Denied or unpaid services from exceeding payer-specific therapy unit limits

$1,000–$10,000 per clinic per year in denied assistant-delivered workers’ comp visits beyond authorization limits, plus time lost to rescheduling and communicating with adjusters. • $1,000–$10,000 per clinic per year in denied OT claims beyond Medicaid unit limits, along with extra FTE time spent managing benefit checks, extensions of benefits, and denial remediation. • $1,000–$10,000 per clinic per year in denied OT services and unpaid units rendered beyond private plan caps, along with staff time spent performing manual benefit checks and managing rescheduled or cancelled visits.

Authorization and cap information from Medicaid bulletins and portals is keyed into spreadsheets or written on paper logs. Front office or SLPs cross out units as they are used and send ad hoc reminders when a patient is nearing the limit. • Authorization PDFs are printed and key numbers (authorized units, expiration date) are retyped into an Excel tracker or noted on a paper chart cover; OTs or schedulers mark off visits with pen or by updating the spreadsheet after each session. • Authorization unit totals are recorded in spreadsheets or on paper and assistants ask supervisors or front office about remaining visits; updates are often passed along verbally or via informal messages.