Blog Post

Billing in the Big Leagues: How to Scale Your RCM Processes as Your Practice Grows

Learn how to scale your physical therapy revenue cycle management processes as your practice grows with these tips.

Kylie McKee
5 min read
July 17, 2019
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It’s the bottom of the ninth; the bases are loaded, and you’re up to bat. This one’s for the win. If you knock it out of the park, you may just get called up to the majors. And no matter how good you are, that’s a big leap. The same is true in rehab therapy private practice. Small practices already have a lot of balls in the air: marketing, keeping employees happy, and providing patients with an exceptional experience, just to name a few. As a practice grows, it becomes more and more challenging to meet those goals. But perhaps the toughest challenge facing growth-focused rehab therapy businesses is keeping their billing processes organized and efficient. If your RCM isn’t designed to scale, you can expect a lot of strikeouts in the form of claim denials, poor collection rates, and ultimately, lost revenue. That’s why it’s crucial to use the best physical therapy billing services, software, and workflows to ensure your clinic remains financially healthy as it grows onwards and upwards. As you set out to make your clinic a bigger, better version of itself, here are four strategies to help you scale your RCM:

1. Standardize your processes.

First things first: Consistency is crucial—especially for a large-scale practice. When everything is set to the same standard—from how you purchase supplies and equipment to which staffing agencies you hire from—it simplifies processes, mitigates financial waste, and even increases patient safety. The more staff you hire and patients you see, the more reason you have to standardize processes across your entire organization. (And if you have these standards in place before you make it to the big leagues, it’ll be a lot easier to get buy-in from your staff.) In terms of RCM, your processes for submitting claims, accepting payments, and sending bills should be written out in your practice policy manual and enforced across all locations.

This means your whole team needs to be familiar with any process changes you decide to roll out—which means you may need to conduct staff trainings as well as send out detailed communications whenever there are process updates or changes. This will save you a lot of headaches (and confusion) as you expand.

Simplify RCM by taking a holistic approach.

Additionally, standardizing your RCM tools by using a single RCM service vendor can help optimize your cash flow—and even increase your revenue yield. In this article from Becker’s Hospital Review, Steve Huddleston, president and chief client officer at nThrive, says, "Consider bringing on a single vendor that takes a holistic approach to the revenue cycle—incorporating solutions that span the entire process from patient access to payment resolution. This way, you'll eliminate the administrative burden associated with dealing with multiple vendors and will be assured that every component is optimized and plays well with the next, while minimizing silos." Even more optimal: Select a vendor whose RCM services are tailored to rehab therapy organizations.

2. Automate whenever possible.

As your business grows, your RCM process must grow with it, and automating any process means it’ll grow in tandem with your practice. At minimum, your billing platform should integrate with your EMR, so information and claims flow automatically and seamlessly. Ideally, your EMR will automatically alert you to important, billing-related information for each patient as he or she arrives for an appointment.

For example, if a patient has a regular copay due at each appointment, your integrated EMR and billing platform should notify you at the time of service. Not having this functionality can lead to billing hiccups for you and surprise bills for your patients—which can ultimately hurt your bottom line and your patients’ perception of your practice. You can also automate things like appointment reminders to ensure patients make it to their next visit, which, in turn, helps those patients stay on track with their goals—and keeps your revenue steady.

3. Track RCM trends.

As I mentioned in this WebPT Blog post, one of the biggest RCM mistakes practices can make is failing to identify trends in their RCM processes. Even if such trends seem negligible at first, as your practice grows, those patterns will have more impact. For example, if you start tracking your most common denial errors, you can find solutions to address the causes of those errors before they start seriously affecting your bottom line.

Additionally, keeping a close eye on your RCM metrics will tell you a lot about whether or not you’re even ready to expand. And to know that, you need to set up a cash flow budget. Here’s how, according to this article from Fundera:

  • “Collect the historical information on last year’s sales. Plug those numbers into the Sales section.
  • Collect the historical information on last year’s expenses. Plug those numbers into the Expenses section.
  • Make any adjustments to the budget numbers based on current plans for the coming year.
  • Pay close attention to the Cash Flow Surplus / Deficit line. Watch for red flags that indicate you’re headed for a cash flow problem.”

Once you have your budget outlined, refer back to it on a regular basis. If you’re exceeding those numbers, that’s a pretty clear indication that it’s safe to expand operations.

4. Choose a software or service.


RCM software is great for practices that handle their billing in-house—especially if it integrates with their EMR. With this option, owners have more direct oversight of the billing process. And as Justin Barnes, Partner and Chief Growth Officer with iHealth Innovations, mentions in this article from Becker’s Hospital Review, “Every CEO, CFO should know where they are financially and run their practice as a business.” That’s a whole lot easier to do when you handle all of your RCM processes in-house. Furthermore, the right billing platform will provide you with analytic reporting that helps you monitor those RCM trends I mentioned in the previous section. Just be sure your software’s pricing structure is supportive of clinic growth; some billing software providers charge based on the number of claims submitted, which essentially punishes growing practices.

As this WebPT Blog post explains, before committing to any billing software, be sure to ask the following questions:

  • Is it specific to physical therapy?
  • Does it integrate with your EMR?
  • What kind of reporting capabilities does it have?
  • Can it verify insurance eligibility?
  • Is it up to date with industry changes?
  • Will it grow with your practice?
  • How often do updates happen?
  • Does it offer free training?
  • Does tech support cost extra?

Compared to an RCM service, a billing software can be a much more cost-effective option for practices of any size, as long as the person using it—whether that’s a dedicated biller or a practice owner or manager—is well-informed on the ins and outs of rehab therapy billing.


Conversely, many practices opt to outsource their billing to a third party. This can be pricey—as we explain in this post, most billing services “charge a percentage of collections (typically 6-12%), which means the more money you bring in, the more you pay out”—but if you don’t have access to an experienced, knowledgeable biller, the benefits may outweigh the costs. When we conducted our most recent State of Rehab Therapy industry survey, we found that smaller practices were far more likely to outsource their billing than larger practices. Of the respondents who said they outsourced their billing, more than 80% were from clinics with fewer than 20 providers. That’s probably because outsourcing not only takes some pressure off owners of practices with one or two other therapists (or practices where the owner is the only therapist), but also offers some peace of mind by providing a team of billing and coding experts who handle all things RCM (including payment collections) so therapists can focus on treating patients.

That said, having less direct oversight of your RCM process can mean you’re less aware of what’s happening on the billing end. Good communication with your billing team can keep you informed, but you’ll ultimately be beholden to their work schedule. On top of that, if a third party handles your billing, you’re probably one of many accounts being serviced by your billing specialist. On the other hand, keeping your billing in-house means having your biller’s undivided attention. (If you’re still wondering whether outsourced billing is the best option for your practice, take this quiz.)

When a clinic grows from one or two providers to a multi-location practice, it enters a whole new ballgame. So, if you’re ready to make that leap, be sure your RCM process is ready to step up to the plate. Got questions about RCM for large-scale practices? Let us know in the comment section below!


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