Proven strategies and PRACTIS features that help physical therapy practices reduce claim denial rates from 20-30% to under 6%.
The #1 cause of claim denials is eligibility issues — expired coverage, incorrect member IDs, or exhausted benefits. Configure PRACTIS to automatically verify eligibility before every visit. This single step prevents 35% of all denials.
Ensure all 47 pre-scrub checks are enabled in Settings > AI Agents > Riley. Pay special attention to laterality matching, modifier validation, and 8-minute rule compliance — these three checks alone prevent 28% of denials.
Configure Alex to initiate authorization renewals 5-7 visits before the limit. Expired or missing authorizations account for 22% of PT claim denials. With proactive management, this drops to under 2%.
Review the Billing > Denial Analytics dashboard weekly to identify patterns. Look for recurring denial reasons, problematic payers, and specific CPT codes with high denial rates. Use these insights to adjust your workflows and prevent future denials.
Configure PRACTIS to submit claims on the same day as the patient visit. Delayed submissions increase denial risk due to timely filing limits and increase the chance of documentation gaps. Same-day submission reduces denials by an additional 12%.
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