Success Story: How This Therapy Practice Increased Productivity by 46%

For Michelle Underhill, MA, CCC-SLP, entering the working world of speech therapy was fulfilling yet frustrating. She was helping others with a full range of communication, cognitive and swallowing difficulties in various settings when the harsh reality hit that healthcare is a business.

One of these realities came in the form of what’s considered a dirty word in the healthcare industry: Productivity. What she soon learned was that productivity equated to billable hours. Michelle remembered struggling with days when the patient needed her to focus on something other than the modalities listed for the day’s session. But, with the expectation to be “highly productive,” this was not always possible.

Michelle started to evaluate her current job and goals for her future. While treating patients, she discovered her passion for those with Parkinson’s Disease, which spurred a desire to specialize. In 2015, she opened Northern Colorado Therapy Services and ventured into the world of solo practitioner.

Going  out on her own, Michelle was confident in her skill as a speech therapist and her ability to serve her client population well. The scary part of the business venture was running the back office and billing side of her practice. This is where she turned to Kareo's practice management solution.

Michelle faced common challenges for independent providers who possess big goals and minimal staff. But Michelle didn’t shy away from the challenges, and she shares the tools and solutions she used to overcome her main practice management challenges:

Challenge: Timeliness of Billing Practices

For Michelle, staying on top of her billing practices was a scary thought. She initially worried about productivity, time management and timely billing. She conquered these challenges by adopting a workplace culture that placed timeliness as a priority.

Solution: Creating a Culture of Timeliness

“My onboarding specialist with Kareo gave me the best advice—bill at the end of every day,” said Michelle. By setting a personal culture of timeliness, Michelle is now able to process 10-15 claims per day while delivering the highest quality of care to her patients.

A process she once feared is now easy. As her business grows, this culture of timeliness is fostered with new staff. Michelle offered this advice: “If daily billing is not a doable expectation in your practice, just select a timeframe and stick to it.” A significant portion of Michelle’s success with billing practices is related to point of care documentation and the culture of her company.

Challenge: What Are Billable Services?

Every independent practitioner has had this question. There is an art to understanding billable services and implementing daily practices that allow clinicians to optimize their billable time.

Solution: Understand the Regulations and Implement Best Practices

Reading Medicare regulations is probably not your idea of fun. But, having first-hand knowledge of the rules and regulations is the best way to ensure you understand what is billable. Michelle spent a lot of time researching regulations before she opened her doors.

One mistake many practitioners make is documenting at the end of the day. This practice creates a chunk of non-billable time. A good practice is to document at the point of care. Collaborate with the patient while you document. Assess progress towards goals, provide education and create a new treatment plan with the patient. “The key to this practice is collaboration,” The patient must be involved in this process in order to be billable.

Challenge: Inconsistencies Between Staff

Every therapist completes their notes, assessments and modalities a bit differently. This is what makes each person unique in their practice. But in order to be efficient, there must be set processes and expectations.

Solution: Create Established Processes

Michelle has now expanded her practice to include a full-time Occupational Therapist and has plans for more growth soon. One of the tools that keeps them productive is a set of established processes. Policies and procedures set standards and take the guesswork out of workflow expectations.

“Following the processes has created efficiencies that allow us to feel that we can give more time to our patients. Neither of us feel that we are spread too thin,” says Michelle. 

Challenge: Who Do You Turn to For Help?

Independent practices often figure things out by trial and error. This fear was real for Michelle. She knew she did not want to go through this alone. She needed support.

Solution: Lean on the Experts

The billing experts at Kareo allowed her to become her own biller with ease. If she has questions, she simply turns to the staff at Kareo who know how to analyze payer reimbursement

“One of the greatest things about Kareo is that they find my errors and teach me how to not make that mistake again. They scrub the claims before they ever go to Medicare and know what will and won’t pass. And, they even help identify underpayments to ensure I get the most out of every visit.”

Challenge: Limited Time

Running a business with few staff members is challenging. Michelle is the owner, clinician, biller and a multitude of other roles. She knew from the beginning that she would not succeed without goals.

Solution: Plan Ahead 

Not a day goes by that Michelle does not look at the next day. In her culture of timeliness, she has also created a practice of always knowing what the next day brings.

She estimates that for every 1 hour she spends with a patient, it takes an additional 1½ hours to complete documentation, send the bill and receive payment. This planning allows her to be productive, efficient and deliver the highest quality of care.

Solutions Deliver Results

Productivity doesn’t have to be a dirty word. Using a metric derived from number of patients divided by hours worked, Michelle can review her practice’s productivity data and see positive results.

In 2016, with two full-time therapists, she and her staff were 34% productive, compared to 80% productivity in 2018 for the same period. This is a 46% increase in productivity which adds to her culture of timeliness in both the clinical and billings parts of her practice.

In 2016, Michelle’s practice had an average days revenue outstanding of 34 days. Today, she is down to an average of 22 days. As a result of implementing the right tools and processes, as her clinical productivity increased, her billing time decreased.

The reality of today’s healthcare system requires you to be aware of billable hours as part of your success. By creating consistent practices, you can be productive while delivering high-quality therapy care to your patients.


To learn more about how to raise the bar on your billing and clinical processes, contact Kareo today.

About the Author

Melissa has been a Registered Nurse for 20 years. She has an extensive background in Nursing leadership and obtained her Master’s in Healthcare Administration in 2016...

Subscribe to Our Newsletter!

Enter your email address to receive "Go Practice" as an email newsletter.

Kareo and PatientPop are now Tebra

The digital backbone for your practice success.

The combined power of Kareo and PatientPop

As leaders in clinical, financial, and practice growth technology, Kareo and PatientPop have joined forces as Tebra to support the connected practice of the future and modernize every step of the patient journey. Learn more