before anything goes out.
What we guarantee
Any denial reason that repeats within a payer is flagged the morning after the remittance posts. We agree on the metric before the Sprint starts and measure it over the first 20 business days after go-live. If we miss it, you get half your Sprint fee back. Dollar savings are tracked in your monthly saves log, reported rather than promised.
Questions
How does it track the Medicare threshold?
It uses the published amount for the year and each patient's running total from your billing data, counted by internal ID. It flags patients as they approach it so documentation is ready. It does not decide medical necessity; your therapists do.
We have a billing company. Who sees this?
You do. It gives the owner an independent view, so your monthly call with the billing company starts with specific causes.
Do I need new software for this?
No. The system reads from the tools you already use, with read-only access by default. A guardrail layer controls exactly which data the AI can see.
What does it cost?
A 3-week Sprint is $6,000 fixed and includes the morning brief plus one automation tied to an agreed metric. Ongoing support is $1,500 a month, or $500 a month to keep it running without new automations. If the agreed metric is missed over the first 20 business days after go-live, half the Sprint fee is refunded.
How is this different from a dashboard app or a free AI kit?
A dashboard app shows numbers when you go look. A free AI kit gives you the parts, and you do the setup, the upkeep, and the checking. Here the alarms are built for your kind of business, they watch outside data like market rates and rule changes alongside yours, and on Run or Keep-Running, the person who built them keeps them working and logs what they caught.
More alarms for outpatient rehab therapy clinics
Seven more things worth watching.
- Plans of care missing signatures or recertsTrack therapy plans of care waiting on physician signature, recerts coming due, and progress reports owed, before visits are put at risk of denial.
- Visits scheduled past the authorizationFlag therapy visits booked past an authorization's approved visit count or end date, so patients are not surprised by a bill or a pause in care.
- Unsigned notes and unbilled visitsCount therapy visits with unsigned daily notes or no claim, by therapist and payer filing limit. Only note status is read, never note content.
- Underpaid visits versus your contractsCompare every paid line on your remittances with your contracted rates by payer and CPT code, and flag short payments before they become normal.
- Cancellation and no-show spikesSpot rising cancellations and no-shows by clinic, therapist, and time slot against your own baseline, and see which ones were never rebooked.
- Patients dropping off their plan of careList patients with an active plan of care and no next visit booked, plus open plans past their end date with no discharge, by internal ID only.
- Referrals not scheduled for an evalFind therapy referrals with no evaluation booked, follow-ups that stopped after one call, and referring offices that suddenly went quiet.
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