Billing and revenue cycle management has always been a challenge for the physical therapy practices. As a practice owner you need to make a selection between In-House and Outsourced Physical Therapy Billing. What’s the best solution out of these two? 

In-House Billing: Pros and Cons 

Handling billing in-house gives you direct control and visibility into your revenue cycle. You avoid paying service fees to a third party. Assuming competent staff, patients may also have a more seamless experience working with your in-office team.  However, in-house billing requires dedicated staff, ongoing training expenses and it carries the risk of errors or falling behind if your team lacks expertise. Less experienced staff also may lack the motivation or resources to follow up on challenging claims.

Outsourced Billing: Pros and Cons 

Outsourced Physical Therapy Billing provides specialized expertise, advanced technologies and scalability to drive revenue. Companies invested in the success of billing will diligently pursue complex claims to maximize reimbursements for your practice.  Increased collections, cost-efficiency, reduced claim denial rates and more time to focus on patient care are powerful advantages. However, fees are incurred and you have less direct access for status checks. 

True Cost of In-House Billing

While in-house billing avoids third party fees, there are significant tangible and hidden costs to consider such as:

• Staff wages, taxes, benefits
• Practice management software, clearinghouse and mailing costs
• Revenue losses from errors, trends, patient bad debt
• Intangible costs of stress, excess time spent on billing

Key Metrics for Outsourced Physical Therapy Billing Savings from outsourced billing often surpass service fees. Specialty companies aim for 95-98% collection rates, a significant gain over average in-house efforts. Tracking key performance indicators help reveal the true impact:

• Days in A/R: Speed of reimbursement
• Collection Rate: Reimbursement optimization
• Denial and Clean Claim Rates: Billing accuracy
• Reimbursement Time: Posting efficiency

Choosing a Billing Company

When evaluating billing company options, key aspects to examine include:

• Proven experience with physical therapy billing
• Integrated practice software and payment technologies
• Breadth of services: verification, auditing, reporting
• Responsive communication and customer support
• Transparent pricing aligned to maximize revenue

Getting references, evaluating sample reports and understanding exactly what tasks are covered by base fees versus add-on a la carte pricing gives you the information needed to determine if the relationship will be collaborative and profitable.

Critical Questions to Ask Prospects 

Open conversations focused on understanding which team handles key areas of responsibility provides insights into operations. Examining workload expectations and procedures helps set accurate expectations. Some examples of clarifying questions:

• Who verifies correct modifier usage: in-house or outsourced?
• How are patient billing inquiries handled?
• Is authorization obtaining included or separate?
• Are statement fees and mailings covered?
• Is third-party subcontracting used?

Aligning interests and workflows from the start prevents frustration. Being an educated consumer puts your practice in a position to receive maximum value.

Final Words 

While outsourcing billing operations requires relinquishing some direct control, the benefits often overshadow the costs for busy practice owners. Just be sure to thoroughly evaluate experience, technology capabilities, services offered, support model and pricing strategies when selecting a partner. Tracking metrics and open communication ensures alignment. Investing in specialized support provides physical therapy entrepreneurs relief from constant billing stresses so they can get back to caring for the community.