Occupational Therapy revenue cycle management
Occupational therapy revenue leaks in therapy thresholds and timed-code rules - the KX modifier, the 8-minute rule and plan-of-care compliance. AI agents keep covered therapy paid.
Occupational therapy billing turns on therapy thresholds and the KX modifier, correct timed-code units under the 8-minute rule, and a compliant plan of care. MedXFlow supports coding, tracks thresholds and authorizations, and runs claims, posting and denials end to end.
Coding & documentation
- Timed-code units & KX - Calculates timed-code units under the 8-minute rule and applies the KX modifier at the threshold.
- Plan-of-care tracking - Tracks plan-of-care certification and recertification so claims stay compliant.
Eligibility & benefits
- Therapy benefit verification - Verifies therapy coverage and remaining visit limits before care.
- Copay & responsibility - Surfaces patient responsibility ahead of the visit.
Prior authorization
- Therapy authorization - Submits and tracks authorizations for continued therapy with documentation.
Claims, posting & denials
- Claim scrubbing - Scrubs claims for modifier, unit and medical-necessity edits before submission.
- Denial management - Works threshold, unit and plan-of-care denials by root cause.
What you get
- Timed units captured correctly under the 8-minute rule
- KX modifier applied with documentation
- Visit limits verified before care
- Fewer therapy denials
Frequently asked questions
What is the 8-minute rule in occupational therapy?
The 8-minute rule determines how many timed treatment units you can bill based on total minutes of direct one-on-one therapy. Calculating units correctly is essential because errors either lose revenue or trigger denials.
Why are occupational therapy claims denied?
Common reasons are incorrect timed-code units, missing the KX modifier above the therapy threshold, and expired plan-of-care certification. Automating unit calculation and threshold tracking prevents them.