Brace Health resources
Practical guidance authored by the people who work on billing and practice operations every day.
10 resources
An ABA practice choosing a billing company should verify the vendor’s experience with its actual payer mix and service model, document who owns authorization and intake work, and understand how claims, denials, payments, and unresolved items will be managed. Get responsibilities, exclusions, and transition terms in writing.
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Before a cash-pay therapy practice starts billing insurance, it should map which services and providers may be billed, confirm payer-specific enrollment and participation requirements, define documentation and system workflows, and explain the change to patients. Enrollment, contracting, coverage, and billing rules vary; a billing vendor cannot replace the practice’s payer and clinical responsibilities.
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An occupational therapy practice should evaluate a billing company by the work it will own, its familiarity with the practice’s payer and documentation workflows, how it handles exceptions, what it reports, and which tasks stay with the practice. Confirm scope and service fit in writing before sharing access or transferring claims.
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A speech therapy practice should choose a billing company by checking whether it understands the practice’s payer mix and service model, how it handles documentation and claim exceptions, what work it owns, and how it reports unresolved items. Confirm payer-specific requirements and scope in writing rather than relying on a general claim of specialty expertise.
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A therapy practice can make a more defensible pre-visit estimate by combining the benefit information available, the planned service, and relevant claim history. Explain the assumptions and uncertainty; only the payer’s claim adjudication determines the final insurance result and patient responsibility.
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Before sending a patient statement, confirm the claim has been processed, the payer response and adjustments are posted, the balance is supported, and the statement is going to the right person through an approved channel. Hold unclear or disputed balances for review.
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A benefits check can return information available from an eligibility transaction, such as coverage status or benefit details. It does not guarantee that a specific service will be covered or paid; claim adjudication depends on the submitted claim, plan terms, provider and service details, and payer rules.
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A practice should distinguish an estimate from the patient responsibility established after the claim is processed. Before requesting payment, reconcile the payer’s adjudication and any contractual adjustments, then communicate the balance and payment options clearly under the practice’s policies and applicable rules.
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A PT practice can prepare a stronger rate request by connecting a focused ask to evidence the specific payer may value, such as specialized access, network adequacy, or near-term cost. The case and likely outcome vary by payer and market.
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Physical therapy owners can start with five billing measures: submission lag, rejections and denials, AR aging, payment realization, and open exceptions. Each measure needs a consistent definition and a next action.
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