Physical Therapy Plus, an outpatient physical therapy practice in New Mexico, raised its revenue per visit from $103.57 in 2022 to $135.67 in 2025. That is a $32 per-visit increase, or 31%, over three years, during a period when Medicare lowered physical therapy reimbursement by about 10%. Days in AR were cut from about 30 to 15. The complexity the practice generated fell to roughly a quarter of where it started. Owner Petra Pirc did it without changing how her therapists treated patients, and with units per visit essentially flat. She did it with better data, better coding accuracy, a smarter payer mix, and a revenue cycle built to reduce complexity rather than absorb it.
From staff therapist to practice owner
Petra Pirc has been a physical therapist since 1998, with more than two decades of clinical experience. In November 2019, she took over Physical Therapy Plus, a well-established outpatient orthopedic practice founded in 1987 with locations in Los Alamos and Santa Fe, New Mexico. She bought it just before COVID.
Her story is a common one. A strong clinician takes a chance on ownership to build a better financial future, serve her community, and create a stable, potentially scalable business. What physical therapy school does not teach is how to run one. As Petra put it, when she took over she had no real awareness of what it meant to be a business owner, and no mentoring in place. Then the world shut down.
The practice survived COVID, in part through a PPP loan Petra pursued on instinct in the first weeks of the shutdown. But surviving is not the same as thriving. The practice ran in-house billing that Petra inherited from the previous owner, staffed by a biller who had been hired off the street rather than professionally trained. As Petra started paying attention, she saw the problem firsthand: denials piling up, reimbursement that was hard to recover once a claim was denied, insurers that were difficult to even reach. "The whole revenue was going down," she said. "The bank account was shrinking."
You're a revenue cycle business that does physical therapy
Petra met Robert Kowalick at the APTA Private Practice Section conference in late 2022, where he was speaking about revenue cycle. What drew her in was not a sales pitch. It was the way he framed the problem and the compassion behind it. She remembers a diagram of arrows pointing in different directions and then coming back together, and thinking, yes, this is genuinely difficult, and I want to understand it.
That framing is the foundation of the RCS model: a physical therapy practice is a revenue cycle business that performs physical therapy for revenue. That is the premise Bob built the business on, and the starting point for everything RCS does. What a clinician does for a living, from a financial standpoint, is convert provider time into potential revenue through CPT codes, units, modifiers, and clinical documentation. Potential revenue only becomes cash if the revenue cycle converts it. Anything that gets in the way is what RCS calls Revenue Cycle Complexity.
Bob approaches a business the way he was trained to approach a patient. A good physical therapist does not stop at symptoms; they find the root cause and change things there, so the result lasts. "That's our mindset as physical therapists treating patients," he says. "As a physical therapist owning a business, you have to think about your business the same way." Physical Therapy Plus became an RCS client in January 2023.
What Petra's numbers looked like in 2022
RCS begins with data, because the data tells the story. Looking at Petra's 2022 baseline against 2025 made the opportunity visible.
In 2022, Physical Therapy Plus was collecting $103.57 per visit, of which $23.23 came from the patient and $80.34 from insurance. Its average days in AR on the insurance side sat at about 30. On its own, that was not a bad number. But based on the practice's payer mix, RCS calculated a Target ADO of roughly 22 days, which produced an ADO Score of 131%. The clearer warning sign was the aging: 65% of the practice's insurance AR was more than 90 days old. That is the signature of a biller who does not have enough time to convert the accounts receivable to cash, falling further behind month after month.
The complexity number told the same story. RCS measures Objective Risks, which are anything that puts the practice's revenue cycle objectives at risk: a credentialing issue, an authorization problem, a patient registration error, a documentation gap, a verification-of-benefits issue, a software or clearinghouse problem, or a payer error. When Physical Therapy Plus started, about 16% of its volume carried an objective risk. That is an average number, not an alarming one. But the amount of time those risks add to the billing process is enormous, and it is what stands between a practice and its money.
Change one: coding the care they were already delivering
The largest driver of Petra's revenue-per-visit gain was how accurately her team coded the care they were already delivering.
In 2022, four codes made up about 97% of the practice's coding: therapeutic exercise (97110) at 37%, neuromuscular reeducation (97112) at 34%, manual therapy (97140) at 22%, and therapeutic activities (97530) at under 4%. That concentration is normal; nationally, about 90% of all physical therapy coding lives in those same four codes.
The change was not a change in treatment. It was a change in accuracy. Many therapists perform functional and neuromuscular work but default to coding all of it as 97110. As Bob explains it, the purpose behind what a therapist does is what determines the correct code. A six-inch step-up performed for quad strengthening is one code; the same step-up performed and documented to improve a patient's ability to climb stairs is another. "What we're talking about is explaining the why behind the what," Bob says. "You have to absolutely code exactly what you're doing and why you're doing it."
Getting there took real work inside the practice. Petra invested time educating her therapists on connecting the clinical purpose of an exercise to the right code, and made coding a recurring topic in staff meetings. By 2025, the practice was doing roughly 30% less 97110 and progressively more 97530, a shift that continued through the year. Units per visit barely moved, changing by less than 2%. Same care, same effort, a more accurate distribution of codes. Of the $32 per-visit increase, about $21 came from CPT distribution.
Change two: dropping the plans that paid the least
The second structural driver was a series of deliberate decisions about which insurance Petra was willing to accept.
Over time, the practice stopped taking the plans that paid well below its average and consumed the most time: certain Medicaid HMOs, fixed per-diem workers' compensation arrangements, low-paying commercial contracts on fixed rates, and other low-value HMOs. Together, those plans had made up roughly 7% of the payer mix while paying far below the practice's average revenue per visit. Eliminating them was a structural change to how the practice converts time into potential revenue. Of the $32 per-visit increase, about $11 came from payer mix optimization.
Those payers were expensive in a second way, too. The lowest-paying plans also tend to be the most complex to bill, consuming more of the billing team's time and generating more friction to get paid. Dropping them improved revenue and reduced complexity at the same time.
Change three: cutting the complexity that slows billing down
Better coding and a better payer mix determine what is on the table to collect. Collecting it is a separate job. "You can be the greatest physical therapist, do the best CPT coding, have the greatest payer mix, and still never get paid," Bob says.
This is where the RCS model does its most distinctive work. RCS breaks the billing process into 50 tasks and tracks time on each one to the minute, then uses that time data to identify what happened elsewhere in the practice to make a task slower and harder. The billing function is uniquely positioned for this, because it is affected by every other function in the practice. As Bob puts it, "the biller lives in the closet with all the skeletons and knows everything that's going on." RCS converts that experience into data.
The reason complexity matters so much is structural. Billing Time Demand, the time it actually takes to bill and collect, is driven far more by complexity than by volume. Bob has had clients running 500 visits a month whose billing took five times as much time as clients running 5,000 visits a month. Yet most of the industry staffs billing on a fixed time supply: a set number of people, a set number of hours. When complexity rises, a fixed supply cannot keep up, and the shortfall shows up first in accounts receivable. Comparing the highest-complexity practices RCS works with to the lowest, denial management time runs about 4,060% higher per claim. That is roughly forty times the work for the same claim.
Petra attacked this directly. She worked through the errors and omissions across her operation that were making her billing outcomes harder to reach. The result: her Objective Risk rate fell from about 16% of volume to 3.6%, which means the practice now creates roughly 23% of the complexity it used to. Days in AR were cut from about 30 to 15, roughly cutting the time to get paid in half. Fifteen days is close to as good as it gets; very few practices in the country can say their average days in AR is that low. And it is only possible because the underlying complexity is that low. As Bob frames it, the practice moved out of the "complexity creation business" and into the complexity reduction business, which is the only place a great outcome is reachable. "You have a certain number of firemen," he says. "They can only put out so many fires. If you're just lighting fire after fire after fire, eventually they can't put them all out."
The results, side by side
| Metric | 2022 (baseline) | 2025 (today) |
|---|---|---|
| Revenue per visit | $103.57 | $135.67 (+$32.10, up 31%) |
| Days in AR (insurance) | ~30 | ~15 |
| Objective Risk rate (per 100 visits) | ~16% | 3.6% |
| Complexity generated | baseline | ~23% of the original |
| Units per visit | baseline | changed less than 2% |
Of the $32 per-visit gain, roughly $21 came from CPT distribution and roughly $11 from payer mix optimization. The practice reached it without changing how its therapists treated patients, and with units per visit essentially flat.
Why it worked
Petra's results follow a simple chain that sits at the center of how RCS works: better data leads to better process, better process leads to better outcomes, and better outcomes lead to a better business. RCS supplies the data foundation, collaborates with the practice on improving process, and measures whether the outcome actually moved. "We provide the foundation of just the best data you can possibly have," Bob says. "We then work with you and collaborate on improving process. ... Then you have a better outcome. You have a better outcome, which means you have a better business."
The relationship is built to align incentives rather than pit them against each other. RCS operates an outcome-based model, so its fee decreases as the practice's outcomes improve and complexity falls. What Petra pays RCS today is less than she was paying for her full-time in-house biller. As Bob puts it on the episode, "This $32 a visit is 100% profit. It didn't cost you more. In fact, it cost you less." It is a genuine partnership; as Bob says of the outcome, "it's not my outcome, it's not her outcome, it's our outcome. We are a team."
The model also explains where the problems come from in the first place. After seven years of data across millions of claims, RCS has found that 71% of all revenue risks are created inside the practice but external to billing. Bob states it plainly on the episode: "The payer is not your problem. Your software's not your problem. You're the problem." He does not mean it as blame. He means it as good news, because the largest share of the problem is inside the practice's own control, which is exactly where a collaborative, root-cause partnership can fix it.
Structure is the throughline. RCS uses a parallel-process billing structure, with specialized roles for claim submission, payment posting, patient balances, and accounts receivable, and even separate people for statusing claims versus working denials. A small in-house operation, by contrast, usually runs a linear process: one biller submits claims, posts payments, handles patients, closes the month, and only then works AR with whatever time is left. That structure has a ceiling, and complexity pushes right through it. "Structure drives behavior," Bob says.
Petra's advice to other owners
Petra's biggest takeaway was about awareness. "You need to have the data," she says. "You need to understand and have a really personal experience with how all of these complexities of billing are affecting not just the bottom line, but also the burnout of my staff."
She recommends that owners spend a day in the shoes of the person trying to recover a denied claim, living the runarounds and the hold times. "If this is what it takes for us to get paid, I will do everything I can to avoid me or my people going through that kind of ineffective runaround." That firsthand experience is what motivated her to simplify, clean up her processes, and follow the steps RCS mapped out with her.
Three years in, her outlook has changed as much as her numbers. "I know that I can control my practice, that I can control the outcome, and now the foundation is there so that I can grow," she says. "You've changed everything around for us."
Find out where your revenue cycle stands
Petra's practice was never terrible; it was average, and average was quietly costing it revenue, time, and enterprise value. What changed the outcome was making the complexity visible, then reducing it at the root. As Bob tells practice owners: have you done everything under your control to get the best outcome for the structure you have? If the answer is no, that is where to look first.
Every RCS relationship begins with a revenue cycle assessment that quantifies the complexity inside your practice and the opportunity to improve your outcomes, shared with you at no cost and no risk.
Request Your Free Revenue Cycle Assessment
Listen to the full conversation with Petra Pirc on the Rehabbing Your Revenue Cycle podcast: https://rehabbingyourrevenuecycle.com/episodes/how-reducing-revenue-cycle-complexity-and-optimizing-coding/.
Frequently asked questions
How can a physical therapy practice increase revenue per visit?
Physical Therapy Plus raised revenue per visit 31% over three years, from $103.57 to $135.67, without changing how its therapists treated patients or billing more units per visit. The gain came from two structural changes: more accurate CPT coding distribution, which reflected the true clinical purpose of care already being delivered, and payer mix optimization, which eliminated low-paying, high-complexity plans. Of the $32 increase, about $21 came from coding distribution and about $11 from payer mix.
Does changing CPT coding mean changing how you treat patients?
No. In this case, units per visit changed by less than 2%. The therapists did not treat patients differently; they documented the clinical purpose behind what they were already doing so the correct code was used. As Robert Kowalick puts it, the why behind the what is what determines the code, and you must code exactly what you are doing and why.
How do you reduce days in AR for a physical therapy practice?
By reducing the complexity that consumes billing time. Physical Therapy Plus cut days in AR from about 30 to 15 as its Objective Risk rate fell from about 16% to 3.6%. Billing Time Demand is driven far more by complexity than by claim volume, so reducing errors and omissions across the practice frees the time needed to convert accounts receivable to cash quickly.
Where do revenue cycle problems actually come from?
Across seven years of data and millions of claims, RCS finds that 71% of all revenue risks are created inside the practice but external to billing, in functions like patient registration, verification of benefits, authorization management, and documentation. Because most of the problem is inside the practice's control, it is also where the greatest opportunity to improve is.
Do I have to outsource my billing to get these results?
No. RCS does not try to convince practices that bill in-house to outsource. Ascend Solutions supports in-house billing teams with the same data platform and infrastructure. The determining factor is structure and complexity, not who does the billing.