Beyond the billing office: 5 leadership strategies for physicians managing revenue cycle staff

Most physicians did not train to spend evenings untangling denials and payment questions. Yet in an independent practice, revenue cycle performance is not a back-office detail. You do not need to become a coder to lead this well. You need shared measures, clear ownership and a steady habit of fixing the process before problems pile up.

1) Put one metric on the wall and make it everyone’s job

Revenue cycle work is a chain. Weak handoffs create rework.

Pick one “North Star” metric that reflects the full chain, such as clean claim rate or first-pass yield: the share of claims that move through without manual rescue. HFMA defines clean claim rate as the share of claims that pass edits requiring no manual intervention. Targets vary by specialty and payer mix. The point is simple: put the number in front of the team every week, understand what nudged it up or down and keep moving it in the right direction.

Spell out what the metric means in plain language, connect it to the handful of drivers behind it and keep the weekly check-in specific. If performance drops, ask what changed, where the process broke and what small fix you can test before next week.

2) Find “shadow work” that is draining clinical capacity

Shadow work is billing work that drifts to the wrong people because no one owns the workflow. Prior authorization is a common example. CAQH estimates that adopting the electronic standard can save medical providers and staff about 14 minutes per authorization. In some settings, shadow work also includes tasks like submitting zero-dollar encounter claims or correcting administrative-only billing just to keep payers satisfied.

For two weeks, ask each person to note billing-related interruptions, especially repetitive tasks or work that requires switching systems. You are looking for patterns, not perfection.

Then redesign one path at a time. Route billing questions to a single intake channel, standardize what information is required to resolve common issues and eliminate duplicate data entry when possible. Focus on removing preventable work, not redistributing it.

3) Treat retention as an operating design problem, not a bidding war

Coders and billers have options. Pay matters, but people often leave because the day-to-day is chaotic: nonstop context switching, fuzzy expectations and no clear path forward. BLS projects roughly 14,200 openings a year for medical records specialists over the next decade, a bucket that includes medical coding roles.

Make the path visible. Use a real career ladder, not a vague promise. AHIMA’s career map is a good reference point. Translate it into your team in plain terms: levels, the skills needed at each level and what it takes to move up. Keep it practical, from entry-level claims work to certified coding roles to QA, auditing or lead responsibilities.

Design roles for focus. Define what “good” looks like beyond volume, including accuracy and fewer avoidable denials. Group work where you can, so complex tasks are not constantly interrupted by low-value disruption.

Use skip-level meetings to surface friction early. Once a month, the physician owner meets briefly with one or two frontline billers or coders without their direct manager present. Keep it to three questions: what keeps showing up, what slows you down the most and what single change would cut the most rework.

4) Govern your systems before you buy new ones

Billing pain often triggers tool-shopping. More often, the practice is underusing what it already has or using it inconsistently. If your team is living inside spreadsheets and separate logs, you do not have one set of facts.

Name your practice management system as the source of truth and agree on basic definitions for denial categories, aging buckets and write-off reasons. Cut back on shadow spreadsheets where you can and tighten access controls so sensitive data is not sitting in personal files.

If the backlog is swallowing the team, use a pressure valve. Outsource a narrow, well-defined slice, such as legacy A/R follow-up or routine claim status checks. Keep ownership of definitions, access controls and escalation paths inside the practice.

5) Lead with clarity and psychological safety

When every performance conversation feels like a blame session, problems go underground until they turn into month-end surprises.

Normalize blameless problem solving. Billing staff absorb a lot, from payer pushback to patient confusion about bills. When a metric slips, stay in problem-solving mode: what changed, where did the process break and what small fix can we test this week. That tone makes it easier to raise issues early, including documentation patterns that lead to avoidable denials.

The takeaway

You do not need to become a coder to lead a coding team. You need a managed rhythm: one shared score, fewer avoidable handoffs, a team that can stay in role and a culture that treats revenue cycle as a system you can improve.

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4 ways to boost your medical practice’s profits in the fourth quarter

It’s almost that time again: the fourth quarter, the busiest time of year for many medical practices. As patient deductibles are met, a window opens for patients to receive services with little or no cost-sharing — and that presents an opportunity for them and practices alike.


This window only opens once a year, and for many types of practices, it can be make-or-break for profitability. It’s a good idea to plan to make the most of it, especially since the revenue your practice generates in Q4 can provide a soft landing for Q1, when many patients will look to save money by putting off nonurgent healthcare services.

Here are four of my favorite tips for making the most of the last weeks of the year.

Communicate early and often.

It’s easy for patients to miss out on the chance to receive care without cost-sharing once the holiday rush arrives. Communicating with patients now, before the holidays are in full swing, gives everyone more time to plan and schedule.

What’s more, some of your patients may not understand how much money they might save. For example, younger patients who’ve never met their deductibles before may not realize how much they can save on a procedure if they schedule it now instead of next year. By reaching out and explaining the potential savings, you’ll help patients not just save money, but also receive beneficial care they’ve put off.

To make sure your message is heard above the everyday media noise level, use multiple forms of contact – general information posts on social media and your website, personalized emails, and even phone calls for patients who are likely to benefit most significantly. Remember that repetition is essential with important messages, so don’t be afraid to create a series of social media posts and emails to be shared and delivered over many weeks. Be sure, also, that the employees who handle your phones and appointment setting have the tools and training they need to answer patients’ insurance questions.

Let technology do some of the heavy lifting.

To target your outreach to patients who could benefit most from scheduling services before December 31, you’ll need to identify them first. This task is a perfect opportunity to get more use out of your EHR and practice management system. Searching on ICD-10 codes, for example, can help you determine which patients had diagnoses that indicate surgical procedures or other treatments that typically carry cost-sharing. Searching your practice management system for CPT codes can help refine your lists based on whether patients have already been billed for that service.


There are usually multiple ways to do these sorts of queries and reports. If you aren’t sure you know all the tricks — or whether there are new features you might have missed — now is a great time to reach out to your vendor(s) for a refresher.

Technology can also help you get the word out. Once you’ve identified your target patient audience, you can email them via your portal–a great way to track the response and also encourage more use of the portal. Social media tools like Hootsuite and SocialBee can help you schedule reminder posts throughout the fall, so that no one has to remember to do it when things get more hectic.

Make sure your staff knows the drill.

The fourth quarter can be stressful for everyone in your practice. Being organized, clear and prepared can help avoid unnecessary stress.

You may have already stated your holiday time off policies (for example, in your employee handbook). But refreshing everyone’s memory as the holidays approach will help avoid confusion (and, potentially, hurt feelings). If you think you’ll need extra help, make sure you’ve already planned out how you’ll get it.

Review your reminder process.

With many patients hoping to receive services before the December 31 deadline, it’s even more important that no visit or surgical slots are lost to missed appointments or late cancellations. There’s still time to review your reminder procedures to be sure they’re on point. Confirm that your staff is collecting the contact information needed to remind patients by the methods they prefer. And be sure to test that your systems are working to deliver those reminders reliably.

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The leading causes of denials and how to prevent them

Each new denial is essentially a revenue leak. Even when claims are recovered, the costs associated with that recovery must be subtracted from patient revenue. Recent data put that recovery cost at roughly $118 per denial. Factor in the lost revenue from your unrecovered claims and it’s clear why denials are a painful financial drain on practices.


What makes denials so frustrating is that many are avoidable. The leading causes are well known, and it’s possible to prevent these leaks before they occur. The key is having processes in place to identify and correct errors and omissions before a problematic claim is ever submitted.

Defining denials

Unlike a rejection, which occurs when a submission lacks pertinent data or proper coding, denials are received, reviewed, and found to be inadequate by the payer or health plan. This may be due to insurance plan coverage stipulations, limits, or an untimely filing. Denials cannot be resubmitted, but they can be appealed. It’s the appeal that can prove costly.

Most common reasons for denials

The number one cause for a denial is that a patient isn’t eligible for care under the terms of the insurance plan. In the research cited above, nearly one in five respondents said “registration/eligibility” was the leading reason for denials. The simple step of doing eligibility checks before a patient is seen by medical staff can prevent this.

Other common reasons for denials are:

• Insufficient information. A simple omission, such as date of birth, can lead to a costly denial.
• Duplicate billing. This happens when a similar or equivalent claim is sent because of a clerical error or overlap in office duties.
• Improper or outdated CPT or ICD-10 codes. The codes, which determine what is paid, change quarterly, and your practice — or your RCM vendor — is responsible for capturing and operationalizing all updates.

Untimely filing. You only have so many days to file the claim.
Service is not covered. A patient’s coverage may have been terminated or their maximum benefit has been met (often in the case of physical therapy).

Out of network. Some plans require doctors and practitioners to be “in-network” for coverage.
Problems with modifiers. Errors can result from submitting invalid modifier combinations. Many invalid modifier combinations can be avoided with better training for coding personnel or by using a qualified medical billing service.

Prior authorization required. Some payers want authorization or a referral from another physician before services can be performed.

Mitigating risk with technology

The complexity of medical billing puts tremendous pressure on practices as many processes are unlikely to catch common errors such as duplicate billing or incorrect CPT codes. This is where technology can be transformative. It can, for example, automate the updating of CPT codes practice-wide to significantly reduce the risk of using an outdated CPT code.

Technology can also assist with prior authorization, guiding staff through the important steps of assessing patient eligibility. While there is no substitute for adequate staff training and education, having a stepwise process to guide staff who process claims ensures the right information is collected and verified before a claim ever leaves the practice.

Putting technology into practice

A few years ago, a five-person practice in Attleboro, Massachusetts, seeing between six and 15 patients daily, would routinely write off denied claims. It cost them thousands monthly. By adding new technology to predetermine eligibility, the practice addressed its main issue and the number one reason for denied claims: ineligibility.

In the new process guided by technology, front desk staff can verify patient eligibility with the insurance company prior to an appointment. When a patient presents her insurance card during check-in, any issues with eligibility can be addressed in real time. Having this take place beforehand ensures a better experience for the patient and a smoother check-in and billing process for the practice.

Technology and automation don’t replace the human touch patients expect. In fact, revenue cycle management technology, which offers much more than predetermined eligibility review, is enabling practices large and small to focus less on managing loss and more on efficiently and profitably building a vibrant office that provides a better patient experience.

Takeaways

Many practices feel powerless as claim after claim is denied. A closer look, however, reveals that many denials are avoidable. Fix those leaks and you’ll see immediate return to your bottom line. What’s more, you’ll streamline operations and save time that can be put back into delighting patients. Here’s how you can get started:

Audit your practice to see if you’re at risk for any of the most common reasons for denial.
Train and retrain staff to recognize and be vigilant around the key error points that lead to denials.
Consider revenue cycle management technology, which, when properly integrated with your EHR and/or practice management system, can automate critical aspects of the billing process.

Start benchmarking your progress; see how much profit you recoup by stopping leakage that is caused by denials. Focus on “denial rate,” which the American Academy of Family Physicians says should be between 5 to 10 percent on average. Less than 5 percent is more desirable.

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The billing conundrum

I am working with two physicians who are leaving a large group because they are dissatisfied with the back-office operations and billing situation. Years ago, they had their own practice and did everything in-house. Now, three years later, they want to recreate the practice of their past.


These experienced docs operated a successful private practice in another market before coming my way. After a lot of discussion, it became apparent that they are not only strong clinicians who know what support they need from their clinical staff, they also have the characteristics of good leaders who know how to motivate a small staff and engender a healthy “family business” type environment.


We’ve found them a great independent practice association to work with, one that provides good in-network rates and a slew of value-added services and vendor connections to help make it a smooth transition. In fact, there’s only one real issue.

Billing. What did you expect?

I’ve worked with a host of practices over the last 10 years. Some billed in-house. Some billed in-house but employed a certified coder to oversee things. Others used a certified coder to oversee outsourced billing. Others were cash only. And some were out-of-network, a whole other Pandora’s Box of issues.


Billing is always a hot topic with docs. I’ve met many who have felt no person or company could collect their money better than an in-house staff. I’ve met others who shied away from outsourced billing because of a bad story they heard years ago from a peer, and there are certainly some bad stories out there.


Anxiety is always present when turning over the collection of your money to people you don’t see every day. Should it be?


Unless you’re an all-cash practice or have a practice that is predominantly Medicare or Medicaid, I’ve come to feel like outsourced billing is the way to go for a number of reasons:

• Payer relationships 
• Regulations 
• Complexity of insurance plans and ACOs 
• Government and hospital reporting requirements 
• Claims denials 
• Perspective on payer reimbursements 
• Patient balances 

This is, of course, a short list. In fact, each topic can generate a lot of discussion and comment. It’s almost impossible for someone not dealing with payers every day to understand how they are constantly changing reimbursements, reporting requirements, and even some rate structures. This can be especially endemic within the government plans.


I think the bigger questions to ask are these: Can a billing company stabilize my cash flow, aggressively address my revenue cycle, and keep me up to date on all billing-related matters that might impact my practice? Can they help my staff and me learn how to code more effectively and understand what payers are looking for in complex coding situations? Is their pricing truly expensive given what I would have to create within my own office and, more importantly, manage?


Focus on that last word. Most docs I know don’t want to take on another internal management position where they are going to be forced into a learning curve on a subject with extreme levels of detail and risk. In fact, in most instances where I’ve seen in-house billing, the docs start by being dedicated but fall away as their private practices and lives becomes more demanding. Managing the billing effort and staff becomes a pariah of a responsibility. Cash flow usually suffers in one way or another. Only, no one noticed until their salary check was affected. Then crisis mode and high anxiety levels set in.

It’s not always about cost. It’s about the value realized for the expense. You have to ask a lot of questions. You can rely on your peers for a variety of opinions, good and bad stories, and cost data. Or, you can work with a consultant who’s been down this road before, who can analyze what you need and be there to ask all the right and necessary questions.

You need to find ways to effectively use your time and manage the nonclinical parts of your practice as healthcare reimbursement becomes more complex in lockstep with the growing responsibilities of your clinical practice. Outsourced billing, when done right, is certainly one of them. And if the entry strategy is good, there should be no reason for anxiety.

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