In-House Billings vs. Outsourced vs. PtEverywhere: What’s Right for Your PT Clinic?

Navigating billing and revenue cycle management can be challenging for your practice. You have to keep up with the frequent changes in PT coding and insurance policies while ensuring your patients get the best care. If you’re considering managing billing in-house, outsourcing to a third-party service, or leveraging billing software, understanding how each option works helps you make an informed decision. 

In this article, we’ll explore the pros and cons of in-house billing, outsourced billing, and software solutions to help you find the best fit for your physical therapy practice.

Understanding Your Physical Therapy Billing Options

Below are some of the major physical therapy billing options you can explore for your practice: 

In-House Billing

In-house billing handles billing and the revenue cycle process internally. It ensures you maintain direct control over patients’ sensitive health and financial information, which reduces the risks of data breaches. The billing process provides full visibility and control over the entire process, including filing claims and tracking reimbursement. 

In-house billing is ideal for businesses with a larger workflow and the resources to hire a medical billing specialist. The specialist oversees every aspect of the billing process, including verifying patient insurance, matching CPT codes with therapy sessions, and filling and reworking claims. Practice owners can also opt for this option if they have billing expertise. 

Outsourced Billing

Outsourcing billing involves a physical therapist facility contracting a third-party firm to handle claim filings, payment processing, reimbursement, and revenue tracking. With this contractual arrangement, clinics can leverage the firm’s trained medical billing specialists to streamline the complexities of physical therapy billing, such as documentation of patient information, coding procedures, and compliance management. 

Billing through PtEverywhere

Handling PT billing with PtEverywhere lets you automate insurance verification, claim submission, tracking outstanding balances, payment posting, and financial reports. PtEverywhere provides flexible payment features that support cash-based out-of-network and hybrid billing practices.

Additionally, therapists can now spend less time chasing payment before getting reimbursed. PtEverywhere is equipped with tools for tracking outstanding balances through its financial dashboard, which monitors package revenue, auto-charges, and renewal dates.

In-House Physical Therapy Billing: Pros and Cons

Thinking about managing your physical therapy billing in-house? Consider the benefits and potential drawbacks before making your decision:

Pros

• Full visibility: Handling billing internally gives you direct oversight of every aspect of your billing and revenue cycle management. It also provides the physical team with access to financial data, denied claim status, and reports. 
• Speedy problem resolution: Identifying and resolving coding errors, payer issues, and missing documentation early on helps physical therapists' clinics avoid operational bottlenecks, cash flow disruptions, and compliance risks. Running billing internally enables you to address billing issues promptly without relying on third-party vendors. 
• Save costs: Third-party billing companies take a percentage of your collections. Keeping billing in-house helps clinics avoid these recurring service fees. Outsourced billings often come with hidden costs, including those for reporting, follow-ups, and denial management. On the other hand, managing billings in-house lets you maximize your revenue and avoid hidden fees.   

Cons:

• High Overhead Costs: Handling billing in-house may seem like a smart way to cut costs, but it can end up being capital-intensive compared to outsourcing. The cost of hiring and training in-house staff, covering payroll expenses, and investing in reliable billing software quickly adds up.  
• Prone to Error: Frequent changes in billing regulations often lead to errors because in-house staff may not have the time or resources to keep up with every update.  Similarly, in-house billing teams usually juggle multiple responsibilities, extending to other front-desk duties. This divided attention increases the cases of incorrect code selection, missing or misapplied modifiers, and miscalculating therapy units. 

Outsourced Physical Therapy Billing: Pros and Cons

Here are some of the pros and cons of outsourcing physical therapy billings:

Pros

• Access to billing experts: Outsourcing to billing companies lets clinics leverage the expertise of billing specialists. For a fee, billing specialists handle your claim submission, patient documentations, payment posting, and denial follow-up. They also help you avoid compliance risks by keeping up with the latest industry regulations. 
• Reduce workload: Managing billing externally allows the front desks and other administrative teams to focus more on patient care coordination and scheduling rather than chasing down claims or payments. For smaller clinics, outsourcing means physical therapists can prioritize quality care for patients. 
• Improves cash flow: Errors in CPT codes, medical documentation, or missed authorization are some of the reasons claims get denied. Billing companies ensure more claims are accepted, and denials are followed up on faster, eliminating delays in reimbursement from the insurer and the patients. With the steady cash flow, physical therapists have access to capital to keep the clinic running.  

Cons

• Dependence on the billing company: One of the major downsides of outsourced billing is the dependence on the billing company. If the billing company has a staff shortage, data breaches, or operational failure, your clinic is directly affected. 
• Slows down decision-making: Clinics don’t have access to instant information and depend on scheduled reports or updates from the vendors. The back and forth between the clinics and the billing company can slow down essential operational decisions. 
• Data security threats: Outsourced billing means sharing sensitive patient and financial data with a third-party company. A billing company that doesn’t comply with regulatory standards, such as HIPAA and GDPR, makes you vulnerable to data security threats.

Cash-Pay & Hybrid Practices: Billing Considerations

Each patient has a different financial situation and insurance coverage. Some prefer cash pay for faster payment and less red tape, while others depend on insurance to make care affordable. Using a billing software like PtEverywhere, which supports multiple payment options, ensures care is accessible to all patients. 

Cash-Pay Billing Practices

Cash-pay practices allow clinics to focus on patient care without the administrative burden associated with insurance billing. It also eliminates unpaid claims and delayed payments, ensuring a more efficient cash flow. 

PtEverywhere is equipped with features that streamline the payment process for cash-based clinics. It also processes credit card payments for clients who prefer to pay for sessions directly. The platform automates invoice processing, which can be exported in various formats via the patient portal.

Hybrid Billing Practices 

Hybrid billing practices allow patients to choose a payment method based on their preference. Patients can opt for cash-pay, insurance billing, or even a membership-based model. 

For clinics with hybrid billing practices, PtEverywhere simplifies multiple payment methods without the hassle of data reentry. The platform empowers your patients with a user-friendly platform that seamlessly integrates in-person and telehealth services. 

How PtEverywhere Simplifies Physical Therapy Billing

PtEverywhere is an enterprise-grade revenue management solution that supports cash-based and hybrid payments. With just two clicks, practice owners can generate a superbill that patients can submit to their out-of-network plans. It automatically verifies eligibility, preventing surprise denials that could disrupt your cash flow. 

PtEverywhere reduces the risks of data breach from insider risk and accidental exposure. It has a role-based permission that separates therapists from billing staff. It runs a full audit that tracks every adjustment and refund. The platform is PCI-compliant and supports recurring payment tokenization, reducing the risks of financial fraud and data breaches. It replaces sensitive payment details, such as credit numbers, with a unique, random characters known as a token.  

Request a demo today to see how PtEverywhere’s all-in-one billing system can help your practice reduce errors, maximize reimbursements, and maximize revenue.