Case study · Outpatient physical therapy, 38 clinics

The front desk collected 107.7% of what was expected. 3,976 visits still went short.

Short answer: a billing company serving a 38-clinic PT franchise group asked if its front desk collected what it should. The total said yes. Visit-level data, January to September 2026, showed $158,818 slipping into patient AR and 1,626 arrived visits with no claim.

39,842 visits · Jan to Sep 2026 38 clinics · one PM and EMR platform 89,960 scheduled · Mar to Aug 2026 Diagnostic · no cash outcome claimed

October 27, 20265 min readASP-RCM Solutions

Edition

Oct 2026

Archetype

38-clinic PT group

Metric

107.7% collected

Horizon

Jan to Sep 2026

Focus

Front-desk cash

Length

5 min read

107.7%

Of expected patient responsibility collected at check-in: $1,577,518 against $1,464,208

3,976visits

Of 39,842 collected short of the estimate, one in ten

$158,818

Shortfall that became patient AR to be billed by statement

1,626no claim

Arrived visits with no claim, 796 of them older than 30 days

The windows we measured

One export, four clocks, and nothing yet called a result

Our first 30 days measured the $6.39 million AR book; this page reads the other half of the export: schedule and front desk.

1
Sep 2025Plan-of-care discharge window opens
2
Jan 2026Point-of-service window opens
3
Mar 2026Scheduling funnel window opens
4
Jun to Aug 2026Intake measured
5
Sep 2026ASP AR and VOB work begins; export received
6
Sep 17, 2026Review presented; cash outcomes open

Plans of care

Discharges Sep 2025 to Aug 2026: 26.3% stopped attending

Point of service

39,842 visits, $1,577,518 collected

Schedule funnel

89,960 scheduled, 85.5% arrived

Intake sizing

1,519 VOB, 491 auth units a month

ASP work

AR, VOB, review; cash not yet measured

Measured windowsClinical discharge windowModel from intakeASP engagement

Point of service

107.7% collected, 3,976 visits short

Point-of-service collections, January to September 2026

Over- and under-collections sit on different patients; only the under-collections become statements. ASP-RCM engagement records.

Expected at check-in39,842 visits

$1,464,208baseline, 100%

Collected at check-inthe total the group saw

$1,577,518107.7% of expected

Shortfall on 3,976 short visitsbecame patient AR

$158,81810.8% of expected, about $40 a visit

ExpectedCollectedUnder-collected, now statements

The visit-level view

What the distribution adds to the total

Measure	Value	How to read it
Visits in the window	39,842	January to September 2026
Collected at check-in	$1,577,518	107.7% of expected
Visits collected short	3,976	One in ten visits (3,976 of 39,842)
Shortfall that became patient AR	$158,818	About $40 per short visit (158,818 / 3,976)
Visits collected above the estimate	The balance of the 107.7%	Estimate quality, not surplus

The schedule funnel

89,960 scheduled visits before any claim exists

Scheduling funnel, March to August 2026

Growth hides the leak: 1,626 arrived visits had no claim, 796 already past 30 days and moving toward a filing limit [1].

85.5%arrived, 76,916 visits

11.2%cancelled

1.9%

Arrived85.5%About 76,900 visits; 1,626 of them had no claim

Cancelled by patient11.2%About 10,100 visits

No-show1.9%About 1,700 visits

Growth and plans of care

More visits, shorter plans

Same-store arrived visits, year over year

The month compared; more visits, more places for a claim to go missing

6,181

Prior year67% of current

9,188

This year100%

+48.6% arrived visits

Median visits per plan of care

Sep 2025 to Aug 2026; 26.3% of discharges stopped attending

12 visits

Completed plan100%

5 visits

Stopped attending42% of a full plan

7 fewer visits billed than the plan written

TakeawayStopped attending is a front-desk and scheduling signal first, a revenue signal second.

Sizing the front-end work

1,189 new cases a month becomes 1,519 VOB and 491 authorization units

Input	Value	Unit of work	Status
New cases per month	1,189	One primary VOB each	measured, Jun to Aug 2026
Cases with a secondary plan	27.7%	A second VOB each	measured
Cases on auth-type plans	20.6%	An authorization request each	measured
VOB units per month	1,519	Sets staffing and queue rules	model, not measured throughput
Authorization units per month	491	Where missing-authorization denials start	model, not measured throughput

Why it mattersThe first production review found 60% of AR denials were front-end: invalid insurance or coordination of benefits, missing authorization, taxonomy. These queues are where they start.

What we put in place

Six reports that turn the percentage into names and dates

Short-visit list by clinic

Every visit below its estimate, by clinic and week
The 3,976 as names and dates

Estimate versus collected per visit

Over-collections flagged as estimate errors
Target: a narrow band around 100%

Arrived, no claim

Daily report, oldest first
The 796 over 30 days go before new ones

Stopped-attending list

Plans that ended early, by clinic, for clinical and scheduling teams
We report; the clinics decide

VOB and authorization queues sized from intake

1,519 VOB and 491 authorization units a month
Rules set before the first case

Front-end denials routed to root cause

Taxonomy, COB and authorization denials go back to the intake step
Not to a rework queue

What is still open

Reported as measured, including what is not a result

$0
No cash or net collection result yetThe payment file has not been supplied; nothing here is a collection outcome.
AR
The $158,818 may already be partly collectedStatement and portal payments on those visits were not in the export.
VOB
The VOB and authorization figures are a modelSized from intake; measured throughput comes later.
271
Eligibility automation is a separate storyThe engine-level eligibility and 271 findings for this group: one-call VOB and 271 gaps.

For other PT groups

Judge the front desk by the distribution, not the total. A clinic can collect 107.7% and still send one patient in ten a $40 statement that costs more to chase than it returns. Arrived visits with no claim never show in an aging report, because no claim exists to age.

FAQ

Frequently asked questions

How can a front desk collect more than 100% of expected and still have a leak?

The total nets over-collections against under-collections on different patients: $1,577,518 collected against $1,464,208 expected, while 3,976 of 39,842 visits were short by $158,818. Over-collections are estimate errors; under-collections become statements.

What is an arrived visit with no claim?

A visit the patient attended, recorded in the schedule, with no claim created. The group had 1,626, 796 older than 30 days. They never appear in an aging report because there is nothing to age.

Why size VOB and authorization work from intake?

Intake gives the real volume: 1,189 new cases a month, 27.7 percent with a secondary plan, 20.6 percent on authorization plans, so 1,519 VOB and 491 authorization units a month. That sets queue rules before the first missing-authorization denial.

Are these results?

No. They are first-30-days findings, reported as measured. No payment file, so no cash outcome is claimed; statement collections on the 3,976 short visits were not in the export.

Sources

Checked October 27, 2026. Client figures are ASP-RCM engagement records for one organization, reported as measured; confirm regulatory sources before relying on them.

ServicePhysical therapy billing services MatrixTherapy payer matrix ToolTherapy units calculator Case studyPT franchise AR baseline, first 30 days Case studyPT visit-to-claim reconciliation Case studyCorePulse one-call VOB and 271 gaps White paperPT billing services vendor scorecard 2027

See your front desk at the visit level

Send a schedule and point-of-service export. We show expected versus collected per visit, arrived visits with no claim, and the VOB and authorization volume your intake generates.

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