Occupational therapist CFO services: choosing your payer mix on purpose

Payer mix is the real profit lever

Every payer prices the same treatment hour differently and pays on a different clock: SABS work through HCAI is often the slowest to collect but can be the largest volume source, WSIB pays a fixed and fairly predictable fee, medical-legal assessments pay fastest but depend on referral relationships that can dry up, and private pay is the smallest line for most practices but the only one with no fee schedule attached. Most owners inherit this mix from whichever referral sources found them first, rather than choosing it, and rarely revisit the proportions once the schedule fills up. We build an effective realized rate and an AR-days figure for each channel and review them quarterly, so the mix becomes a decision the practice revisits on purpose rather than a fact it discovers at year-end. A practice weighing a new insurer contract or a new WSIB referral source should ask the same question every time: does this channel's realized rate, after its typical collection delay, actually beat the mix it would replace, or does it just add volume that looks busy on the schedule.

What a home visit costs before it is ever booked

Drive time and mileage are real costs that never appear on an invoice, and a scheduling geography that clusters visits by neighbourhood can recover meaningful hours a year compared to a route built purely around appointment times. Once cost-per-visit data separates windshield time from treatment time, decisions about which referral areas to accept and which to decline stop being guesswork and start being arithmetic. The same data settles a pricing question that comes up constantly in mobile practice: whether a distant referral is worth accepting at a fixed SABS or WSIB rate once the drive is priced in, or whether it only makes sense at a private rate. Practices that map this out once tend to stop chasing every referral and start choosing the ones that actually pay for the drive.

Growing through associates or through assessments

A practice generally scales one of two ways: recruiting associate OTs on a percentage split, which adds treatment capacity but comes with the classification discipline covered on our OT payroll page, or building out medical-legal assessment capacity, which pays faster and is taxable but depends on steady referral relationships with insurers and lawyers rather than patient volume. We model both paths against the practice's fixed overhead — rent, admin wages, software — to show which one actually improves the bottom line rather than just the top line. A third path some practices underrate is simply raising utilization among existing associates before recruiting more of them, since an underbooked associate's split still carries a full share of fixed overhead with none of the offsetting revenue.

Cash flow around insurer delays

A 13-week cash flow forecast for an OT practice has to treat an approved-but-unpaid HCAI plan as a receivable, not as cash, because the gap between plan approval and funds landing is real and recurring. Building the forecast around that lag, rather than around when the work was delivered, is what keeps payroll and rent covered in a slow collection month without a scramble.

Monthly numbers worth tracking

• Effective realized rate by payer: what each channel actually pays per treatment hour after any holdback or rate cap, not the list price.
• AR days by payer: SABS, WSIB, and private balances aged separately, so one slow channel cannot hide inside an average.
• Taxable revenue run-rate: assessment and equipment sales tracked monthly against the $30,000 threshold, so registration is a planned event, not a surprise.
• Cost per visit: drive time and mileage folded into the true cost of a home visit, by area and by payer.

None of these numbers require new software — most come straight out of the scheduling platform and the bank feed once someone builds the reporting once and keeps it current. The value is in reviewing them on a schedule rather than reconstructing them the one time a bank balance looks wrong. For the underlying bookkeeping this reporting depends on, see our OT bookkeeping page; for a US-facing practice, the filing questions sit on our OT cross-border tax page.