Physical Therapy Billing | Understanding AR | Gain a Peace of Mind and Double Your Profitability

Yuval Lirov, PhD and Eldad De-Medonsa, PhD

Physical Therapy clinic owners complain about nightmares and headaches because of lack of control and low predictability of their cash-flow. Without the ability to predict your cash-flow, you cannot measure or control your profitability.

Your cash-flow fluctuates from month to month because of uneven patient flow and charge differences between various patient conditions. More importantly, your cash-flow fluctuates because of payers delay and underpay reimbursements.

A diligent and disciplined billing process helps reduce payer delay and underpayments. It starts with the ability to measure your accounts receivable (AR).  This article shows how to use simple calculations to reliably predict your cash-flow based on your earlier charges. Once we are able to predict it, we also show a simple and effective path to double your profitability.

Some practice owners approximate their next month payment expectations by averaging previous months’ payments. This method is flawed as it ignores the charge fluctuations due to month-to-month differences in patient visits.  Others extrapolate their next month payments by computing a ratio of payments to charges over previous months and applying it to the current month. This method is flawed too as it ignores month-to-month changes in billing performance.

The method described below avoids this flaw by computing a ratio of payments to charges over previous months and applying it to the current month extrapolation.

1. % AR > 120 – Definition

Insurance companies delay their payments to PT practices. According to the PTB-12 survey, insurance payment delay has the following distribution:

Physical Therapy Billing_chart

There are two ways to look at this chart:

  1. When will you get paid for the charges you posted this month?
  2. How much will you get paid this month for the charges posted in the previous months?

The table below illustrates both ways of interpreting the chart above and the impact of the payment delay:
physical therapy billing_AR

For instance, this month you will get paid 46% of the current month payments, 18% of previous month’s, 9% of the earlier month, and 6% of 3 months ago. The remaining 21% of 4 months and above will probably not get paid ever.

For this reason, the AR beyond 120 days is a reliable proxy for overall billing performance.  The Percent AR>120 is the percentage of charges not paid for over 120 days as part the overall AR.

2. How to compute monthly payments?

Ignoring the AR beyond 120 days that is unlikely to get paid, we arrive at a convenient way to predict our payments, given the past history of your charges:


3. Why a Reduction of %AR>120 is Important to Your Bottom Line?

To answer this question, let’s see what’s sensitivity of your bottom line to billing performance fluctuations. To this end, let’s take a change of 1% in %AR>120 and see what difference it makes to your collections.

1. Calculate sensitivity


2. Calculate the impact of significant performance improvement


physical therapy billing_AR120_Chart


physical therapy billing_AR120_Closeup


4. How Does an improvement on %AR>120 Impact Your Profitability?

Our research shows that industry average profit of a practice is 14.4%.


Returning to the example in the earlier section, the impact of reducing %AR>120 down to 9% is 15% in collection or $9,288 in added revenue. The extra $9,288 is all profit since all expenses were already paid. Therefore, the new monthly profit is a sum of the previous profit ($8805) plus the new addition due to improved billing performance:


physical therapy billing_profit