Occupational Therapy Practices
Insurance reimbursement lags, per-visit revenue, and school or facility contracts make OT cash flow harder than it looks. Books that show what you actually collected.
The Industry
An occupational therapist completes 25 sessions in a week. Insurance pays in 45 days if the claim is clean. Some claims get denied or adjusted down. The school district contract pays quarterly. The skilled nursing facility takes 60 days. By the time cash actually shows up in the bank account, it bears little resemblance to the work done that week. You can have a packed schedule and still wonder why the checking account feels tight.
Most OT practice owners are still treating patients themselves, often full schedules, which leaves no time to chase down why a claim was denied or whether the school district is two weeks late on a payment. The clinical work gets done. The billing gets submitted. But the gap between what was billed and what was collected becomes a black box. Revenue feels like a guess rather than a number you can trust and plan around.
Who This Covers
Who This Covers
Pediatric OT practices, outpatient clinics, therapists contracted with school districts, practices with skilled nursing facility or hospital contracts, solo practitioners, and multi-therapist practices. Any occupational therapy business dealing with insurance reimbursement lag and contract payment timing.
What Complicates It
What Complicates It
Insurance payments arriving weeks or months after services. Denials and adjustments that reduce what actually comes in versus what was billed. School district contracts that pay on their own fiscal schedule. Facility contracts with net 60 or net 90 terms. Therapist payroll whether per visit or salaried. Supplies and evaluation materials. A mix of payer types that each pay differently and on different timelines.
What We Handle
The books need to distinguish between what you billed and what you collected. Those are two different numbers, and the difference matters. We track insurance payments against billed amounts so you can see what actually came in from each payer. When a claim gets adjusted or denied, that adjustment shows up in your records instead of disappearing into the gap between expectation and reality. School and facility contracts get tracked as receivables with aging so you know when a payment is late and can follow up before it becomes a problem.
Beyond revenue tracking, we handle the cost side. What does it actually cost to deliver a visit when you account for therapist compensation, supplies, rent, and overhead? That number tells you whether your rates work. Tax preparation and planning fit into this picture too. Many OT practice owners are paying more in taxes than they need to because the entity structure is wrong or because nobody is doing the planning work ahead of time. We keep the books and do the tax work, so everything connects. The clinical billing stays with your billing team or clearinghouse. We handle the accounting.
Revenue Tracking and Receivables
Revenue Tracking and Receivables
Billed versus collected revenue tracked clearly. Insurance remittances reconciled against claims so you see what actually came in. School and facility contract receivables aged and monitored. Invoicing for contract clients handled if needed. Monthly reporting that shows real collected revenue, not just what was billed. Full-Service Bookkeeping configured for the way OT practices actually get paid.
Cost Visibility and Tax Work
Cost Visibility and Tax Work
Cost per visit calculated including therapist pay, supplies, and allocated overhead. Margin visibility that shows whether current rates actually work. Tax Strategy for practice owners including entity structure review and retirement planning. Quarterly estimated taxes set properly so April is not a surprise. All of it covered in the Bookkeeping and Tax Package for one monthly price.
What Goes Wrong
A practice owner looks at the schedule and sees 120 visits last month. Each visit bills at $150 on average. That feels like $18,000. But insurance adjusted some claims down to $110. A few got denied for authorization issues. The school district has not paid for last quarter yet. The skilled nursing facility is running 75 days behind. Actual cash collected was closer to $11,000. Without clean books that track collected revenue separately from billed revenue, you think you made $18,000 and spend accordingly. The cash shortfall feels sudden when it has actually been building for months.
The other problem is cost blindness. You know what you pay your therapists. You roughly know rent and supplies. But when someone asks what it costs to deliver one visit after all expenses, most practice owners have to guess. That guess is usually wrong. A visit that bills at $150 and collects at $115 might cost $95 to deliver once you account for everything. That is a real margin, but it is not the margin you thought you had. And if costs creep up while rates stay flat, the margin disappears without any visible warning in a schedule that still looks full.
Billed Revenue Mistaken for Collected
Billed Revenue Mistaken for Collected
Busy schedules that feel profitable but cash flow tells a different story. Insurance adjustments and denials that reduce actual collection below what was billed. No tracking system that shows the gap. Decisions made based on billed revenue when collected revenue is the only number that matters for cash flow and planning.
Receivables That Age Without Attention
Receivables That Age Without Attention
School contracts that pay quarterly but nobody notices when Q2 payment is three weeks late. Facility contracts at net 60 stretching to net 90 because no one followed up. Denied claims that could have been appealed but the deadline passed. Small slips that add up to real cash shortfalls over a year.
What Changes
Monthly financials show what actually came in, not what was billed. You see collected revenue by payer type and can identify which payers are paying promptly and which are dragging. Receivables get aged and reviewed so late payments get flagged early. You know the real number, and the real number is what you use for decisions. Cash flow becomes something you can plan around instead of react to. The gap between busy and profitable becomes visible and manageable.
The cost side becomes clear too. You know what a visit costs and whether your rates support the margin you need. When costs rise, you see it in the numbers and can respond with rate adjustments or cost controls. Tax planning happens throughout the year instead of April. Entity structure gets reviewed to make sure you are not overpaying self-employment taxes. Retirement contributions get timed correctly. The books, the taxes, and the strategy all connect because the same CPA handles all of it. If you want to talk through how this would work for your practice, reach out for a consultation.
Real Numbers for Real Decisions
Real Numbers for Real Decisions
Collected revenue tracked separately from billed. Payer performance visible so you can see which sources pay reliably and which do not. Cost per visit calculated so you know your actual margin. Financial statements that reflect reality and support decisions about rates, hiring, and growth.
Tax Work That Fits the Picture
Tax Work That Fits the Picture
Entity structure reviewed to minimize self-employment tax where it makes sense. Quarterly estimates set based on actual collections and seasonality. Year-end planning before December instead of scrambling in April. Business and personal returns prepared by the same CPA who keeps the books all year. Everything connected and nothing falling through the cracks.
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Tell us about your business and what you need help with. We'll ask a few questions, explain how we can help, and tell you exactly what it will cost.