How to choose a physical therapy billing company: 9 questions to ask

What makes physical therapy billing different

A billing company that does well for a general practice can still struggle with physical therapy. These are the areas where specialty experience shows up in the numbers:

• Timed codes and the 8-minute rule, where minutes must support the units billed.
• The KX modifier and the annual Medicare threshold, which need tracking per patient.
• Plan of care certification and progress reports, which payers check when they review claims.
• Payment adjustments for services furnished in whole or in part by assistants (CQ and CO modifiers).
• Visit limits and authorization rules that vary by commercial plan.

9 questions to ask before you sign

Ask every company the same questions, and write down the answers so you can compare them side by side.

1. Who will code and bill our claims, and what are their credentials? Ask for the team that will work your account, their certifications (for example CPC or equivalent) and their experience in physical therapy. A good answer names roles and credentials. A vague answer about "our team" is a signal to keep asking.
2. What does the percentage cover, and what costs extra? Get the included and excluded services in writing. Confirm the percentage applies to net collections, meaning money actually collected, and not to charges. Ask whether front desk work, prior authorization, credentialing and patient statements are included or quoted separately.
3. How do you apply the 8-minute rule and check units? Ask for a worked example and how they check billed units against documented minutes before claims go out.
4. What reports will we see, and how often? At minimum, monthly reports on collections, AR aging, denial rate by reason and clean-claim rate, with claim-level detail available on request. If you cannot see the claims, you cannot check the work.
5. How do you work denials and appeals? Look for denials worked by cause, appeals filed inside each payer window, and root causes fed back to coding and the front desk. Ask how long a denied claim waits before someone touches it.
6. How do you track the KX threshold? Ask how they follow each patient toward the Medicare threshold and what they review before adding KX.
7. How do you track plan of care certification and visit limits? Ask who monitors certification dates and authorization limits so visits are not billed outside them.
8. Who owns the data, and what happens if we leave? You should own your data, and payer accounts and portals should stay in your practice name. The contract should say how records and open AR are handed back and how long that takes.
9. Can we speak with a practice like ours? Ask for references in physical therapy. A company that cannot offer any is telling you how much specialty experience it has.

Red flags

• No named coders and no certifications.
• A fee based on charges instead of collections.
• No access to claim-level reports.
• A long lock-in with no exit plan or data return.
• Payments deposited into an account you do not control.
• No references in physical therapy.

How billing companies charge

Most charge a percentage of net collections. Some charge a flat monthly fee or a per-claim fee. Percentage pricing aligns the billing company with your cash, but the rate means little until you know what it includes. Compare the total cost for the same scope, and ask what is quoted separately.

What to check in the contract

• Term, minimums and notice needed to end the agreement.
• Who owns the data and the payer accounts, and how records are returned.
• How open AR is handled after termination, and whether a fee applies.
• A business associate agreement for HIPAA.
• Which services are included and which are quoted separately.
• How payments flow into your bank account.

How to compare two or three companies

1. Send each the same sample of de-identified claims and ask for a written review.
2. Ask each the same nine questions and record the answers.
3. Check two references in physical therapy.
4. Compare total cost for the same scope, not just the headline rate.

Where PhysiAssist fits

PhysiAssist bills for physical therapy practices with certified coders, a 24-hour chart turnaround and 99% coding accuracy on monthly internal audits. PhysiAssist charges 2.8% to 5% of net collections, depending on specialty mix, claim volume, payer mix and how clean your current process is. The rate covers coding, claim submission, payment posting, denials and AR follow-up. Front desk, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately. See pricing for details. We would rather you compare us with others using the questions above than take our word for it.

Frequently asked questions

How much does a physical therapy billing company cost?

PhysiAssist charges 2.8% to 5% of net collections, depending on specialty mix, claim volume, payer mix and how clean your current process is. The rate covers coding, claim submission, payment posting, denials and AR follow-up. Front desk, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.

What is the difference between a billing company and in-house billing?

A billing company takes over coding, claim submission, payment posting, denials and AR follow-up, usually for a percentage of collections. In-house billing keeps those jobs on your payroll. The right choice depends on volume, how clean your claims are now and how much management time you can spend.

Should a physical therapy practice choose a flat fee or a percentage of collections?

A percentage of net collections ties the billing company's pay to the money it brings in, while a flat fee is predictable but does not depend on results. Whichever you choose, get the included services in writing and compare the total cost across companies on the same sample of claims.

What are red flags when hiring a physical therapy billing company?

Watch for no named coders or credentials, a percentage of charges instead of collections, no claim-level reporting, long lock-in terms with no exit plan, payments sent to an account you do not control, and no references in physical therapy.

How long does it take to switch billing companies?

Plan for a few weeks of onboarding for credentials, payer portals, fee schedules and open AR. Ask the new company for a written transition plan that covers claims in process, so nothing ages out while the handoff happens.

Related: Physical therapy billing services, KX modifier: when to use it, 8-minute rule calculator.