Let's be honest, billing isn't why you got into healthcare. You opened your practice to help patients recover, improve their quality of life, and make a real difference. But somewhere along the way, you realized that running a therapy clinic means dealing with a mountain of administrative work, and billing sits right at the top of that pile.
So here's the big question: Should you keep billing in-house, or is it time to hand it off to the experts?
There's no one-size-fits-all answer here. Both options have their pros and cons, and what works for the multi-location PT clinic down the street might not work for your growing OT practice. Let's break it all down so you can make the call that's right for your clinic.
The Real Cost of In-House Billing
When people think about in-house billing, they often focus on control. And yes, having your billing team right there in the office does give you direct oversight. But let's talk about what that control actually costs you.
Staff Salaries and Benefits
A full-time medical biller typically earns between $45,000 and $60,000+ per year, depending on experience and your location. And that's just the base salary. Once you factor in employer taxes, health insurance, PTO, and other benefits, you're looking at a significantly higher number.
Now, what happens when your biller goes on vacation? Calls in sick? Decides to take another job? Suddenly, you're scrambling to cover claims, and your cash flow takes a hit.
Software and Technology
Billing software isn't cheap. Between subscription fees, clearinghouse costs, and the occasional upgrade, you could easily spend $3,000 to $10,000+ annually just on technology. And that doesn't include the time it takes to train your staff on new systems or troubleshoot when things go wrong.
Training and Compliance
Here's the thing about therapy billing, it's complicated. Timed codes, modifier requirements, authorization rules, and payer-specific guidelines are constantly changing. Keeping your in-house team up to speed requires ongoing training, which costs both time and money.
Plus, compliance is on you. If your biller makes a coding error that triggers an audit, your practice is the one on the hook.
The Hidden Cost: Your Time
As a clinic owner or director, every hour you spend managing billing issues is an hour you're not spending on patient care, marketing, or growing your practice. That mental load adds up fast.
What Outsourced Billing Looks Like
When you outsource your medical billing services, you're essentially handing off the entire revenue cycle to a team of specialists. They handle claim submission, payment posting, denial management, appeals, and follow-up, all while staying current on the latest regulations and payer requirements.
Most outsourced billing companies charge a percentage of collections, typically between 3% and 8%, depending on your specialty, claim volume, and the services included. That means you only pay when you get paid.
The Expertise Factor
Here's where outsourcing really shines. Professional billing teams live and breathe this stuff. They know the ins and outs of therapy billing solutions for PT, OT, SLP, and mental health practices. They understand modifier stacking, authorization timelines, and how to appeal denials effectively.
When you work with a dedicated billing partner, you're tapping into years of specialized experience without having to build that expertise in-house.
Scalability Without the Headaches
Growing your practice? Adding a new location? Bringing on more providers? With in-house billing, scaling up means hiring and training additional staff. With outsourced billing, your partner simply absorbs the extra volume. No job postings, no interviews, no learning curves.
Let's Compare: In-House vs. Outsourced Billing
Here's a quick side-by-side to help you see the differences at a glance:
| Factor | In-House Billing | Outsourced Billing |
|---|---|---|
| Cost Structure | Fixed salaries + benefits + software | Percentage of collections (only pay when you get paid) |
| Control | Direct oversight of daily operations | Managed by experts; less hands-on control |
| Expertise | Dependent on staff knowledge and training | Access to specialized billing professionals |
| Claim Accuracy | Varies with staff proficiency | Professional coders reduce errors and denials |
| Denial Management | Limited follow-up capacity | Dedicated teams for appeals and corrections |
| Compliance | Your responsibility to stay current | Billing partner handles regulatory updates |
| Scalability | Requires hiring and training | Scales seamlessly with your growth |
| Staff Burden | High, pulls focus from patient care | Minimal, frees your team to focus on what matters |
When In-House Billing Makes Sense
We're not here to tell you that outsourcing is always the answer. For some practices, keeping billing in-house is the right move. Here's when it might work for you:
✔️ You have a large, established practice with the resources to hire, train, and retain a dedicated billing team.
✔️ Direct control is a top priority, and you're willing to invest the time and money to maintain oversight.
✔️ You already have a rockstar biller who knows therapy billing inside and out and isn't going anywhere.
✔️ Your claim volume is high enough to justify the fixed costs of salaries, benefits, and software.
If that sounds like your situation, in-house billing can absolutely work. Just make sure you have a backup plan for when your biller is out of the office.
When Outsourcing Is the Smarter Choice
For many small to mid-sized therapy practices, outsourcing just makes more sense. Here's when partnering with a billing expert might be your best bet:
✔️ You're spending too much time on billing issues instead of running your practice or seeing patients.
✔️ Denials are piling up, and you don't have the bandwidth to appeal them effectively.
✔️ Cash flow feels unpredictable, and you're tired of chasing down payments.
✔️ You want cost efficiency without the overhead of full-time staff.
✔️ Your practice is growing, and you need a billing solution that can scale with you.
✔️ You want peace of mind knowing that experts are handling compliance and staying on top of payer changes.
The ALS Integrated Services Difference
At ALS Integrated Services, LLC, we specialize in therapy billing solutions for PT, OT, SLP, and mental health practices. We're not a giant, faceless billing company, we're a boutique team that treats your practice like a partner, not just another account number.
Here's what that looks like in practice:
✔️ Transparent reporting so you always know where your revenue stands
✔️ Dedicated attention from a team that understands therapy-specific billing challenges
✔️ Proactive denial management to recover revenue that might otherwise slip through the cracks
✔️ Streamlined processes that improve cash flow and reduce administrative burden
We take the backend headaches off your plate so you can focus on your mission: delivering exceptional patient care.
Frequently Asked Questions
Will I lose control of my billing if I outsource?
Not at all. A good billing partner keeps you in the loop with regular reports and open communication. You stay informed without being buried in the day-to-day details.
How long does it take to transition to outsourced billing?
Most practices can transition smoothly within a few weeks. We handle the heavy lifting so you don't experience interruptions in your cash flow.
Is outsourcing really more cost-effective?
For many practices, yes. When you factor in salaries, benefits, software, training, and the cost of denials, outsourcing often saves 20–30% compared to in-house billing.
What if I'm not happy with the service?
That's why finding the right partner matters. At ALS Integrated Services, LLC, we build relationships based on transparency and results. If something isn't working, we fix it: together.
Ready to Explore Your Options?
Choosing between in-house and outsourced billing isn't about finding the "right" answer: it's about finding the right answer for your practice. If you're feeling stretched thin, watching denials pile up, or just wondering if there's a better way, it might be time to have a conversation.
Thinking about making the switch? Let's chat about how we can take the load off. Visit www.alsintegratedsvc.com or call 513-597-1358.