Stop Avoidable Denials
Before the Patient Walks In
CoverageSight is launching a founding clinic pilot to validate a structured, pre‑visit financial risk review for physical therapy (PT) clinics — so you can catch avoidable denials before the patient walks in.
Built for small PT clinics where financial risk becomes irreversible after the visit.
Why now: As deductibles rise and payer rules tighten, reactive billing workflows get more expensive every month.
Pilot clarity: No software required. You share an export of upcoming appointments; we deliver a weekly risk report.
Who This Is For
Clinic owners, office managers, and billing teams who want more predictable monthly cash flow.
Best fit if you do eligibility manually and still get surprised by visit caps, authorizations, and coverage gaps.
Why Small PT Clinics Lose Money
Most clinics verify eligibility. Few verify risk. The gaps below are where preventable denials and delayed cash flow start. If just two visits per week deny at $160 per visit, that's over $16,000 per year in delayed or lost revenue for a small clinic.
Visit Caps & Benefit Exhaustion
Plans often limit PT visits (e.g., “20 visits/year”). If the patient is out of visits, the claim can deny or shift to patient responsibility.
Missing / Expired Authorization
Many payers require prior authorization (approval) for PT. If it’s missing or the visit limit is reached, payment gets delayed or denied.
Plan Resets & High Deductibles
At the start of the year, deductibles and benefits can reset. Without a pre‑visit check, patients get surprised and collections get harder.
Coverage Mismatch for Treatment Plan
Coverage may be active, but specific services can be excluded or limited. Risk is highest when planned care doesn’t match benefits.
How the Founding Clinic Pilot Works
Sample weekly risk report snapshot shown above (illustrative).
This is not software access. It’s a founder‑led pilot to validate a repeatable pre‑visit risk review workflow and quantify revenue exposure.
Most eligibility tools answer: “Is coverage active?”
CoverageSight answers: “Is this visit financially safe?”
We focus on the pre‑visit window—the only time risk is still reversible.
Share an Appointment Export
Clinics share a simple export of upcoming appointments (next 7–14 days) from your EHR/PM (Electronic Health Record / Practice Management) or billing system.
Appointment exports are handled securely and deleted after analysis. We do not store PHI beyond the pilot window.
Founder‑Led Risk Review
We analyze common denial drivers: visit caps, benefit exhaustion, missing/expiring authorization, coverage gaps, high deductible exposure, and coordination of benefits.
Weekly Risk Report + Action List
You receive a structured report: flagged visits, recommended actions, and an estimate of weekly revenue exposure — so your team can intervene before check‑in.
What to Expect in the Pilot
Week 1
30‑minute workflow review + export of the next 7–14 days of scheduled visits. Risk analysis delivered within 48 hours.
Weeks 2–4
Weekly pre‑visit risk report with flagged visits, action items, and an estimated revenue exposure summary.
End of 30 Days
We evaluate: % of visits flagged high‑risk, estimated revenue at risk, operational gaps discovered, and whether you want to continue.
Goal: quantify how much preventable financial risk exists before visits occur — and whether structured risk review improves cash predictability.
Why Not Just Do This Manually?
Manual eligibility checks are helpful — but they're not a structured, repeatable pre‑visit financial risk review.
One‑time, not continuous
Staff checks eligibility once. Risk changes as visits accumulate and authorizations expire.
Relies on memory + edge cases
Busy teams miss plan quirks: visit caps, reset dates, and coverage mismatches.
Doesn’t track future appointments
Manual checks aren’t built to monitor visit caps and authorization limits across the next week of visits.
Reactive instead of proactive
Without a system, issues surface after denials. CoverageSight helps prevent them before check‑in.
CoverageSight creates a consistent pre‑visit workflow — so you don't leave money on the table.
Benefits
Fewer Denials
Preventable denials drop when coverage issues are caught early.
Faster Cash Flow
Cleaner claims get paid sooner, reducing Days in AR (Accounts Receivable).
AR = money owed to the clinic.
Better Patient Experience
Clear costs up front = fewer surprises and more trust.
What This Could Improve
Outcomes will vary by payer mix and workflow. The point is to move revenue cycle work from reactive (after denial) to proactive (before the visit).
Preventable Denials
Reduce denials tied to benefit limits, missing authorizations, and coverage gaps by catching them before the visit.
Days in AR (Accounts Receivable)
Fewer denial cycles and resubmissions can reduce Days in AR — how long it takes to collect cash after services.
Billing Rework
Less time chasing authorizations, correcting insurance order, and reworking claims after rejection.
Patient Financial Clarity
Earlier visibility into patient responsibility reduces surprises and supports better collections.
Pilot Investment
Pilot clinics contribute a monthly fee to participate. This keeps the cohort small, committed, and integrated into real workflows.
Pilot pricing reflects hands-on founder involvement and will not be available once automation launches. We’ll discuss details on the call.
Apply for the Founding Clinic Pilot
Founding clinic cohort: We’re onboarding 3–5 small PT clinics for a founder‑led pilot.
Best fit: clinics doing eligibility manually, struggling with visit caps/authorization tracking, and wanting more predictable cash flow.
No long‑term commitment. Pilot runs 30 days.
Email: admin@coveragesight.com