Every January, insurance reverification for PT and OT teams becomes a major pressure point, and many PT and OT practices find themselves scrambling, even though it happens at the same time every year. Coverage resets, payer portals slow down, visit limits change, and teams work to keep schedules full without jeopardizing reimbursement. It can feel like a significant surge of administrative work just as patient demand ramps up.
In this session, Randy Boner, Associate Director of Client Success at Infinx Healthcare, shares what he sees every day in the field and how leading organizations are turning reverification from a yearly crisis into a predictable, manageable workflow through better preparation and process discipline.
Why Reverification Hits PT and OT So Hard
For PT and OT groups in particular, the disruption starts with the schedule. Patients seen late in the year often continue their care plans into January. And because the January reset coincides with new treatment plans and benefit renewals, PT and OT teams face a unique convergence of clinical and administrative load. When the calendar flips, visit limits reset, deductibles start over, plans change, and prior authorizations may need to be resubmitted.
Suppose those existing patients are not reverified before the new year. In that case, front desks and billing teams end up chasing patient eligibility and benefits verification after the fact, dealing with denials, or writing off balances that could have been prevented. Without a clear reverification plan, the seasonal surge quickly overwhelms staff.
What Smart Preparation Looks Like in December
As Randy emphasizes in the session, preparation isn’t optional — it’s everything. The most successful organizations use December to get ahead of the chaos rather than react to it.
They begin by reviewing eligibility and authorization reports to identify patients with plans that renew on January 1, prioritizing those individuals for reverification before their first visit of the new year. Patients with mid-year renewals, such as July-to-July plans, can be deprioritized.
Teams also launch targeted patient outreach, confirming upcoming appointments and checking whether patients anticipate any insurance or benefit changes. Even simple scripting like “Will your coverage be different after January 1?” can help prevent surprises at check-in.
On the operational side, they focus on cleaning and stabilizing their data — validating payer mappings and IDs, updating portal credentials, confirming facility information, NPIs, addresses, and physician tables, and reviewing order entry practices to ensure information is captured consistently. Small data issues that go unnoticed throughout the year tend to explode under reverification volume.
Finding the Right Role for Automation and AI
Automation works best when you know exactly where it fits. Randy and his team often start by analyzing a client’s payer mix to determine which payers and plans can be fully or partially automated through clearinghouse integrations and payer portals, and which will always require some level of manual expertise.
Clean payer mapping is critical. Inconsistent payer naming or outdated IDs can cause automation to fail, no matter how sophisticated the technology. Equally important is workflow consistency. If users handle similar cases in different ways, or if diagnosis codes, provider NPIs, or key data elements are frequently missing, automation cannot deliver reliable results.
For PT and OT groups, clearly defined rules around referral and prior authorization automation requirements remain essential. Not all of that information is available through portals or clearinghouses, so there will always be a role for human specialists alongside automation. Tools like insurance discovery can help surface additional active coverage that patients may not realize they have, improving both reimbursement and the patient’s financial experience. (Learn more about the Infinx Insurance Discovery Solution here.)
Prioritizing Work When January Arrives
Once January hits, not everything can be done at once. The goal is to automate as much as possible and reserve human effort for the highest-impact work.
Randy recommends always prioritizing “business as usual” patients first. These are patients on the immediate schedule whose eligibility and benefits must be confirmed before their visit. Many organizations dedicate one team to same-day appointments and another to working the reverification backlog, typically targeting completion by the end of January, depending on volume.
Many organizations also rely on intelligent queueing and orchestration tools that automatically route cases based on payer, workflow, CPT code, service type, and other parameters. This approach improves turnaround time and quality by aligning specialized teams with the work they are best equipped to handle while still maintaining oversight of automated cases. (You can explore a Patient Access Plus demo here.)
Lessons from the Field and What Comes Next
From the front lines, Randy highlights two areas where clients are already seeing measurable impact. The first is expanded Medicare automation that now supports a broader range of plans and coverages. Given how time-consuming and variable Medicare portals can be, automating eligibility and benefits for these patients is a significant win for PT and OT groups.
The second is the use of intelligent queues across operations, which is already delivering faster turnaround times and better quality across reverification workflows.
The Rise of Predictive Reverification
Looking ahead, Randy sees proactive intelligence as the next phase. Instead of simply automating tasks, AI will help predict which payers will change requirements, which patients are most likely to need reverification, when to start that work, and how to prioritize it. Predictive reverification is emerging as a top priority because of the burden this season places on providers and revenue cycle teams.
Making Reverification Readiness a Year-Round Habit
If Randy were in charge of reverification for an organization, he would start with consistent monthly checks. That includes reviewing payer mappings, validating data tables, monitoring order entry quality, and continuously analyzing payer mix and automation performance. Often, expanding automation is as simple as addressing recurring clearinghouse errors or upstream data gaps.
He recommends at least quarterly reviews, with monthly checks as the gold standard. The most successful clients treat reverification readiness as a living process. When data and mappings stay current all year, January feels like just another month rather than a crisis.
If your PT, OT, or multi-specialty organization feels the strain of reverification season, consider how intelligent automation and expert support can turn it into a predictable, manageable process. To see how solutions like Patient Access Plus and insurance discovery can transform your reverification strategy, request a demo if you are interested.