NFZ vs private - billing models for a physiotherapy practice

Mr Tomasz is opening a physiotherapy practice and faces a decision that will shape his entire business model: go for a contract with NFZ (Poland's National Health Fund) to secure a steady stream of patients, or operate purely privately, where he sets his own prices but has to build a client base from scratch. Friends give him mixed advice - some praise the stability of NFZ, others complain about the bureaucracy and low reimbursement rates.

This is one of the most important business decisions in running a physiotherapy practice. In this article we'll compare both models in terms of billing, formal requirements, documentation, and profitability, so you can make an informed choice.

Two models, two logics

Before comparing the details, it's worth understanding the fundamental difference:

• The NFZ model - you provide publicly funded services under a contract with the National Health Fund (NFZ). NFZ pays you for services rendered at a set rate, within a limit.
• The private model - the patient pays you directly. You set the prices, scope, and organisation of your work yourself.

Both models require registration of medical activity (RPWDL), OC insurance, and full medical records. They differ in everything that happens after that.

An NFZ contract - how it works

To bill NFZ, you need to win a tender announced by the regional NFZ branch and sign a contract. This requires meeting detailed conditions:

• Appropriately qualified staff
• Required equipment and facilities
• Meeting premises and sanitary requirements
• Reporting to NFZ

Billing takes place within a limit (either a lump sum or a contract for points/services). So-called over-performance beyond the limit isn't always reimbursed, which can be painful.

Pros and cons of NFZ

Pros:

• A steady stream of patients (the waiting list for physiotherapy is long)
• The patient doesn't pay - easier to attract
• Prestige and trust

Cons:

• Low reimbursement rates
• Rigid reporting and bureaucracy
• Limits and the risk of over-performance not being paid
• Having to win a tender
• NFZ inspections of the validity and correctness of billing

A private practice - how it works

In the private model, the patient pays directly. You set your own price list, decide on visit length and methods. There are no limits or tenders - but there's a challenge: you have to attract your own patients.

Pros and cons of the private model

Pros:

• Full freedom over pricing and organisation
• Higher margin per visit
• No limits or reporting to NFZ
• More individualised, unhurried time per patient

Cons:

• You must attract and retain patients yourself
• Revenue depends on attendance
• Price competition
• Tax obligations and the cash register are on you

Comparing the models

Criterion	NFZ	Private
Revenue source	NFZ (limit)	Patient, directly
Pricing	NFZ rate	You set it
Attracting patients	Easy (waiting list)	Need to build a base
Bureaucracy	High (reporting)	Low
Margin per visit	Low	Higher
Risk	Over-performance, NFZ inspections	Attendance, competition
Entry	Tender	Registration and start-up

The mixed model - the most common in practice

Many physiotherapists combine both models: part of the business on an NFZ contract (stability), part private (margin). This lets you diversify revenue. It does, however, require careful separation of billing - NFZ-funded and privately paid services must be recorded correctly, and you can't bill the same service twice.

[Solo] Example - solo practice: You start privately, because an NFZ tender and contract requirements are too demanding at the outset. You build a patient base over 1-2 years, and once you have a stable schedule, you consider adding an NFZ contract for part of your hours.

[Group] Example - group practice: A larger practice starts with a mixed model: it wins an NFZ contract for outpatient rehabilitation and simultaneously runs private visits in the afternoons. The key is separate record-keeping for both streams and a clear schedule split.

Documentation and billing - what to watch for

• Medical records - identical in both models, kept the same way
• NFZ reporting - an additional, separate obligation under the contract
• Cash register - applies to private sales; with NFZ, billing goes through the Fund
• Inspections - NFZ checks the validity and correctness of contracted billing; independently, KIF and Sanepid check standards and conditions

How to choose a model to start with

When making the decision, it's worth answering a few questions:

• Do I already have a patient base? If so, the private model gives a higher margin from day one. If starting from zero, an NFZ contract ensures an inflow of patients.
• Do I meet the NFZ tender conditions? Requirements around staff, equipment and premises can be a barrier for a newly opened solo practice.
• How much time can I devote to bureaucracy? NFZ reporting is a real administrative burden.
• What's the competition like in my area? A high number of private practices may favour an NFZ contract as a differentiator, and vice versa.

There's no single right answer - the key is matching the model to your practice's stage of development and the local market. Many physiotherapists start privately, build a reputation, and only then pursue an NFZ contract as a revenue stabiliser.

Frequently asked questions

Can I combine NFZ and private practice?

Yes, the mixed model is very popular. The condition is strict separation of billing - services funded by NFZ and those paid privately must be recorded separately. You can't bill one service twice.

Which is more profitable - NFZ or private?

The margin per single visit is higher in the private model, but it requires attracting your own patients. NFZ gives a lower rate but a steady stream of patients. For many practices, the safest option is the mixed model, combining NFZ stability with private margin.

How do I get an NFZ contract?

You need to win a tender announced by the regional NFZ branch and sign a contract. This requires meeting conditions on staff, equipment, premises, and readiness to handle reporting. It's a higher barrier to entry than starting privately.

Does the medical documentation differ between the two models?

No - the obligation to keep medical records is the same. With NFZ there's additional reporting to the Fund, and in the private model there are obligations around the cash register and billing payments from patients.

CTA: Want organised documentation regardless of your billing model - patient records, consents, GDPR and procedures ready for an NFZ, KIF or Sanepid inspection? The STANDARD package includes a full set of documents for a physiotherapy practice. See FizjoReady packages →

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