AMO billing errors in speech and language therapy: how to avoid them
AMO billing errors that trigger rejections and overpayments in speech and language therapy: concrete cases regarding the billing unit, assessment, renewal, IFD, and DAP. Reference sheet to download.
Countries covered : France
Billing is one of the most frequent sources of rejections and overpayments in speech and language therapy. This page focuses on concrete cases where a billing code triggers a rejection by the health insurance fund or an overpayment claim during an audit.
It does not reproduce the fee schedule: for the billing unit value, coefficients, and calculation method, please consult our page dedicated to AMO billing.
1. Applying an outdated billing unit value
The typical case: the software has not been updated after a rate increase and continues to apply the old value of the AMO. The entire billing is then incorrect, and the discrepancy stands out during an audit. The reflex: check the current value (see our billing page) and keep it updated in your software.
2. Billing an assessment with an incorrect coefficient
The classic mistake consists of applying an assessment coefficient that does not correspond to the assessment actually conducted, for example, billing a more "complex" assessment than the one performed. During an audit, the assessment report (CRBO) is requested to justify the billing: a CRBO that does not match the billed coefficient paves the way for an overpayment claim. For the coefficient applicable to each type of assessment, see our page dedicated to AMO billing.
3. Billing a renewal at full price
The reassessment is billed with a reduction compared to the corresponding initial assessment. Billing it at the full rate of the initial assessment is one of the most common mistakes: the difference becomes a recoverable overpayment. The exact rate and terms are detailed on our AMO billing page.
4. Billing for a session duration not actually performed
Sessions are billed according to distinct coefficients related to the duration and type of care. Applying a long session coefficient to a short session (or vice versa) is a classic cause of rejection: the actually performed duration must correspond to the billing code. Session coefficients by duration can be found on our billing page.
5. Billing the IFD outside of the specified cases
The flat-rate travel allowance (IFD) is added only when the travel conditions are met. Two symmetrical errors generate discrepancies: forgetting it when it is due, or adding it to a procedure that does not qualify for travel allowance. The second case, undue addition, is the one that most frequently comes up during audits.
6. Operating under a DAP that no longer exists
7. Billing two sessions on the same day without meeting the conditions
Conducting two sessions on the same day for the same patient is only possible under certain conditions. Billing them systematically, without these conditions being met, is a frequent cause of overpayment claims during a targeted audit.
Speech and language therapy billing reference sheet to download
Billing unit, assessment and session coefficients, IFD, renewal reduction: a sheet ready to display. Access the PDF by entering your email:
The antidote: a solid file that justifies the billing
Most of these errors can be prevented by a solid file: a retained assessment report (CRBO), renewal assessments that document progress, and dated session notes. This is also what protects you in the event of a retrospective audit.
This is where Delta saves time: you capture your observations through live note-taking or post-session dictation, and the tool generates structured reports based on your template, with longitudinal patient memory from one session to the next. HDS hosting, GDPR compliant.
Frequently asked questions
Which billing errors trigger the most rejections?
Applying an outdated billing unit value, billing an assessment with a coefficient unsuited to the assessment performed, billing a renewal at full price, or billing for a session duration not actually performed. For the values and coefficients to apply, see our page dedicated to AMO billing.
Why is a renewal billed at full price a problem?
The reassessment is billed with a reduction compared to the initial assessment. Billing it at full price creates a difference that can be recovered as an overpayment during an audit. The exact rate can be found on our AMO billing page.
Is the DAP still necessary in speech and language therapy?
No for renewals and extensions: Amendment 21 removed the prior authorisation request (DAP) in favour of a retrospective audit. The mistake consists of delaying a procedure while waiting for an agreement that no longer exists; see our page on the reassessment.
When does the IFD become an overpayment?
When it is added to a procedure that does not qualify for travel allowance. The flat-rate travel allowance is only billed if the specified travel conditions are met.
Can you bill two sessions on the same day?
Only under certain conditions, for the same patient. Outside of these situations, billing two sessions on the same day exposes you to an overpayment claim during an audit.
Accurate billing starts with a solid file
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