WILLIAM AVERY | PHYSICAL THERAPY DENIAL REVIEW CHECKLIST
Reviewed: October 3, 2026
https://www.williamaveryco.com/physical-therapy-denial-management

Use this blank guide in your practice's approved billing workflow. Store any
patient or claim information only in approved secure systems. This is an
operational checklist, not an appeal form or a coverage determination.

1. CONFIRM THE STATUS
[ ] Locate the payer response for the affected claim or service line.
[ ] Distinguish rejection, pending status, adjudicated denial, and payment issue.
[ ] Read the remittance, adjustment/remark information, and related notices.
[ ] Confirm that someone owns the review; identify urgent response dates.

2. GATHER THE RELEVANT EVIDENCE
[ ] Original claim and submission/acceptance history.
[ ] Payer notice, decision dates, and previous follow-up records.
[ ] Coverage or authorization records relevant to the stated reason.
[ ] Clinical documentation needed for the specific issue, obtained from the
    responsible clinician without inventing or altering the care documented.
[ ] Applicable payer policy and response instructions for the date of service.

3. SELECT AND ASSIGN THE RESPONSE
[ ] Record the specific issue and why the evidence supports a next action.
[ ] Confirm whether correction, requested information, appeal, payment research,
    or another payer-designated process applies.
[ ] Verify the deadline, how it is calculated, and the source of the instruction.
[ ] Assign an owner and identify missing records or approvals.
[ ] Confirm the recipient, submission method, and required supporting material.
[ ] Do not assume a payer phone call replaces a required submission or pauses
    a response deadline.

4. RECORD FOLLOW-THROUGH
[ ] Save the submission confirmation and an internal follow-up date.
[ ] Record the next payer response and any remaining action.
[ ] Reconcile the outcome with the account: payment, continued dispute,
    information request, or an adjustment requiring practice approval.
[ ] Confirm patient responsibility before any balance transfer.

5. REVIEW RECURRENCE
[ ] Group related issues by payer, reason, and relevant workflow.
[ ] Separate newly denied claims from repeat follow-up on the same claim.
[ ] Identify any process change, assign a contact, and set a review date.
[ ] Check subsequent claims before concluding that the change solved the issue.

REFERENCE POINTS
CMS: First-level Medicare appeals and correction of minor errors
https://www.cms.gov/medicare/appeals-grievances/fee-for-service/first-level-appeal-redetermination-medicare-contractor
CMS: Payment and remittance advice
https://www.cms.gov/medicare/coding-billing/electronic-billing/health-care-payment-remittance-advice
APTA: Documentation and claims denials
https://www.apta.org/your-practice/documentation/overview

Use current payer-specific requirements. No checklist guarantees payment.