The short answer
Do your own billing if your caseload is small, your payers are simple, and you have the time. Hire a billing service if billing eats your evenings and you want to keep your practice. A third option is a setting where billing is handled entirely for you, such as a group or a supported network.
Should you do your own billing?
It makes sense when:
- Your caseload is small or mostly private pay.
- You take one or two straightforward payers.
- You like the business side and have time for it.
- You want to see every dollar move.
The cost is time, and the risk of missing denials or deadlines when life gets busy.
When does a billing service make sense?
- Billing regularly spills into evenings or weekends.
- Denials and aging claims are piling up.
- You take several payers or government programs with their own rules.
- You'd rather spend that time with clients or away from work.
Billing services usually charge a percentage of collections or a per-claim fee. You still own the practice, the contracts, and the risk of nonpayment.
What should you ask a billing service?
- How do you charge, and are there extra fees for appeals or patient statements?
- Do you handle eligibility checks and authorizations, or only claims?
- How do you work denials, and how quickly?
- What reports will I get?
- Do you have experience with CHAMPVA and VA Community Care, if I take them?
- Who owns my data if we part ways?
- Will you sign a business associate agreement?
What's the third option?
Work in a setting where billing isn't your job at all: a group practice, or a supported network. The tradeoff is control: you don't set the rates, and you work within their payer mix. The upside is that billing risk can shift off you, depending on the contract.
| Do it yourself | Billing service | Group or network | |
|---|---|---|---|
| Time spent | Most | Less | Least |
| Cost | Your time | A fee | Built into the arrangement |
| Control over rates and payers | Full | Full | Limited |
| Who carries denials | You | You | Depends on contract |
How ValorWell handles this
ValorWell is the third option for therapists serving Veterans and their families. ValorWell handles billing, claims, payer follow-up, and denials for CHAMPVA, VA Community Care, and Foundation-funded care. You're paid weekly for documented sessions, and denials don't come out of your pay.
Because it's nonexclusive, you can keep billing your own private practice, with or without a billing service, alongside ValorWell work.
Important limits
- No option removes documentation. Every model depends on complete notes.
- A billing service doesn't take on your financial risk. Unpaid claims are still unpaid.
- ValorWell sets the rates and the payer mix for its work. That's part of the tradeoff.