#173 3 Early Warning Signs Your Medical Billing Is Broken

Resources mentioned 

• Practice Revenue Leak Scorecard (free, ~60 seconds): https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3
• Book a call with our team: https://natrevmd.com/contact/
• Visit us: natrevmd.com 

Are your patient volumes climbing but your bank deposits flatlining? That's one of the most terrifying patterns in private practice  and the scariest part? Your reports might not show any of it. 

In this episode, we break down the 3 early warning signs that your billing is broken and give you a clear, actionable plan to diagnose the problem before it becomes a six-figure issue. 

If you're running an independent medical practice doing $250K+ a month, this is the gut check you need. 

What we cover 

• Warning Sign #1: AR over 90 days creeping above 15–20% — and why your team might be "statussing" claims instead of resolving them 
• Warning Sign #2: Lack of transparency from your billing team (in-house or outsourced) — what to ask for, and what their answer tells you 
• Warning Sign #3: Receipts dropping while charges stay stable — the two most common causes 
• A real example from a practice we work with — credentialing holds and why pulling the data first matters 
• Your 3-step action plan to run this week 

Chapters 

(00:00) Charges up, deposits flat: the signal most owners miss 

(01:30) Free Practice Revenue Leak Scorecard 

(02:15) Warning Sign #1: AR >90 days 

(04:30) Warning Sign #2: Lack of transparency from your billing team 

(06:30) Warning Sign #3: Receipts drop while charges stay stable 

(08:30) Recap: the 3 key takeaways 

(09:30) Your 3-step action plan this week 

(11:30) Book a free revenue audit 

About NatRevMD 

We're a physician-led medical billing and revenue cycle management company built for independent medical practices. Founded by Dr. Heather Signorelli, we help private practices stop revenue leaks, fix broken billing operations, and protect their margins. 

Transcript

SPEAKER_00 0:05

Is your patient volume and charges going up every single month, but your bank deposits are either flat, worse, shrinking? That is the most terrifying feeling, and sometimes it's from a payer holding AR, follow-up not happening, or worse write-offs without your knowledge. Welcome to NatRevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of NatRevMD. Let's get started. Today we're going to talk about the early warning signs that you can evaluate to make sure your billing team is on top of your processes. And if they're not, you have very clear things that you can go to speak to them about, things that you guys can sit down and discuss. Because anytime you see a red flag, you want to be able to have a team that you can sit down with, pull the data before you panic. And sometimes there's a real explanation. Sometimes there's an issue going on with a payer right now. For example, right now we have a practice with two specific uh credentialing issues. They're pending payer decisions, and revenue is stuck into those appeals are resolved. Um, you know, those are being managed every single day, every single week. But when they flagged it, we pulled the data together and we'd already been having conversations about these pairs, but then they can see exactly what the revenue impact and the timeline to get addressed. So, really, really critical that you guys are pulling data together with your team, looking at it and figuring out if there's a real issue going on. That's, you know, if you've got questions and concerns, right? Sometimes there is data to support the reasoning for things, and other times there's a real issue. And the scariest part is that your surface level reports might not show all of it. So today we're going to break down those early warning signs your billing team may be broken and that you can get a clear actionable plan to diagnose the problem before it destroys your margins, or the things that you can identify to see, okay, yeah, it is really time to make to make a change. So obviously, before we dive in, we do have some new quick tools that you can use to assess whether or not your billing process is working. We've got a practice revenue leak scorecard, few questions, 60 seconds, and uh can show you where your risks are. So link in the show notes. All right, so pain point number one. One of the first major warning signs, it obviously is a sudden or steady increase in your days in AR or your AR over 90 days, right? So for your practice, your insurance AR over 90 days really needs to be under that uh 20% uh over 90 of your total AR, right? Obviously, even better if it's lower. We have many practices that are even below 5%. Just depends on the practice workflow, surgical processes, and just payer mix. So obviously, practices with more hospital claims may have higher AR over 90 days, just as you're waiting for some of those hospital claims and tandem of your outpatient claims. So you do want to know where you started with your AR over 90 days as you're trying, you want to trend this every month, is what I'm trying to say. Right. So if you've been hovering around 5% AR over 90 days and now you're sitting at 15, you want to start asking questions and seeing what's going on. Um, and if that number does start to creep up above 25% or higher, it means that claims are getting stuck somewhere. And that may be like we have a practice right now that has a lot of coordination of benefit issues. And so sometimes those COB issues require a lot of back and forth between the practice, between the patient before we get the corrected information. We're working with the insurance company as well and then resubmitting those claims. And so you've just got to understand your patient mix, your payer mix, and your billing process. And again, trending those AR over 90 days, which we do every, every single month. Really, really important. The other thing that might be happening that you want to ask your team about or start looking at the notes is are they just statusing claims, right? So frontline billing staff may not know how to resolve a claim. And so they're statusing it. So what does that mean? That means calling the insurance company, getting an update on the claim, but then putting the update information in there, but then not actually ever resolving the claim and say maybe they don't really understand how to resolve it. And so they do something, right? They submit a medical record, they change a modifier, they resubmit, but then you still are getting a denial. And so then they call again, they talk to the insurance company, they put a reference number in. But again, the claim kind of gets keeps getting called on, and maybe something happens, maybe something doesn't happen, but we're not getting to a resolution. So, really, really important to have escalation loop that if a denial is happening more than more than twice, I would say, that somebody higher up is able to help support that frontline staff. And so that's where a manager can come in and be able to do that, or a certified coder can help and do that. Somebody with higher level experience who can help manage those denials, really, really critical. We have three different levels of double checking within our own company for those denials that are getting stuck. Um, and obviously the last result resort is being bringing them to the um to the office to the client to be able to say, hey, you know, this is just continuing to go round and round. We've we've got to come up with a plan. And so, really, really important to have that, um, have that pathway for success. So, pain point number two, um, so the second warning where there's a lack of transparency or poor communication from your billing team. So, whether they're in-house or outsourced, if you have a specific question or you're asking for a specific report, like a data service, a collection report, or breakdown of denials by CBT code, and you get excuses or delays, or you just don't get a report at all, really, really important to start asking your question. What are they hiding? Why are they doing this? Are they doing it not being able to provide you those answers because they don't know? Are they missing that kind of middle level management uh tier that you aren't able to get those questions answered by somebody who really knows what's going on? Obviously, a competent billing operation should be able to produce clear, accurate KPIs, reports. It should be able to show you exactly what they are tracking so that when you're asking these questions, this isn't the first time that they're pulling that information, right? They're managing it every single week. So if they're hiding the data, there's usually a reason why, or if there's a lack of communication, there's usually a gap there that you need to get addressed. So pain point number three, the third and most critical warning side is obviously an unexplained drop in your receipts, especially when your charges remain stable. So if you do see this happening and maybe you'd see an AR issue and you've had poor communication, all of these are leading to signs that you've got you've got an issue. So if you're listening to this and you're like, oh no, that's me, I hear you. You just need to be able to find somebody who can help sit with you, go over the metrics, and understand if there's a better option. And I know that's terrifying because it's the beginning of the year, patient volume is busy, and you are trying to run your practice as well. But I'm telling you, if these things aren't addressed, it will build up over time. If you are you're doing 250,000 more net receipts per month, we do do a uh complimentary metric audit. So head on over to our website, notrevmd.com, and it's in the top right hand corner free revenue audit. And we're happy to take a look. Either your team is failing to work on denials or we've got a write-off problem, or again, like I mentioned, there's some sort of holdup in your accounts receivable that you need to get clarity around. And so is it a credentialing issue? Payers do have issues too. You know, we've had multiple payers over the last year who have had issues where they've started managing claims inappropriately and then we're having to write appeals to get them done correctly. And so that created a hold of claims that then they weren't getting paid appropriately. And so then we had to keep track of all of those separately and then do the appeals and then work to get that process fixed. So, really, really important again, that higher level strategic individual or you know, one or two layers needs to be involved in that process. And again, that, you know, receipts lag or the decrease in receipts is kind of an uh an indicator that something is going on, obviously. Again, you got to really make sure you're looking at charges and make sure the charges haven't dropped. Really, really important to track and trend those. We track those with a 13-month view so that we're always looking and understanding, okay, well, charges were 30% higher in the beginning of the year last year than they were this year. So that's going to impact receipts. So the key with all of these things is that you are tracking every single one of these metrics month over month so that you know the signals when something is off become before it becomes a massive problem, and that you can sit down together and understand, understand what's going on, determine a pathway to resolution, and again, be able to get to the point where your revenue is back where it should be. All right. So to recap, right, if you want to make sure that you are not missing anything in your billing team, right? So that you have a close eye on things, uh, you're gonna be watching that AR over 90 days. Obviously, if it's climbing, that insurance AR is climbing over that 20, 25%, you're sitting down with your team. Obviously, if it's trending higher, even if it's below that, but you're seeing it trend higher and higher every single month, it's time to sit down and understand what's going on. And if um, and your patient AR just is important too. We're just not focusing on that and that this episode. But again, all of these metrics are important. Um, the other thing is just really making sure that there's transparency between the billing team, whether that's an in-house team or your outsource team, just so that you guys are all on the same page around clear expectations around KPIs. If there is a problem, you have time to discuss it and that um you're all on the same page in terms of what it looks like to fix and resolve things in the manner that you expect. And then the last is as you track those average uh charges and receipts, just making sure that a widening gap between those two could indicate that you've got a billing issue and that you want to address that. So the three things that you can walk away with doing is if you haven't already started tracking, so you want to pull an AR aging report, right? Looking specifically at that percentage of your total AR that's over 90 days. If your EMR or PM software pulls an easy denial breakdown, you'll want to take a look at those. Um, we have a few practices where those denial breakdowns do require a higher level subscription in your in your clearinghouse subscription. So, like Trizetto, you have to pay additional to be able to get access to that denial breakdown that's in a clear, easy format for you to understand. Where possible, we're providing all of those denial breakdowns on a monthly basis in our dashboards. Um, you'll just want to ask your billing team, is that possible? Can I see it? And what's been going on in those denials? And then obviously trending those charges and receipts and then making sure that you're if there is a steady, you know, amount of charges, but you've had a drop in receipts that you understand exactly where that's coming from. Typically, you'll see that show up in your accounts receivable, right? Where you have a drop in receipts because your AR over 90 days is increasing. So that will explain it, but you then want to sit down and go, why? Is it a specific payer? Is it specific denials? Is it team turnover? Like what exactly is it that's causing that? And so you'll want to tackle each one of these things so that you can make sure that you have just a really clear understanding of your practice. All right. So, like I said, um check out that practice revenue leak scorecard. And that link is in the show notes. 60 seconds tells you exactly where you stand. And if your scorecard says it's time for an expert to take a look at your numbers, we'd love to be able to set up a call and our team uh can meet with you and look at what's going on and um see if we can help. All right, thanks so much for listening to the podcast and have a great week.