Voices in Health and Wellness
Voices in Health and Wellness is a podcast spotlighting the founders, practitioners, and innovators redefining what care looks like today. Hosted by Andrew Greenland, each episode features honest conversations with leaders building purpose-driven wellness brands — from sauna studios and supplements to holistic clinics and digital health. Designed for entrepreneurs, clinic owners, and health professionals, this series cuts through the noise to explore what’s working, what’s changing, and what’s next in the world of wellness.
Voices in Health and Wellness
The Revenue Cycle Reality Check with Christian Robertozzi
The financial health of your healthcare practice depends far more on what happens after patient care than most practitioners realize. Dr. Christian Robertozzi, physical therapist and co-founder of Total Care PT Billing, pulls back the curtain on the misunderstood world of healthcare billing in this eye-opening conversation.
Drawing from his dual experience as both a practicing clinician and billing specialist, Robertosi challenges the common belief that declining revenues stem from poor insurance reimbursement rates. "The revenue is there," he explains, "it's just good billing is not." This perspective comes from helping numerous practices literally double their monthly income without seeing additional patients—simply by implementing proper billing practices.
Most clinic owners operate in financial darkness, too busy providing patient care to monitor what's happening behind the scenes. They don't realize their billers might be quietly writing off denied claims instead of fighting for proper payment. The solution starts with accountability: dedicating just 30-60 minutes monthly to reviewing basic metrics like accounts receivable reports and CPT code reimbursement rates. This simple habit creates the visibility needed to identify and fix revenue leaks.
What makes this conversation particularly valuable is Robertosi's willingness to share specific, actionable advice drawn from years in the trenches. He outlines exactly which financial metrics matter most, how to interpret them without advanced financial knowledge, and the warning signs that your billing operations need attention. Whether you're struggling with practice finances or simply want to maximize your rightful reimbursement, this episode provides the blueprint for transforming your practice's financial health.
Ready to reclaim what's rightfully yours? Subscribe to our podcast for more insights from healthcare leaders who've mastered the business side of patient care, and share your billing challenges with us in the comments.
📇 Guest Contact & Social Info
Name: Dr. Christian Robertozzi, PT, DPT, OCS
Title: Co-Founder, Total Care PT Billing
Email: doc@thatstheknot.com
Website: https://totalcareptbilling.com
Location: Bentonville, AR
Company: That’s The Knot PT (formerly) / Total Care PT Billing
LinkedIn: https://www.linkedin.com/in/christian-robertozzi
Hello everyone and welcome back to Voices in Health and Wellness. I'm your host, dr Andrew Greenland, and on this podcast we sit down with practitioners, clinic owners and health leaders who are doing the real work, and today's guest brings a unique perspective on one of the most overlooked issues in private practice billing. Dr Christian Robertosi is a physical therapist and orthopaedic specialist who's seen the system from the inside. He's also the co-founder of Total Care PT Billing, a company that helps clinics streamline their revenue cycles and finally get some clarity on what's coming in and what's leaking out. Christian, thank you very much for being on the podcast today.
Dr Christian Robertozzi:I started a relationship with Prompt and Prompt started sending us referrals, and so what we've seen in the last two and a half years of having this billing company is that a lot of these clinicians are very much like me, at least on the front end. They really don't know what's going on in their clinics. At least on the front end is they really don't know what's going on in their clinics. And so we're going about taking. You know, we see two different types of clinics. We see the new clinician, so they're starting from scratch and that's easy. There's nothing that we need to track down. But the bigger headaches and issues out there that maybe we can talk a little bit more about is we have these clinics that are established. They're seeing a fairly high amount of patient streamlining in patients coming into their clinics. So they figure, since the money's coming in, everything's good. And then usually once their biller, their previous biller starts to taper off in the effort, they see revenue drop down. Then they start to get upset, and so what we see is you know, people complain about reimbursement with insurance, but my experience has shown me that the reimbursement for the most part.
Dr Christian Robertozzi:There are a few exceptions out there in the country, a couple of states that notoriously reimburse lower.
Dr Christian Robertozzi:The revenue is there, it's just good.
Dr Christian Robertozzi:Billing is not, and because the clinician is just running around trying to see these patients and keep his or her head above water, just seeing these patients getting the documentation done and submitting the claim to us so that they can get paid. They really don't know what's going on behind the scenes, and so they assume that when their revenue starts to taper off, it's because insurance is reimbursing them poorly, and really, to taper off, it's because insurance is reimbursing them poorly, and really it boils down to they're not paying attention to the claims that are not being paid, you know rejections for whatever reason, and and they're not they're not staying on top of their staff, and so because they're just assuming that everybody else is doing their job like they are, that everything is the insurance company's fault, and really it, it, more times than not, seems to be internally. If they can get their systems in place, their revenue goes back up and they're they're doing better. So that's that's kind of what we're doing in a nutshell and where we see some of the problems with clinics right now got it.
Dr Andrew Greenland:So this sort of the genesis of this business was really out of, perhaps, a sense of frustration or the fact that there's a big hole in the whole industry in terms of how this process works, from the billing aspects through to the reimbursement although you say the reimbursement is not the problem, it's everything else. But you've really driven to do this by virtue of the problems you were having in your business. Is that a fair thing to say?
Dr Christian Robertozzi:yeah and and uh. I mean I've seen it several times with the clinics that we we do take over. You know we're not business people by by trade and so we really don't know what's going on. You know, you just kind of fumble through it and then you know. I think I just took um understanding the revenue cycle a little bit more seriously than most other people do. It's a headache, it's hard right, Like I have my you know my staff chasing down pre-authorizations, trying to get more visits for people, just figuring out what the actual, you know like insurance benefits aren't necessarily listed correctly in these portals, and so then that leads to the person, the insurance verification specialist, to make a phone call. It's a lot of work just so that you can get paid. You know when, once you do your job, and so I can see why people would be hands off.
Dr Christian Robertozzi:It's very complicated and um it's, it's very complicated and, um, it's it's tough to understand. And then finding the people that actually can do it, um, are, they're out there? They're absolutely out there, but it it takes knowing a little bit about that to vet these people before you hire them, and that's also tough and time consuming yeah, so what does your day-to-day look like now?
Dr Andrew Greenland:I mean, are you still involved in patient care? Are you fully focused on the billing operation side of things?
Dr Christian Robertozzi:Yes, I have. I have my own clinic. It's been operational now for eight years, but then we started total care and so we about two and a half years ago. And so the clinic is a job for me. I'm very much in it, working in it, seeing patients Monday, wednesday, thursday and Friday. On Tuesdays I kind of dip back into the total care side and make sure that everything's going well and working with the staff and seeing what needs to improve or whatever. But yeah, I'm in both. But the total care is more of a business for me.
Dr Christian Robertozzi:You know, sarah is my chief billing officer. She's been with us for the last two and a half years and she's a superstar. She understands the revenue cycle from start to finish. She understands cpt codes, she understands hipaa compliance and all that good stuff. So she's the one really leading and HIPAA compliance and all that good stuff, so she's the one really leading the rest of the team. And then we have a really great team of billers as well as insurance verification specialists, and so, yeah, I'm in both and enjoy it.
Dr Christian Robertozzi:We've been able to help a bunch of clinics go from like being on death's doorstep to doubling their revenue. They can keep their doors open and continue to grow and flourish. That's the part that I enjoy. I was never quite that far along in terms of having my revenue dry up, but I've felt that pain and I'm sure if any other clinician is listening to this right now, whether they know it or not with probably a few exceptions out there they've gone through that pain of not having money come in like it should, and they work hard. You know they deserve it. They need to pay their staff, so they're dealing with the stress of making sure that everybody is paid, so I take a lot of pleasure in knowing that that's one less thing to worry about. It really shouldn't be on their plate to begin with, but it comes to their attention once it gets bad enough. So we like to help out got it.
Dr Andrew Greenland:So you, I mean, are you servicing other clinics in this niche or you extended it to the wider sort of health and wellness um industry we're, we're, we're pretty specialized.
Dr Christian Robertozzi:So I'm a physical therapist by trade and so I understand that coding um. I have a relationship with a um, an emr company, prompt, which is a really killer uh platform. It's billing um. The billing portion of that platform is incredibly strong and so I liked it. As a clinician, I it allowed me to see everything. So once my my business partner was like hey, we should, we should go and do this ourselves. We just reached up to them and said, do you do referrals? And like, yeah, sure, so that was those kind of how it got it.
Dr Andrew Greenland:I mean, I've done a number of these interviews um these podcasts and I have to say that everyone I've spoken to in a unis, a us health and wellness space insurance is the one thing that seems to be the universal bugbear in terms of the things that are bottlenecks for their business, and obviously I'm very interested to hear that you work in this niche. I just wonder, wonder, what the market is like for other niches in the health and wellness space. Are there other people doing this and to what extent and kind of? How do you fit into that picture? Cause it seems like there's a massive demand for this kind of thing and from what you said about what you're able to achieve for people, it sounds pretty amazing.
Dr Christian Robertozzi:There there is a demand, so here's, let me. Let me tell you at least how physical therapists work. Right, like our profits. Margins even though there is money to be made are a lot slimmer than a private practice physician or an orthopedic surgeon or a neurologist, right, their revenue is much, much higher. So ours is thinner, and so that makes the clinic owners very sensitive to cost, and so they're not looking at me as a money generator. I'm just another bill on their, on their docket, and so my competition there's.
Dr Christian Robertozzi:There's billing all over the place, and what's happening a lot is is a lot of that billing is being sourced overseas, and the people that are doing that, you know they're in different time zones. They might not understand the revenue cycle here as much. There's lots of limitations, I think, that they encounter, and so they're doing it for super cheap. But they're doing a poor job, and I've taken over a couple of clinics that had outsourced it to that, but they're only charging a very, very small amount because that billing company can do that, because they're paying their staff next to nothing. We charge at, I think, an honest rate. It's definitely enough to pay good billers to do a good job, and what we've done in the past is we've had clinics where we've doubled their monthly revenue or at least increased it substantially, even though their patient care is about the same. So, yes, there's a really big need for good billing.
Dr Christian Robertozzi:Some people want to have billers in-house because they want to be able to have that conversation in real time, and once a clinic gets big enough, it can be feasible to do that. It becomes more feasible to do that. Some people, for whatever reason, maybe they're not big enough and so it would be really expensive to have somebody full-time, and so having a fractional biller, kind of like us, makes more sense financially. But a good biller will make you money. They should not, and it's taken me years to to see this and understand it.
Dr Christian Robertozzi:There's a lot of need for it, and somebody that really knows what they're doing will make you money. They'll fight for the work that you've already put in and get you paid, and they're relentless. A bad biller is going to quietly this is here's an example of where you see problems A bad biller instead of telling you, hey, I'm getting these denials, I need you to do a peer-to-peer with this insurance company they're just going to quietly write it off and your AR looks great, right, because that was closed out and so things look like they're moving smoothly. That person is probably this example here, is probably just writing stuff off left and right and the clinician doesn't know it, until they start to see their revenue drop and that's when the questions start to get asked got it.
Dr Andrew Greenland:So, based on some of the things you've mentioned about, you've been able to double um the income by virtue of the service you provide. So do you think most clinic owners actually know what their true billing picture looks like?
Dr Christian Robertozzi:no, no, and even you know it's interesting too because, um, we will do audits of of people's billing practices. Pts is pretty straightforward, I think. Uh, getting into positions they have way more codes and it gets more complicated, but we're pretty straightforward, um, and we'll just bring up differences in billing for their time. Right, pts are very much time-based CPT codes. You need to spend time with people. So with Medicare guidelines CMS guidelines you can bill up to in most cases, four units for the hour. Ama guidelines you can get five units. Ama guidelines you can get five units. And so when we bring that to the attention of a clinic owner, hey, your staff are historically billing out three units in an hour for this Medicare patient and maybe only four units for some of these commercial insurances where it could be five. If you just add that extra unit, you could be bringing in X number of more dollars.
Dr Christian Robertozzi:Some people are very receptive to it. Some people think that we're trying to trick them into doing something fraudulently, which of course we're not. It's interesting. There can be resistance to that too. So the owner needs to educate themselves. There needs to be a little bit of work on their end to understand what what they're doing. Um, we can only guide them right. We can't put those units in. Certainly, if they haven't, the work hasn't been done interesting.
Dr Andrew Greenland:So what do you say are some of the simple and powerful things that clinics could perhaps do to get a clearer financial picture, based on your experience with working with um, with these various um clinics that you have done?
Dr Christian Robertozzi:a clearer picture. Um, really, you need to carve. You know, the problem is and I'm guilty of this too right, like once your day starts you're just seeing patients all day, carving time out to sit down with your biller or billers, depending on how big it is and taking that time and having them show things and explain things to you would be a game changer for probably most clinics out there. And you don't necessarily even need to understand the intricacies of billing. But if you pull up your chart of people that you saw last month, right, and then you pull that same chart up again this month and then you start to go line by line of payments and you see there's a couple blanks in there, that's a great place to start.
Dr Christian Robertozzi:You don't have to understand anything else outside of. Like, there's not a dollar sign next to these people's names. Why don't you explain that to me? Why didn't we get paid on these people? That's scary, right? You're not making money necessarily by spending that time with your staff, and so that feels like a waste of time.
Dr Christian Robertozzi:But I will tell you that would be a huge game changer for any clinician. Just taking it I'm sure it depends on the clinic size, but like taking 30 to 60 minutes a month, you know, once a month, maybe once a week, depending on the size of the clinic and just staying on top of your billing once a week, depending on the size of the clinic, and just staying on top of your billing your biller would be a huge shift in in positive revenue for you guys, because now they know you're watching and they're going to start asking. You're going to start asking questions to your biller on why we're not getting paid on this person. It's been three months. It should have been paid by now. They're going to work a little harder absolutely um.
Dr Andrew Greenland:So, delving into the weeds a little bit, are there any um numbers or metrics that you think every clinic should be tracking that? You've found that most aren't doing yeah, that's good.
Dr Christian Robertozzi:Uh, yeah, like the easiest part is just looking at your, your ar, right, you? There's a couple different things that we look at with our clinics that we we talk about weekly. So what is your zero to 30 day AR? So how quickly are you getting paid on the claims that you submitted within the first 30 days? Some clinics can be a little bit different.
Dr Christian Robertozzi:My business partner owns a DME company. He's happy if he gets paid in the first 90 days. His timeline is much longer, so you need to understand your timeline. We have some clinics that do a lot of workers comp and that historically takes longer. So zero to 30 isn't always appropriate, depending on the type of clinic. You are insurance and and it pays in a reasonable amount of time 30 days, 45 days so that number should be pretty good. It should be pretty high. You know we shoot for 80 to 90 percent, so seeing that number is is a great first pass test to see the the health of your, your income.
Dr Christian Robertozzi:The other is understanding the CPT codes that you're putting out. Our EMR can print the average reimbursement per CPT code and that can be really powerful, right? You might be billing something out that never gets paid and your biller just never talks to you. Because you never talk to them, so there's no reason for them to have that conversation with you. They're doing their job and you're doing yours, but you've been billing out this code for years and don't know that that code doesn't pay or doesn't pay well, and that there's actually another option out there.
Dr Christian Robertozzi:So once those questions start to be had between you and your biller, you start to understand how insurance is paying you and and that can help shape the way you're coding and that also boosts Revenue as well. So having those two things looking at your, your AR reports on a regular basis and then CPT reimbursement that's not necessarily so much of a weekly thing. That's a pretty standard. That doesn't change too much. But seeing if you're getting a lot of denials in certain areas or for certain CPT codes, that's interesting information too. Right Now you can recode that particular service to something else that does reimburse and now your revenue goes up. So those are the two or three that I would look at Brilliant.
Dr Andrew Greenland:I'm guessing what you do is very much just kind of done for you solution from the way you're talking. But how do you stop the clinics getting overwhelmed with tech and spreadsheets when you start working with them?
Dr Christian Robertozzi:We're having a conversation like this and we'll point out something super easy. Hey, you know they're already, usually when we get them they're already overwhelmed. Um, because now this clinic owner has been trying to manage the billing in the background, why they've been looking for somebody like us. So we're really high on service. You know, usually clinics start to see that something bad is happening because the communication breaks down. Right, that's like a universal human truth. Right, like if you're a, you could be the best physician in the world and a terrible communicator. They, they won't like you not very much, unless you're like really amazing.
Dr Christian Robertozzi:But the clinician that does a great job, showing empathy and listening. Right, everybody loves that person. It's no different with your biller. Right, like that person, when you ask them a question, they need to respond, and so that's something that we're really high on with our billing staff is that you know you're answering those text messages, those emails, those phone calls. So, just by the clinician seeing that when they have a question we answer it and it's really a legitimate answer because we're really doing it, that lowers the stress.
Dr Christian Robertozzi:And then we're taking care of all the billing on the background. So once they, there's usually a little bit of trust that needs to be built in the first couple of weeks for them to really understand that we're different and we really are doing our job. But again, you know, whether it's me or anybody else right like you, you really need to know that your staff is doing a good job. They might love you and they might be really doing their best, but that might not necessarily be the best work that can be done and that's where you need to manage it.
Dr Andrew Greenland:Brilliant. So it sounds like you've found lots of solutions and you're helping lots of people, but are there any bottlenecks still left that you've got left to solve? If you've got something you'd like to make, wave a magic wand over to fix in the billing landscape for the clinics that you work with yeah, I mean we've, we've kept our hands away from doing credentialing.
Dr Christian Robertozzi:It's. It's painfully slow, um, and you're usually having your contract sent back to you because you missed, you know, one dot here or there, forgot to cross a T? Um, we've, we've done it like once or twice and and we end up being the bad guys because it it takes so long and it's it's not really our fault, it's just it's a gruelingly slow process and so we've kind of walked away from it because that's like a nobody wins scenario. I have a really great lady that does it. She's in Massachusetts, michelle. That would be one.
Dr Christian Robertozzi:Um, I don't want to necessarily tackle that. Uh, what are the boogeymen out there? Um, a lot, a lot of times. It's a lot of times like we, we've dealt with lots of companies across the country, so we've seen a lot. So we have a really good understanding of how billing works. And sometimes people are just they've been in the game too long or they think they know more than we do and so they're not willing to change and they really hurt themselves more than not. So maybe I need to get a do a better job of communicating. I don't, I don't know. Those are that's. That's what I can I can see is it's a relationship. We're trying to have a relationship with them in their best interest, like I legitimately want to see these clinics thrive. I know they're working hard, I do the work myself, and so I just want to see them win, and sometimes they won't allow themselves to be successful interesting.
Dr Andrew Greenland:Um. So where do you think this industry is headed in the next year or two and where specifically do you want to be in the next year or two with your operation?
Dr Christian Robertozzi:the billing industry. You know it's interesting. I heard a statistic the other day that in the US the biggest group of healthcare professionals are therapists, and so you're seeing a couple different things. There are private equity firms that understand this and they're starting to snatch up these mom and pop clinics and kind of grow their team of billers, because there's just so much billing going on for us, or us being the healthcare professionals physical therapists, occupational therapists those guys Will it turn into a bunch of really big, uh billers? I don't think so. I think it's tough for them to do a good job.
Dr Christian Robertozzi:I'm small, you know. So I know all of my clinic owners by name. They email me when they have a problem. I solve it. Um, can that be done on a large scale? I mean Amazon's done it, you know. So it's certainly possible.
Dr Christian Robertozzi:I haven't seen a big one out there that's doing it that well, where do I want to be in the next year? You know we're just trying to grow and I enjoy the process. I, like you know, when we get a new clinic it's a new clinician maybe not a new clinician but a new business owner and he or she really doesn't know what they're doing. And I've been through those pains and so I enjoy sitting down with those guys and just kind of talking them through what their next step should be, and that feels good too.
Dr Christian Robertozzi:You know, I remember when I was in their shoes just wanting some help, and everybody that seemed that had advice to give wanted $200 an hour, which I didn't have. So I'm happy to hand out some free advice. I guess you get what you pay for, but I've done it. So I think my advice is pretty sound. So I mean just hopefully just keep on doing this in the next year, you know, hoping to continue to grow our company. We've got a great staff. We enjoy each other. Um, we've got great clients. We enjoy working with them and seeing them thrive. So I mean to do more of this is is fun. Maybe I could take myself out of the clinic a little bit more. Maybe only treat three days, do more billing stuff two days. That would be cool.
Dr Andrew Greenland:I mean, it sounds like you're doing a pretty amazing service for a much more delivering a much needed service for people in this industry. Is there any? Is there any barriers to growth? From your point of view, it sounds like there's must be a huge demand for what you do, but is there anything that's stopping you from growing to the level that you'd like to?
Dr Christian Robertozzi:you know, uh, yes, and some of that's intentional. So we've had um, you'll see some billing companies out there that they'll take anybody, and so that means that their billers are billing in numerous platforms and I think that's a disservice to the clinics that they serve, because these billers aren't becoming ultra aware of how to use each platform, so they're mediocre in each one, and I've seen that from the clients that we've taken over where they had these types of billers. So we've we've specialized not only in just physical therapy billing but just in prompt. Our billers know that like the back of their hand. So we've had so many meetings about this. But we are willing to only bill in prompt so that we are excellent at billing in prompt and get the results that we expect out of ourselves.
Dr Christian Robertozzi:The flip side of that is is we're we're not taking referrals for people that are in other software because we don't want to learn it, we're not going to be good at it, we don't. We don't want to be good at it, we want to be good at working in prompt. So that's our limitation. I guess if there was a sea of prompt users that needed help, call me and I'd be happy to assist you. But otherwise we're kind of left to get referrals from the tender mercies of my friends at prompt and they've been really generous. But that's's, that's what kind of uh. That's the direct uh flow of referrals that we get. How we get them and prompt is what?
Dr Andrew Greenland:sorry excuse my ignorance, what is prompt exactly?
Dr Christian Robertozzi:oh, it's fine, there's a million, it's. It's an emr out there. It's specifically designed for um physical therapists and other types of allied healthcare, like I know they they chiros use it a lot. Occupational therapists use it a lot. So it's, it's those there's. There's some one-offs of different types of healthcare perfect professionals that'll use it, but it's really built and designed for those types of clinicians therapists, you know, chiropractors.
Dr Andrew Greenland:Brilliant. What do you? Would you say what kind of clinic owners are best positioned to thrive in the new environment, or where billing is going in the future?
Dr Christian Robertozzi:Somebody that's willing to take ownership of their clinic. That seems that might seem silly. Well, it's my clinic. Of course I'm going to take ownership of it. But I will tell you that, even though there are a lot of clinic owners out there, I feel like they've kind of washed their hands of everything once they open the doors and they expect everybody else to do it. And there might be clinics out there that do just fine with that. My experience has shown me that the clinic owners that are involved in a positive way and take ownership for the clinic's outcomes are the guys and gals that do the best.
Dr Christian Robertozzi:Somebody that thinks that everybody else should do it for them is in for a really rough time. You just need to be out there hustling right Like you need to be the face of the clinic. You need to have a good rapport with your staff. You need to make sure that you're having those touch points with your staff. They like you. They like working there. If they don't, why? That's your job to you know solve it. You need to be out there making sure that your relationships are strong with your referral sources, the physicians that are supporting your clinic, making sure that they're happy with you.
Dr Christian Robertozzi:It's hard. I mean it is much harder than being a staff clinician anywhere, but it's very doable and it's very rewarding. It's exciting. I think it's way better than just working for somebody. So you just need to be willing to put in the work. That's the you know outside of work ethic. I think anybody can get it done. You just need to know that that's the life you're signing up for and it's and it's a lot different than just punching the card and being a nine to five employee.
Dr Andrew Greenland:Christian, thank you so much for your time this afternoon. It's been a really thoughtful and eye opening eye opening conversation, and you've been really generous with your insights. I think it's lots of actionable information that people listening to this will find helpful. So thank you for your time.