Rehab Billing Service Outsourcing - Zero-Sum Argument and Cost-Benefit Analysis

Over 17 percent of accounts receivable for an average physical therapy practice are beyond 120 days since the date of service. Although this may not seem to be a problem, as it would be expected that the money will come eventually, in fact an unpaid claim that is 180 days overdue has less than 1% chance of ever being paid. In other words, the average rehab practice delivers almost one fifth of its services for free. Would billing outsourcing be an appropriate solution for this problem?

Extra Time and Reduced Cost Benefits

Traditionally, advocates of outsourced physical therapy billing bring up extra time and cost gains as two main arguments in their favor. The rehab practice owner uses the extra time for patient care, family, or practice development. Cost gains are typically measured in terms of salaries and benefits of reduced billing personnel. However, the first argument (extra time) is often irrelevant to therapists satisfied with their schedules and practice sizes, and the second argument too often turns into a wash in light of commission-based fees typically charged by the billing services.

Zero-Sum Argument Against Outsourcing

Opponents of outsourced rehab billing often use the deficient denial follow up argument, which is a variation of a "zero-sum argument." It is based on an assumption that physical therapy billing service has a limited capacity for follow up and physical therapists receive selective follow up based on arbitrary criteria, such as unpaid balance. A win in terms of follow up effort for one physical therapist is a loss for another. The rehab billing service provider may skip follow up entirely, collecting the fee only on claims that were paid without any manual intervention and causing the payments to each physical therapist to shrink because of forfeited erroneous or delayed claims. But the rehab practice owner with in-house billing operation has all of its follow up capacity focused on a single practice and so, the argument goes, the in-house billing service must deliver better results than the outsourced service.

Measuring physical therapy billing quality, i.e., the percent of accounts receivable beyond one hundred and twenty days, exposes the fallacy of this argument. Note that ten percent improvement in overall billing quality means ten times more to the bottom line than one percent reduction in billing costs. Therefore, an outsourced physical therapy billing service provider charging a percentage of total collections has a larger incentive to improve overall payment performance and maintain better client loyalty than to sell a deficient service to another physical therapist.

In conclusion, rehab practice owners must establish objective performance and compliance criteria and use them systematically and within individual practice context when deciding about billing service outsourcing. Note that billing quality is a key component of the billing cost computation and the decision to outsource the billing service is based on a multi-fold improvement in billing quality. The rule of thumb is that the new combined percentage of fees and uncollected revenue outperforms in-house costs and A/R, and such performance improvement can be verified independently and continuously.