Billing is one of the most complicated aspects of running a clinic. And considering the fact that billing rules seem to change as often as the season, it’s easy to make mistakes—and find yourself face-to-face with a billing blunder beast. (Try saying that three times fast!) At some point, even the most vigilant providers and billers need a little bit of help crossing all of their t’s and dotting all of their i’s, so to speak.

So, how do you decide which billing solution is best for your needs? Specifically, should you use an in-house billing software or outsource your billing to an RCM service? Let’s examine.

Is PT Valuable? Why Outcomes Data is the Proof We Need - Regular BannerIs PT Valuable? Why Outcomes Data is the Proof We Need - Small Banner

Billing Software

When you process your billing in-house using a billing software, you rely on the expertise of your own staff. This means you’re responsible for every step of the billing process, which is great if you prefer a more hands-on approach to your practice’s billing. Furthermore, because you handle everything in-house, you can quickly resolve any issues that do arise. So, if your billing process is efficient—and you have a highly trained and capable biller on staff—this option might be your best bet.

Additionally, using a billing software often costs less than enlisting a billing service, especially if you choose a web-based software, which eliminates the need to purchase costly hardware. Another cost-saving and efficiency-boosting measure: Make sure your billing software integrates with your EMR. That way, you don’t have to worry about any double entry of codes and demographic information—which is especially important with complicated rule and regulation changes.

RCM Service

If you don’t have a solid billing team and software in place, an RCM service can offer some major peace of mind. I mean, the service literally handles all your billing for you. In that sense, having a team of revenue cycle management pros working for your practice seems like a no-brainer. However, there’s one major factor you have to consider with this option: cost. Most billing services charge a percentage of collections (typically 6-12%), which means the more money you bring in, the more you pay out. And that can cause issues when it comes to budgeting for your practice’s monthly expenses, as there can be significant variances in costs depending on how busy you were that month.

That said, if you have a quality team of RCM experts on your side, the costs don’t have to outweigh the benefits. As this Greenway Health resource explains, “A good RCM vendor will be able to demonstrate an ROI.” But, there’s more to this decision than financial ROI. Case in point: Practices that switch to an RCM service typically experience a reduced billing burden—and that means fewer headaches. After all, when you outsource your billing to a professional billing service, you don’t have to worry about staffing or the time-consuming claims process—including maximizing reimbursements and combating denials. Additionally, you can count on timely accounts receivable (AR) collections and a staff of experts who remain up to date on the latest regulations, which can prove vital when it comes to Medicare compliance. (Modifiers, anyone?)

Hybrid Billing Model

By this point, you might be thinking, “Hey, both options sounds pretty good!” And if so, you’d be right: using a billing software and outsourcing your RCM to a team both have their respective benefits. But, what if you want the benefits of in-house billing while simultaneously taking some of the RCM burden off your staff’s plate (and retaining your current in-house biller)? Well, you’re in luck: say hello to the hybrid billing model.

With a hybrid model, you get the support of an expert billing team while retaining a hands-on approach to your RCM processes. And as your clinic grows, you’ll also free up your—and your team’s—time so you can focus on other important things (like treating patients or marketing your practice). In most cases, you can expect to continue handling administrative tasks (like credentialing, data entry, insurance verification, and patient payment posting) while leaving the more technical stuff (like claim scrubbing, A/R management, and collections) to your outsourced team. Talk about a win-win.


So, which option should your clinic choose? Should you follow the dollar signs? Well, when it comes to billing operations, you should consider more than just cost. Here are some questions you can ask yourself to help with the decision-making process:

  • Do I have an efficient process in place?
  • Is that process meeting my clinic’s needs?
  • Does processing my billing in-house sound like a good fit?
    • If so, do I have someone capable, well-trained, and technically savvy on staff to process my billing?
    • If not, am I ready to hire someone who is?
    • Do I love a hands-on approach to all things billing?
  • Does a billing service sound like a good fit?
    • If so, am I comfortable with letting an outside team handle my billing?
    • What are my monthly collections?
    • Can my clinic afford 6-12% of those collections as payment for a billing service?
  • Does a hybrid service sound like a good fit?
    • Do I currently have an in-house biller I want to retain?
    • Do I want the expertise of an experienced billing team without sacrificing a hands-on approach?

The answers to these questions should help you form a decision. If you already have a process in place, and it’s efficient and cost-effective, that’s awesome. (Just make sure you’re regularly auditing it.) If not, then you might need to restructure how you do things—which can be scary, but absolutely doable.


The ultimate goal of any billing solution is to maximize payments and get that revenue flowing, so rest assured that while choosing a path can be a chore, there’s light at the end of the tunnel—with no billing monsters in sight.

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

    articleJul 17, 2019 | 8 min. read

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

    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 …

  • 4 Things to Know About Billing for Cash-Pay PT Image

    articleSep 28, 2018 | 8 min. read

    4 Things to Know About Billing for Cash-Pay PT

    Some things come as no surprise. Our 2018 State of Rehab Therapy survey validated one pain point we hear about constantly: insurance regulations are one of the biggest barriers to providing quality care to patients. With all the red tape you have to cut through to receive reimbursement for the treatment you provide—not to mention the hoops you must jump through to get (and stay) credentialed with payers —it’s no wonder that more and more PTs are …

  • The Case for Care Cost Transparency in Your Practice Image

    articleApr 26, 2017 | 6 min. read

    The Case for Care Cost Transparency in Your Practice

    Back in the day, the notion of healthcare providers discussing the cost of treatment with insured patients was relatively unheard of. After all—aside from a nominal patient copay—insurance usually footed the bill. That’s not the case today. As Fair Health President Robin Gelburd writes in this Physicians Practice article , the insurance industry has evolved to place greater financial responsibility on patients—hello, high-deductible health plans (HDHPs). As a result, patients want to know the cost of the …

  • 3 Common Rehab Therapy Credentialing Mistakes Image

    articleJul 18, 2018 | 6 min. read

    3 Common Rehab Therapy Credentialing Mistakes

    Proper credentialing is a crucial step in running a successful physical therapy clinic. If your clinic and therapists aren’t properly credentialed with insurance providers from the get-go, your bottom line might suffer. And it’s not just new clinics that are susceptible to making credentialing mistakes; in fact, any clinic that has gone through a change in ownership, rapid growth phase, or any other transition might find itself mired in credentialing headaches. But before we get to the …

  • Stamp of Approval: How to Obtain Prior Authorization for PT Services Image

    articleAug 12, 2019 | 8 min. read

    Stamp of Approval: How to Obtain Prior Authorization for PT Services

    If you contract with third-party payers , then you’re most likely already familiar with the term [cue ominous thunder sounds] “prior authorization (a.k.a. preauthorization)”. And if you’re not yet, just wait. This Verywell article —written for patients—explains that when an insurance company requires prior authorization, healthcare providers must obtain approval from said insurance company before providing patient services, treatment, or equipment. Otherwise, the insurance company won’t pay for it—and either the provider or the patient will be …

  • 8 Reasons You Should Attend Ascend 2019 Image

    articleJun 26, 2019 | 4 min. read

    8 Reasons You Should Attend Ascend 2019

    Great news! Ascend— the ultimate business summit for rehab therapists —is back. Last year, the fifth-annual event hit our hometown of Phoenix, Arizona, for two incredibly educational (and incredibly fun) days. This year—September 19–21, to be exact—Ascend is heading to the Land of 10,000 Lakes (that’s Minnesota, don’tcha know!) for another round of rehab therapy’s can’t-miss business conference. Seriously—you’ve gotta be there. Here’s why: 1.) You’ll earn CEUs. In addition to upping their business acumen, physical and …

  • Death to Denials: 4 Strategies for First-Pass Claim Payment Image

    articleMay 1, 2017 | 4 min. read

    Death to Denials: 4 Strategies for First-Pass Claim Payment

    Claim denials are the worst. You provide your patients with exceptional therapeutic intervention—and bill their insurance companies to recoup payment for those services—only to find out that the payer has no intention of actually doing any paying. Womp, womp. While you could—and should—implement a process to correct and rebill denied claims, wouldn’t it be even better to stop them from happening in the first place? After all, it costs providers an average of $25 to rework a …

  • Collection Objection: Overcoming Patient Excuses for Why They Can’t Pay Image

    articleApr 19, 2017 | 5 min. read

    Collection Objection: Overcoming Patient Excuses for Why They Can’t Pay

    If collecting patient payment at the point of service was important before, then it’s mission-critical now—especially as reimbursements continue to shrink. That’s because—as we’ve mentioned here , here , and here —only 21% of patient balances that aren’t collected at the point of service are ever recovered. That’s a lot of cash you’re leaving on the table if your patient collection strategy is not on point. So, in addition to implementing a solid payment policy, successful providers …

  • 5 Reasons You Should Attend Ascend 2015 Image

    articleApr 28, 2015 | 4 min. read

    5 Reasons You Should Attend Ascend 2015

    Have you heard? Ascend— the ultimate business summit for rehab therapists —is back. Last year, the inaugural event took Dallas—or at least, Dallas physical therapists and private practice owners—by storm for one jam-packed day . This year, Ascend is upping the ante—big time. For starters, our 2015 event will run for two days instead of one—and trust us, you don’t want to miss it. Here are five reasons you should attend Ascend 2015: 1. You’ll earn CEUs. …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.