Skip to main content

Should You Bring Your PT Billing In-House?

PT staff going over patient billing

The visit billing process plays a crucial role in your outpatient rehab business. The kindness of your staff and the expertise of your therapists could not sustain your clinic alone if you didn’t get paid for services rendered – this is why ensuring timely and accurate compensation through an in-house or outsourced billing solution is vital. But which is better for you?

With the right software and training, bringing these responsibilities in-house may help consolidate your team’s workflows and simplify the reimbursement process – but some businesses find it easier to trust a third party with this part of running the business. In this article, we’ll explore some of the main considerations when deciding which route is best for your clinic.

Outsourcing vs. in-house

There are varying opinions on whether billing should be handled in-house or outsourced, and it often feels like a no-win situation for most practice owners. Prior to newer EMRs coming to market, managing billing for larger practices in an efficient manner seemed like a daunting task. It often required an individual to be highly knowledgeable in several aspects of the business to even consider handling it internally; even then, maintaining checks and balances was challenging, with a lot of room for error and risk. 

Outsourcing billing required less overall manpower, but it still presented similar problems, such as: 

  • Are we collecting everything we’re supposed to? 
  • Are we writing things off?
  • Do we have access to the KPIs we want?
  • Are the KPIs we’re seeing accurate?
  • What is the balance of the patient in front of me?
  • Did my claim process correctly?

As an organization, we talk with a lot of practice owners, and we’ve learned that most have tried both approaches and found similar outcomes but with different pain points. Let’s discuss them further.


Starting with transparency: Many billing tools and EMR systems lack the perfect level of connectivity to ensure seamless matching and reconciliation between platforms. This lack of transparency leads to discrepancies and difficulties in tracking and managing billing processes. When bringing billing in-house, practices have the opportunity to establish their protocols and implement quality control measures, resulting in increased transparency. They can have real-time access to billing information, ensuring accuracy and accountability. 

Achieving the desired level of transparency can still be challenging without a robust system in place. With a more advanced EMR, all your data is consolidated in one place, eliminating the need to cycle between multiple software solutions to access information. While you still require a billing manager in charge of it, the processes are streamlined significantly. This makes validating your data much less cumbersome.


Another consideration is control. In-house billing provides practices with direct control over their billing operations. They can customize the process according to their specific needs and have immediate access to their billing data. This level of control allows for quicker response times to billing inquiries and the ability to address issues promptly. 😉

Outsourcing billing to a service provider transfers control of the revenue cycle to that third party. While practices are able to request and review KPIs, they have no say in the prioritization of work. While this can alleviate the burden of managing billing internally, it also means relying on a third party to handle critical financial processes in the time you need them done. While access to an EMR that has great reporting doesn’t significantly change this consideration compared to those with lackluster reporting, it does make the process of maintaining control more achievable.


You can’t handle client billing without paying a couple bills, whichever approach you choose. In-house billing requires investments in personnel, training, software, and infrastructure, which can be expensive and also energy-consuming. Outsourcing helps consolidate these steps with one charge directly to the provider. However, it’s crucial to assess the fees and charges associated with outsourcing to ensure long-term cost-effectiveness compared with building these capabilities internally. With comprehensive software, organizations have considerably more data to make informed decisions regarding the cost of internal billing management compared to outsourcing it to another company.


The last major factor that should not be overlooked is the level of dedication and commitment to delivering high-quality results. It is exceedingly rare to find an in-house team of billers who do not prioritize doing an exceptional job, and it is even more uncommon to encounter a billing company that surpasses the care and dedication of individuals within your own business. 

This aspect, although difficult to quantify using specific KPIs or individual statistics, stands as one of the most prominent differentiators between in-house and outsourcing options. While an outsourced company might proudly proclaim a 95% accuracy rate, an in-house team might express disappointment, stating that they “only” have a 95% accuracy rate. Outsourced teams frequently overlook the fact that they are not solely handling numbers on a spreadsheet; they are managing processes that directly impact the individuals who interact with your business, either positively or negatively, and keeping the lights on at your practice. It is crucial to bear this in mind when considering the best billing solution for your therapy practice.

Choosing what’s right for you

Ultimately, the decision to outsource billing or bring it in-house is a complex decision that requires careful evaluation. The right answer for your clinic depends on factors such as practice size, resources, expertise, and priorities. Assess your individual practice needs and goals alongside your team to determine the ideal setup.

When to outsource billing

At times, outsourcing billing can be a smart choice, particularly when starting a new medical practice and juggling numerous tasks such as marketing, patient acquisition, physician relationships, and community engagement. It can also be beneficial to outsource when the organization is attempting to grow quickly and aims to minimize administrative burden. However, without proper oversight this can get you into a bit of trouble.

When to bring billing in-house

Bringing billing in-house is advisable when your practice is around 3-5 providers and the total cost of outsourcing approaches 6 figures. At this point, with the right tools and training, it is rare that an office team couldn’t do an equivalent if not a better job than a good billing company for a lower cost.


Clinical billing can be one of the more daunting aspects of running an outpatient rehab practice, and choosing the best approach for your clinic – whether outsourcing or handling it in-house – is a hugely important step. There is no one perfect solution, like with most aspects of running your business, and your team needs to consider all the factors to determine what’s right for you as you grow and scale your practice.

About the authors:

Matt and Dan are private practice owners located in Fargo, North Dakota. They were early adopters to Prompt and transitioned their billing operations to an in-house solution with their software migration. In addition to managing their practice, Matt and Dan operate a consulting organization called Enhanced Therapy Solutions (ETS), that provides billing consulting services to outpatient therapy practices. This encompasses the teaching and training of business owners and administrative staff to run their billing operations and understand all key components of the revenue cycle management process to be successful in the transition. If you are torn between in-house and outsourced billing, we highly recommend giving them a call.

Prompt Staff

Prompt Therapy Solutions builds practice management software for physical therapy clinics ranging from single provider practices and startups, to large enterprise organizations.

This will close in 0 seconds