Obviously, this is not an easy decision. There are two main considerations. The first is whether you, as the owner and manager, can best spend your time keeping up on all the changes that affect how you are paid and whether your time is best spent supervising the people and processes related to billing and collecting. Secondly, costs and personnel are important considerations. Most practices spend up to 12% to collect their accounts receivable. Costs not only include personnel, but also supply, postage, hardware/software licensing, maintenance, support, and staff education costs. Hiring and retaining qualified staff familiar with rehab billing is also a challenge. Losing your key billing person to maternity leave, illness, or transfer of their spouse can have a serious long-term impact on your cash flow.