How a practice recovered written-off revenue — and stopped paying a cut of every dollar
An ABA practice that left a percentage-of-collections billing model
This is the story of an ABA practice that recovered money it had already written off — claims billed through a previous platform that were never fully collected — and, in working out how, rethought the single largest controllable line in its budget. We've kept them anonymous, but the trap they were in is one of the most common (and most expensive) in this industry.
How the "managed billing" deal actually works
Their prior setup paired the software with a revenue-cycle-management (RCM) service priced the usual way: hand over your billing, and we'll take a percentage of everything we collect. It's pitched as alignment — "we only get paid when you get paid" — and for a stretched owner who never wanted to become a billing expert, outsourcing the whole headache feels like relief.
Then you do the arithmetic. RCM services in ABA commonly charge somewhere in the range of 5–8% of collections. Run that against a practice collecting, say, $2,000,000 a year: at 6%, that's $120,000 — every year, forever, growing as you grow. For that price you could staff a billing function several times over. And you're paying it for work that is, honestly, mostly repeatable: submitting clean claims, posting payments and ERAs, tracking authorizations, flagging denials, working aging. That's not artisanal labor — it's a workflow problem software is supposed to solve.
Frequently asked questions
Isn't "pay a % of collections" fair since they only get paid when I do?
It sounds aligned, but it buys you someone to do the work — not a guarantee you collect everything. A percentage of revenue, forever, for work that's largely automatable is a steep, permanent tax. And no outside service works your last, hardest denials as hard as the person whose money is actually on the line.
Does an RCM service ever actually make sense?
Yes — for a brand-new practice, or one growing faster than it can staff billing, RCM can be a sensible add-on that buys room to grow. The trouble is treating it as a permanent substitute for owning your data, your visibility, and your collections, priced as a cut of everything you earn. It doesn't take responsibility for your records or your results — that stays with you. So the real question is whether you're using it to accelerate, or to avoid owning something you can't actually hand off.
If a service is working my denials, why do claims still slip through?
Because appeals only recover claims denied in error. Some denials are genuinely correct — exceeding a payer's units-per-day cap (a Medically Unlikely Edit), a session outside the authorization, a code pairing the payer won't allow — and no one can appeal those away. The only way to keep that money is to never send the bad claim, which is front-end prevention (clean, scrubbed claims) rather than after-the-fact denial work.
Why would my old billing software create the problems an RCM service then charges to clean up?
It happens more than people admit: claims denied for documentation gaps the software let through, authorizations that quietly expired, data that didn't flow cleanly. Paying extra to have someone fix problems the platform itself introduced is a strange deal once you say it out loud.
If billing is "automatable," what work is actually left for me?
The repeatable parts — clean claim submission, payment posting, surfacing denials and aging — are workflow software should handle. What's left is judgment: looking at a denial, deciding if it was wrong, and picking up the phone to the payer. That's the part that needs a human with a stake, and it's exactly where in-house beats a detached service.
Can I really collect more doing it myself?
With full visibility into every claim — what was billed, paid, denied, and left on the table — the practice in this story went back through stalled and wrongly-denied claims and recovered revenue the old arrangement had written off. You keep what you collect instead of surrendering a percentage for the privilege.
They offered me free software if I sign up for RCM — isn't that a deal?
Free software in exchange for a slice of your revenue isn't free — it's the most expensive plan you can buy, paid as a percentage forever, with no guarantee of 100% collection. Worth asking: is a cut of every dollar you earn really cheaper than self-service billing you control?
How is Wilma's billing different from just another clearinghouse?
It's self-service billing with full visibility built into the same platform as your clinical and scheduling data — insurance captured at intake and carried through, pre-submission checks (AI add-on) to catch gaps before claims ship, and denials surfaced so you can work them. You keep the revenue and the control.