How to Set Up a Cash-Based Physical Therapy Practice Online

Read about cash-pay physical therapy rates and the benefits. Discover steps to setting up cash-pay based physical therapy at Healthie.

For many physical therapists, offering cash-based physical therapy services is becoming more commonplace. With more restrictions from third-party payers, decreased reimbursement rates, and increased time collecting payments - an out-of-network or cash-based payments structure provides a compelling alternative to insurance-only operations. This industry shift is only expected to increase. With 2021 Medicare cuts to physical therapy services and the lack of clarity that the future holds for reimbursement, many physical therapists are stepping away from insurance based practices and opening cash-based physical therapy clinics. 

Tipping the scale even further, the recent surge (and patient adoption) of physical therapy telehealth services, has created more opportunity for providers in the cash-based space.  Here’s what you need to know, to determine if a cash-based payment structure fits your practice goals, and find practical advice for setting up your physical therapy practice. 

Interested in transitioning your practice to telehealth? Learn how you can set up a free Starter account with Healthie’s EHR + telehealth platform by clicking here.

Benefits of a Cash-Based PT Practice 

There are many benefits to starting your own cash-based physical therapy practice, but the first one to mention is explained right in its name “cash-based.” In cash-based practices providers can bypass billing third party payers and directly bill the patient on the date of service. Patients then pay on the date of their physical therapy services via cash or credit card. 

There are multiple routes that cash-based practices can take in terms of billing their patients, but they do not have to submit to insurance. Out of network physical therapy providers do not belong to the insurance company’s network, and no contract exists between provider and insurance company. Providers do not necessarily have to abide by and partake in the in-network guidelines for billing set by the insurance company for a patient that they treat when they are out of network. By eliminating the time spent on billing to insurance companies, billing errors, and dealing with denied claims, physical therapists will have more time to devote to patient care.  

Providers in cash-based practices also have the freedom to decide the fee’s that they would like to charge for their services. In cash-based practices, you don’t have to be affected by reimbursement cuts, and are not necessarily limited by standard reimbursement rates. There are still legal and ethical guidelines to follow for billing in cash-based practices, however providers have more freedom in making decisions of how they will bill their patients. 

6 Steps to Set Up Your Cash-Based PT Practice 

In order to get started with setting up a cash-based practice online we have come up with a list of essentials that we think will get you going in the right direction:

1. Organize Your Patient Forms

Having the right patient forms is important for staying organized and patient ready through the start-up process. Deciding on the types of forms that you will be using on an everyday basis will lay the groundwork for your success. Providers at a cash-based practice will still need to know the patients past medical history and current condition. It is important that providers make a list of essential forms that all patients are to fill out prior to treatment. This forms may include:

  • Intake Forms
  • HIPAA Form
  • Consent Form
  • Covid-19 Screening Form (if in person)
  • Release of Information Form
  • Patient Testimonial Form

Having the above forms are a great way to make sure that your practice is compliant with legal guidelines and ensure a safe environment for the patient and providers. 

In addition to your baseline forms, it is important that physical therapists also have their documentation notes organized.  Even though cash-based physical therapy clinics are not submitting documentation to third party payers, documentation is still required. It is important that prior to starting a cash-based physical therapy practice you have an outline for your notes, such as initial evaluations, daily notes, etc. Having the ability to integrate forms will be important to consider when choosing a practice management platform. 

Ultimately, making sure you have the appropriate patient forms that are required legally in addition to the ones you want to use on a daily basis will keep you organized and move you one step closer to starting your clinic and treating patients. 

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Healthie offers a complete solution for practice management & client care.

2. Choose a Practice Management Platform

When choosing a practice management platform, the first thing providers should do is create a list of all of the features that they would utilize on a daily basis. There are many platforms that exist, but finding the one that meets the needs of your company will be necessary for your clinic's everyday operations. Below are a few key features to look for in a practice management platform:

  • Documentation software
  • Payment Integration
  • HIPAA compliance
  • Customizable templates
  • Messaging system
  • Telehealth features

Finding a customizable all-in-one system that will allow you to keep your patient files, documentation and payment methods in one place that is HIPAA compliant will decrease the stress of the business side of your practice. A key feature that has more recently come to light is the use of telehealth as a physical therapy service. More and more physical therapists have incorporated telehealth into their daily routines, and so integrating that into a telemanagement platform can ease the process of adding it to your everyday services.  Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs. 

Telehealth and Practice Management Platforms

Recently, more and more physical therapists have added telehealth to the list of services that they offer. By using telehealth, physical therapists can expand their outreach and continue helping people even when they can not come to their session in person. There are multiple benefits to utilizing telehealth at your clinic, and it adds as another revenue stream. That being said, when choosing a practice management platform it is important you take this into consideration. Providing telehealth services for physical therapy requires a platform capable of live, interactive audio and visual transmissions between patient and provider. For physical therapists specifically, providing virtual services requires some basic software:

  • HIPAA-compliant telehealth platform
  • EHR for chart notes
  • Stable internet connection
  • Laptop, computer, or mobile device to host sessions

When looking for HIPAA-compliance in a telehealth tool, there is no need to search for an add-on to what you already use to run your business. Choosing an integrated EHR and telehealth platform that is fully HIPAA compliant ensures that your client’s private health information is protected every step of the way. 

Utilizing a system that not only has HIPAA compliant video streaming capabilities, but also has HIPAA compliant message as well as abilities for HEP videos and photos is a great way to increase patient engagement. You can now work with your patients in between their sessions and stay updated with their progress. Finding a HIPAA compliant practice management software that offers all of these features can be difficult, but we are here to help.

3. Legally Establishing Your Clinic

An important part of starting your own clinic is making sure that all legal areas of your clinic are addressed and up-to-date. Hiring a lawyer to help you through these areas is a beneficial step that physical therapists should consider taking when thinking of starting their own clinics. Making sure you obtain all of the appropriate business licenses and liability insurance is important in ensuring that your practice meets legal standards. 

Contacting your local and state physical therapy boards as well as hiring a legal team will assure that your clinic is compliant, that the appropriate licenses and documents are obtained and that your clinic is following all the rules in order to be as safe and ethical as it could possibly be. 

Lastly, another aspect that falls into both the business and clinical side of the company are legal forms. As mentioned above, having items like HIPAA forms and consent forms are necessary in order to run your clinic by legal guidelines and should be used with every patient.

4. Set Payment Rates and Create Packages

Setting Cash Payment Physical Therapy Rates

As mentioned above, in cash-based physical therapy practices providers do not have to be limited to insurance based reimbursement rates. Providers have more freedom to choose the rates that they would like to charge for their services. That being said, there are legal and ethical guidelines that should be followed when setting your cash-pay rates for physical therapy services.

In order to be successful and avoid patients refusing your services due to unrealistic prices, the APTA  offers resources that can help guide you in the way you would like to be reimbursed for your services. 

Creating Packages

With case-based physical therapy, you have the ability to offer items such as special offers and packages for your services that you would not be able to do if you were using insurance for reimbursement. These special offers and packages can follow different guidelines based on times/days of the week, type of diagnosis, season, or new advancements in the field. 

For example, if you know that during the winter months you see an increase in patients with low back pain diagnoses you may have special offers in the fall on “low back pain prevention” or have a package that includes 3x a week for 3 weeks during the winter, specifically for treating people with low back pain. 

Having a cash based practice allows you these different opportunities that are somewhat limited in insurance based practices. Maximizing the ability to provide special offers and packages is a great way to gain new patients, and increase patient retention and engagement. Using telemanagement platforms that allow continued communication and lasting connections with your patients, like follow up reminders, incentives for referring new patients, email lists, and patient testimonials can also be a great way to stay connected to past patients while gaining new ones. You can also always check in with your clients through convenient client messaging or by setting up food, lifestyle, or activity journaling. Click here to learn how to set up these features with Healthie’s Free Starter Plan today. 

5. Building an Online Presence For your Clinic

In order for you to start a cash-based physical therapy practice online it is essential that you have an online presence. One of the most important assets to your digital marketing campaign is your practice website. Having a strong online presence has been proven to be an effective way in getting people to choose a provider. 

Creating a user friendly, informative website is important in attracting and driving leads. Your website acts as a first impression and should represent your practice's identity in totality. According to recent consumer research, 63% of patients would choose one provider over another due to a strong online presence. Many people may not understand what cash-based physical therapy is and it is important that you explain what it is alongside what you offer. By being upfront, you have the ability to attract more patients.

Physical therapy is an interactive practice and your website should be too. Having the ability to schedule appointments, ask questions or reach out to the provider with concerns is the link that is needed to start the relationship between provider and patient. Highlighting your clinic's specialities and specific services you offer can make you and the staff of your clinic stand out. 

Including patient testimonials is a great source of added support for your practice. Research found that “81% of patients will read reviews about their provider even after they have been referred.” Having patient testimonials on other platforms that include a “call-to-action” button that links them to scheduling an appointment on your website is a great way to drive traffic. 

6. Establish Referral Channels

In order to gain referrals, creating partnerships with local businesses can increase traffic to your website and your in-person practice. Marketing your services to other healthcare providers, wellness professionals, and local businesses is a great way to make connections in your community. It can also be another opportunity to increase awareness on what cash-based physical therapy is and all of its benefits. By educating other members in your community they too can help spread the word to potential future patients. 

Many of the patients that come through your clinic may also be members of local gyms or see other local wellness professionals. A referral partnership can take place between any provider who targets the same demographic of patients that your clinic does. Popular places to seek referral partnerships may be gyms, fitness centers, yoga studios, massage therapy clinics, chiropractic and other physician offices. Many of these providers may also be using telehealth services, and can potentially help guide you in developing a plan for how to promote and maximize on using it as a service. Referral partnerships benefit both parties involved. 

Healthie for Physical Therapists

Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs. With Healthie’s plans, you can easily incorporate your branding and marketing strategies directly into the platform. Create custom emails, add your logos, and build brand awareness using Healthie.  To set up a free Starter account with us today, click here.


Here’s what you gain when working with your physical therapy or occupational therapy clients via Healthie: 

  • Insurance Billing
  • Favorite ICD-10 & CPT Codes
  • Anatomical Charting
  • Patient Engagement
  • Payment Processing 
  • And much more

We have seen physical therapists and occupational therapists find success using Healthie within their practices. Whether you’re a solo practitioner or part of a multi-provider group or organization, our flexible membership plans adapt to meet your business needs. Let us help you launch your practice.

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