Occupational Therapy Medical Billing | Billing Services

According to industry experts, a claims adjustment rate of 20% to 35% is considered good and acceptable. At iMagnum, our account executives have an average of eight years of experience in occupational therapy billing. Because of their knowledge, ability, and dedicated follow-up, iMagnum's adjustment rate is consistently lower, as low as 12% with Medicare. At iMagnum, our A/R rates for our practices are higher than the industry average. Simply put, you and your practice will receive a higher average return per processed claim.

Benefits of billing with iMagnum Healthcare

• Increased revenue and collections
• Payment acceleration and stress reduction
• Access to your patient data and financial information is available 24 hours a day, seven days a week.
• Understand where your money is ?
• Continuity throughout the revenue cycle
• Comprehensive financial and practice management reporting
• The security and comfort of knowing that billing is handled by professionals, and that reimbursements and income will increase

What Makes Occupational Therapy Billing Unique

Occupational therapy billing requires a specialized approach that goes beyond standard medical billing. OT practices must carefully manage time-based CPT codes, evaluation levels, and therapy modifiers to ensure claims are both compliant and accurate. Unlike other specialties, OT billing often involves plan-of-care recertifications, prior authorizations, and strict documentation alignment with patient progress and goals.

Key Coding and Modifier Essentials

• Evaluation Codes (OT): 97165 (low), 97166 (moderate), 97167 (high)
• Time-Based Treatment Codes: 97110 (therapeutic exercise), 97112 (neuromuscular re-education), 97530 (therapeutic activities), 97535 (self-care/home management)
• Therapy Modifiers: GO (occupational therapy), KX (threshold exceedance with documentation), 59/XS (distinct procedural service, when applicable)
• Compliance Requirements: Updated plan-of-care documentation, accurate treatment minutes, and clear medical necessity

Our Proven OT Billing Process

At iMagnum Healthcare Solutions, our approach is designed to reduce denials and maximize collections for occupational therapy practices.

• Eligibility & Benefits Verification – Confirm visit limits, co-pays, and therapy caps.
• Authorization Tracking – Monitor units, dates, and renewal requirements.
• Documentation Quality Review – Ensure medical necessity and treatment minutes support codes.
• Charge Scrubbing & Claim Submission – Claims submitted within 24–48 hours.
• ERA/EFT Posting – Fast and accurate payment posting with denial reason mapping.
• Denial Management – Corrected claims and timely appeals with supporting documentation.
• A/R Follow-Up – Worklists prioritized by age, payer, and claim amount.
• Reporting & Analytics – Weekly dashboards with metrics like denial rate, first-pass yield, and days in A/R.

Who Benefits from iMagnum OT Billing

• Independent OT Clinics: Stable revenue with less administrative burden.
• Multi-Specialty Practices: Seamless integration of OT alongside PT and SLP.
• Hospital Outpatient Programs: Scalable, compliant, and accurate documentation support.

Why Compliance Matters

Our workflows follow HIPAA-aligned standards with secure data exchange and strict role-based access. Regular audits help ensure that all claims are backed by complete documentation, minimizing payer disputes.

What You Can Expect with iMagnum

• Cleaner Claims: Pre-bill scrubbing aligned to payer edits.
• Fewer Denials: Proactive tracking and documentation alignment.
• Transparency: Real-time access to dashboards and reports.
• Guaranteed Focus on Collections: Strong A/R follow-up and appeals management.