Home Specialities Occupational Therapy
The skilled-care test
OT's whole problem
OT-experienced reviewers
note-level review
Medicare & commercial
Every plan you see
Revenue recovery
on care already delivered
The work is invisible. That's what makes it deniable.
Every other therapy discipline is judged on whether the treatment was documented. You're judged on whether it counts as treatment. Your outcomes are ordinary human things — dressing, cooking, driving, working, holding a pen — and the more successful you are, the more ordinary they look. A reviewer reads "practised buttoning a shirt" and sees a helper, not a clinician.
The irony is that nothing about the work is ordinary. The task analysis, the adaptive technique, the graded cueing, the safety judgement — all of it happened. It just tends not to reach the page, because your therapist was busy doing it.
See how your notes readWhat a denial rate costs a $2M practice
Illustrative framing only — we haven't published an aggregated OT benchmark, and we won't invent one. The 15-minute review uses your actual denial and write-off figures rather than an industry average.
Four words that cost you the claim.
"Patient practised cooking." It's accurate, it's honest, and it's the most expensive sentence in occupational therapy — because it describes what a bystander saw, not what a clinician did.
One session. The therapist did exactly the same work in both.
What the therapist actually did
Broke the task into steps she could sequence, trained one-handed technique after the stroke, reduced cueing from constant to occasional, and judged whether she was safe near the hob.
paid — and defensibleWhat the note said
"Patient practised making a sandwich."
denied — "not skilled"Illustrative of what payers and reviewers look for. Exactly what's required varies by payer, plan, and setting.
Five ways skilled care reads ashelp.
Every one of these starts with a note written honestly at the end of a long day — describing what happened, and leaving out why it took a clinician.
The activity that swallowed the treatment
"Patient practised making a sandwich." True, accurate, and fatal. It records what a bystander would have seen and omits everything that made it therapy — the task broken into steps she could sequence, the one-handed technique trained after her stroke, the cueing reduced from constant to occasional, the judgement about whether she was safe near the hob. A reviewer reads lunch and denies it.
Progress recorded as a feeling
"Patient is doing much better with self-care." Better than what? Payers want function they can compare: she needed help with nine of ten tasks in March, she needs help with three in June. Without a measurable line, an episode can be called unnecessary from the very first visit — retroactively.
The equipment nobody justified
You recommend a piece of adaptive equipment because you watched her struggle and you know precisely what will work. If the file doesn't record the assessment behind it — what was tried, what failed, why this device — it's refused as convenience rather than necessity, and either you or the patient absorbs it.
Group and individual work blurred together
Treating one patient one-to-one and running a group are different services at different rates. When the note doesn't make plain which happened — or that a patient in a room with others still received individual skilled treatment — it gets paid at the lower rate, or not at all.
The order that quietly expired
Every plan of care needs a physician's sign-off, renewed on schedule. Treatment continues, the signature slips, and every claim in that gap can be reversed — care delivered in good faith, unpaid.
Bandwidth, not effort
Nobody here is doing anything wrong. Your therapists are writing true notes — they're just writing them for clinicians, and someone else is reading them.
The thinking is the invisible part
The skill in OT is judgement — what to adapt, when to step back, whether she's safe. It happens silently, in real time. It's the hardest thing in medicine to see from the outside and the easiest to leave off a note.
Your therapists write for clinicians
A note that another OT would read and immediately understand is a good note. It's just being read by someone who isn't an OT, and is asking a completely different question.
Nobody's job is to read it as a stranger
Your team checks that notes are clinically sound. Nobody's role is to read them the way a reviewer will — cold, quickly, looking for a reason to say no.
Make the skill visible.
We're not asking your therapists to write more, or to claim anything they didn't do. We're helping them record the part that's already in their heads and rarely on the page — the reasoning that makes it treatment. All inside the systems you already use.
Read your notes as a reviewer would
Our ClearView dashboard flags notes before billing that describe an activity without the reasoning behind it — the ones that will read as assistance to someone who isn't a clinician.
A person, not a guess
Flagged notes go to reviewers who know OT documentation. They work with your therapist to capture what she already did — the analysis, the adaptation, the grading, the safety call — while it can still be recorded honestly.
Recover what was denied as "not skilled"
Where genuinely skilled care was refused, we build the appeal around the clinical reasoning and pursue it. Most of these are winnable, because the care really was skilled.
Keep the calendar clean
We track expiring plans of care and certification dates and prompt your team in time — so care delivered in good faith doesn't become unpaid care.
Who We Serve?
Documentation support and full-cycle billing for occupational therapy.
Outpatient OT clinics
Owner-run practices where "not medically necessary" denials land straight on the bottom line.
Hand therapy & upper-extremity
Highly technical practices where the sophistication of the work is obvious in the room and easy to lose on the page.
Home health & community OT
Therapists working in kitchens and bathrooms, where the setting itself makes skilled care look like everyday help.
Pediatric & school-based OT
Practices juggling clinical, educational and payer expectations, each wanting the work described differently.
Your claims data, handled properly
A BAA is executed before any claims data is shared, and everything is handled in a controlled, auditable environment.
Ten notes. One question: does this look skilled?
It's the only question a reviewer asks, and it takes about ninety seconds a note to answer. We'll read a handful of real ones with you and show you exactly where the clinician disappears from the page. Because notes are clinical records, we put a BAA in place first — it's the honest way to do it, and it takes minutes.
- 1 · BAA first — notes are clinical records, so we get the paperwork right before we read anything.
- 2 · Pick 10 notes — a mix of evaluations, treatment notes, and discharges from your main payers.
- 3 · Share securely — through our secure portal, with identifiers minimized wherever possible.
- 4 · See it live — which notes read as skilled treatment, which read as assistance, and what the difference is worth.
Book your 15-minute review
We'll confirm a time within one business day.
Common questions.
Why does occupational therapy get denied more than physical therapy?
Because your work looks ordinary on paper. Nobody questions whether strengthening a knee needs a clinician. But a note saying a patient practised getting dressed reads to a reviewer like something a family member could have done — so OT is asked to prove a licensed professional was necessary in a way other specialties simply aren't.
Isn't the answer just to write longer notes?
No. It's to write the part that's currently missing. Your therapist already did the skilled work — the analysis, the adaptation, the grading, the safety judgement. The note usually records the activity and leaves out the thinking. We help capture what was already there, not add anything that wasn't.
What do you actually look for?
Notes that describe an activity without the clinical reasoning behind it, progress recorded as feelings rather than function, equipment recommendations without the assessment that justified them, group and individual work blurred together, and physician sign-offs that lapsed mid-episode.
Do you make us change our EHR?
No. We work inside the systems you already use and adapt to your workflow — no EHR change, no disruption to your clinic.
What happens on the 15-minute note review?
We read a small sample of real notes together and ask the only question a reviewer asks: does this look like skilled care? Because notes are clinical records, we execute a BAA first.
Do we have to switch billing companies?
No. The documentation review works alongside your current billing, and many practices start there before expanding.
Get paid like the clinician you are
Fifteen minutes and ten real notes will show you where the skill is disappearing — and what it's costing.