HealthActions Physical Therapy and Fitness runs 11 offices and around 8,000 visits a month. Across all of it, patient accounts receivable sits at 58 cents per visit. The national average is $37.86. HealthActions has no patient AR over 30 days old, anywhere. As of one recent July, the practice's entire patient AR balance was a little over $5,000 for an 8,000-visit-a-month operation, and every dollar of it was current. This is a look at how co-owner Debbie Powell and Director of Administration Jean Weatherly built a patient-payment system that beats the national average by more than sixty to one, and why it comes down to execution rather than anything magic.
Robert Kowalick has partnered with HealthActions for five years, coaching Debbie and Jean on their revenue cycle policies and procedures, sharing the financial-agreement and credit-card-authorization forms the practice still uses today, and benchmarking their results against RCS national data from PT practices across about 30 states. What follows is what that collaboration has produced, executed every day by the practice's own front-desk and clinical teams.
Patients are paying more of the bill than they used to
Patient cost shares are one of the most common revenue leaks in a physical therapy practice, and they are growing. In RCS national data, the average amount of money coming out of a patient's pocket was 16.1% of total practice revenue in 2023. By 2025 it was 20.22%. That is a 25% increase in two years, and the trend is likely to continue.
That share matters more than it sounds, because it lands on a thin margin. The average physical therapy practice runs a profit margin around 10%. When a fifth of your revenue depends on collecting directly from patients, patient financial responsibility stops being a front-desk afterthought and becomes a core revenue cycle function that has to be designed, managed, and executed. Meanwhile the rest of the picture is moving the wrong way; Bob cites APTA data showing Medicare revenue down 40% over the last ten years. Raising prices is not an option. As Debbie Powell puts it, "one of the sad things about our industry is we can't increase our prices." What you can do is collect what you have already earned. HealthActions has grown by about 1,000 visits a month over five years and lifted revenue per visit by five to six dollars in the same period, going against the trend rather than with it.
What HealthActions' patient AR actually looks like
RCS converts total patient AR to a per-visit basis using the practice's current monthly run rate, then compares it to national benchmarks. The gap is not small.
The national average of patient AR per visit is $37.86. HealthActions is 58 cents. On current, zero-to-30-day patient AR alone, the national average is $4.15 per visit and rising, up 37% over two years. HealthActions is still 58 cents, because that 58 cents is all they have; they carry no patient AR older than 30 days. Nationally, 89% of patient AR is more than 30 days old and 64% is more than 120 days old. At HealthActions, both numbers are zero.
Measured against production, which RCS considers the more meaningful view, patient AR as a percentage of total gross charges runs 12.74% nationally. HealthActions is 0.23%. And the time-of-service collection shortfall, the amount a practice would need to collect from each patient at each visit to carry no patient AR at all, averages $4.94 per visit nationally. At HealthActions it is 76 cents.
"The difference," Bob says, "is execution." The process itself is not a secret. Taking a best-practice process and actually doing it, monitoring it, and holding the team to it is the hard part, and it is the part HealthActions has solved.
Train everyone, not just the front desk
The first thing that separates HealthActions is who gets trained. Most practices train the front desk to ask for money. HealthActions trains everyone.
"We not only train the front office, but we also train all of our professional staff as well," Jean says. The reason is that most people who do not work in billing do not understand how an explanation of benefits works, or how a deductible applies before insurance pays anything. So HealthActions teaches its clinicians the same material it teaches the front desk: how insurance actually processes a claim, what a deductible does, and the fact that the practice collects nothing for a visit against an unmet deductible unless it collects at the time of service. When the whole team understands that, the clinician understands why the front desk is asking the patient for money, and can reinforce the value that justifies it.
That is the second half of the system. When a patient pushes back that $25 a visit is a lot of money, the answer is not a discount. "Their health is worth that," Jean says. "Don't they think their health is worth that?" The clinical experience is what makes the patient believe it. As Debbie tells her therapists, "we're only as good as our last visit." If every visit delivers value the patient can feel, paying their share feels reasonable, and they keep coming back to finish their plan of care.
Collect at the time of service
HealthActions collects at check-in, at the time of arrival, every visit. Jean's team treats it as a habit they are building with the patient, not a confrontation. "Everybody is a creature of habit," she says. "It only takes a couple of visits to train a patient that you will be seeking that copay whenever they check in." The reverse is also true; skip it a few times and you train the patient that you are not going to ask.
Knowing what to ask for is its own discipline. HealthActions sets a standard of $140 per visit toward an unmet deductible, and collects the copay amount where there is one, which for many plans runs around $25. The front desk knows the right number by patient because it is written down: the practice keeps an operations manual and a separate manual called simply "verifying and handling insurance," broken down by each insurance type. Benefits are verified up front, with two centralized staff available when a front desk has a question. And because deductibles reset, everything gets re-verified every January 1, with the collection amount adjusting through the year as patients meet their deductibles. The amount a practice asks for in January is not the amount it asks for in August, and HealthActions builds that seasonality into its process.
Have a plan B: a card on file
Some patients will not pay at the visit. HealthActions plans for it. As part of the financial arrangement every patient signs at the start of care, the practice asks to keep a credit card on file, with terms stated plainly: "after all insurance efforts are exhausted, they will be charged for any remaining balance," Jean says. The patient initials that section and signs at the bottom, so there are no surprises later.
The card is stored securely inside the EMR, not written on sticky notes around the office. When a balance remains after discharge and insurance has finished, the finance department calls the patient, states the balance, and tells them the card is being run, so the charge is expected rather than a shock. HealthActions is also careful on the other side of registration: because many of its patients carry secondary insurance, the team coordinates benefits and avoids sending a patient a statement for something a secondary plan will cover. Getting the primary and secondary right at registration is what keeps wrongful patient statements, and the phone calls they generate, out of the system entirely.
Measure it, and tie it to pay
None of this holds without measurement. HealthActions audits time-of-service collection weekly, pulling what was due against what was collected and assigning a collection rate, then reviewing it with every front office team member. "We do audit and we do our weekly stats," Jean says. "We look at that on a weekly basis with all of our front office team members."
The practice then connects that metric to compensation. Team members have measurable items they are accountable for, and maintaining them makes them eligible for a monthly bonus. As Debbie describes it, they are eager to participate and want to do well, which makes the right behavior something the team pulls toward rather than something management has to push. Structure, measurement, and incentives point in the same direction.
Why it works: execution, not magic
Asked whether there is some special ingredient that makes HealthActions different, Jean's answer is deflating in the best way. "I don't think so," she says. "I think it's just you set your policy in place, you define your procedures and then you do it consistently." Bob's framing is the same: these are normal practice owners and administrators with normal patients and normal team members who do an abnormally good job of executing structure and getting the team to want to do it.
That is the whole point of the RCS model. A physical therapy practice that depends on third-party reimbursement is a revenue cycle business, and a revenue cycle, as Bob likes to put it, is a lot like a patient's body; there is always opportunity to rehab it and make it better. The parts of patient collection are ordinary on their own: verify benefits, determine what is owed, collect it at the time of service, keep a card on file for the rest, enforce the policy you wrote, train the whole team, and let the clinical experience carry the value. Put every part in order and the outcome takes care of itself. Take any one part out of order and it can drag down the whole result.
There is a cost to skipping it that most owners never measure. Nationally, 64% of patient AR is more than 120 days old, and as Bob points out, that money rarely arrives. "If you don't do it successfully on the front end, you never do it," he says. It sits in AR, it generates statements and phone calls and follow-up, and it becomes a time inflator on top of a revenue loss. Getting close to zero patient AR is not only a financial win; it removes all of that wasted time, which is why the efficiency of a billing process and the financial outcome of a revenue cycle always move together.
The results, side by side
| Patient AR metric | National average | HealthActions |
|---|---|---|
| Patient AR per visit | $37.86 | $0.58 |
| Current 0 to 30 day patient AR per visit | $4.15 (up 37% in two years) | $0.58 |
| Patient AR over 30 days old | 89% of total | 0% |
| Patient AR over 120 days old | 64% of total | 0% |
| Patient AR as a share of production | 12.74% | 0.23% |
| Time-of-service collection shortfall per visit | $4.94 | $0.76 |
Context: patient payments have risen from 16.1% of practice revenue in 2023 to 20.22% in 2025 nationally, on an industry with a profit margin around 10%. HealthActions runs 11 offices and roughly 8,000 visits a month, and its entire patient AR balance was recently a little over $5,000, all of it current.
What Debbie and Jean would tell you
Jean's advice is the version she lives: set the policy, define the procedures, and do it consistently. The systems are worth building, but the paper is not the point. "I think that just making sure that all the staff understand it and that all the staff follow it" is what matters, she says, which is why the training and the weekly audit exist.
Debbie's addition is about the clinical side of the same coin. Value is what makes collection possible. If the team makes a real difference every visit, patients keep their appointments and pay their share without friction, and the whole revenue cycle gets easier. That belief, trained into the clinical staff and reinforced at the front desk, is the engine underneath the numbers.
Find out where your patient collections stand
Patient financial responsibility is often the lowest-hanging fruit in a practice's revenue cycle, and most owners have never measured how much of it they are leaving on the table. Every RCS relationship begins with a revenue cycle assessment that quantifies where your patient AR and your collection process actually stand against national benchmarks, and where the opportunity is, shared with you at no cost and no risk.
Request Your Free Revenue Cycle Assessment
Listen to the full conversation with Debbie Powell and Jean Weatherly on the Rehabbing Your Revenue Cycle podcast: https://rehabbingyourrevenuecycle.com/episodes/the-patient-payment-systems-for-clinic-owners-to/.
Frequently asked questions
How do physical therapy practices collect patient balances effectively?
The most effective practices collect at the time of service, every visit, and build the whole system around it. HealthActions verifies benefits up front, sets clear amounts to collect by patient (for example, a standard toward an unmet deductible plus any copay), keeps a signed credit card on file for balances that remain after insurance, trains the entire team on how insurance works, audits collection weekly, and ties the collection metric to a monthly bonus.
Why train clinicians on patient collections and not just the front desk?
Because clinicians reinforce the value that makes a patient willing to pay. HealthActions teaches all professional staff how deductibles and EOBs work, so the whole team understands that the practice collects nothing for a visit against an unmet deductible unless it collects at the time of service. When clinicians understand it, they support the front desk instead of undercutting it.
How much patient AR is normal for a PT practice?
Nationally, patient AR averages $37.86 per visit, and 89% of it is more than 30 days old. HealthActions runs 58 cents per visit with nothing over 30 days old. The gap is not the process itself, which is well known; it is consistent execution of that process across every office and every visit.
Why do patient balances matter so much financially?
Patient payments have risen from 16.1% of practice revenue in 2023 to 20.22% in 2025, while the average PT practice runs a profit margin around 10%. When a fifth of revenue depends on collecting from patients, uncollected patient balances come straight off a thin margin, and aged patient AR rarely gets paid at all.
How did Revenue Cycle Solutions help HealthActions?
Robert Kowalick partnered with HealthActions for five years, coaching the team on their revenue cycle policies and procedures, sharing the financial-agreement and credit-card-authorization forms they still use, and benchmarking their patient-payment results against RCS national data. RCS works with practices in two ways: full outsourced revenue cycle management, and, through Ascend Solutions, supporting practices that manage billing with their own team.