NatRevMD

NatRevMD
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Medical billing tips for healthcare professionals — by healthcare professionals.  This podcast is here to help private practices get paid what they’ve earned. We share real-world strategies for accurate coding, smoother billing workflows, and fewer denials — all from a team that’s been in your shoes. Whether you’re just getting started or trying to tighten up your revenue cycle, you’ll get practical advice you can actually use. Join the conversation in our Facebook Group: NatRevMDLearn more at www.natrevmd.com

  1. 12 hr ago

    #206 $12,000 a Month in Revenue You Do Not Actually Have

    Send us Fan Mail Before you build a business case for anything, a new hire, a second location, a new service line, three numbers have to be right. Payer mix. Net collection rate. AR days. Most owners have all three. Almost nobody has calculated them correctly in the last two years. This episode is how to fix that, in about twenty minutes, using your own system.   [Payer mix]  The payer mix on your billing dashboard is almost always built on charges, meaning what you billed. What you need is payer mix by collections, meaning what you actually got paid. Those two numbers are often meaningfully different. Pull payments received by payer over the last 12 months, divide each payer by total net collections, and that percentage is your real mix. Twelve months and not three, because open enrollment shifts and Medicaid redeterminations distort any shorter window.   [Net collection rate]  Gross collection rate compares you to your billed charges, a number nobody ever pays. Net collection rate compares what you collected to what you were contractually owed. Net collections divided by gross charges minus contractual adjustments. Discretionary write-offs, bad debt and charity, do not belong in that adjustment figure, because including them overstates the rate. Most well-run practices land between 95% and 98%. Under 90% is a red flag. Above 99% usually means contractual adjustments are being under-written.   [AR days]  AR balance divided by average daily charges over the last 90 days. Lower is generally better, but the blended number hides the story. Split insurance from patient, then look payer by payer. Under 35 days total is healthy. Medicare should sit at 20 to 28. Medicaid at 35 to 60. Patient AR above 40 days means balances are not being collected at the point of service. Any payer trending up for three consecutive months is worth a conversation.   [Why this matters for a business plan]  A 10% shift toward Medicaid lowers your blended rate per visit by $8 to $15 depending on specialty. In a 30,000-visit-per-year practice that is $240,000 to $450,000 of annual revenue difference, and it is completely invisible if you are using charge-based payer mix. A practice modeling at 96% when the verified rate is 92% overstates revenue by four cents on every dollar. On $300,000 a month that is $12,000 a month that does not exist. And a plan built on 30-day AR while the practice actually runs at 52 days has a cash flow gap in the first 60 to 90 days that the plan never accounts for. That gap shows up as a cash crisis, not a revenue problem.   [Three actions this week]  Pull payer mix by collections: 12 months, by payer, as a percentage of net payments  Pull your net collection rate: net collections divided by gross charges minus contractual adjustments, 12 months, run 90 days in arrears  Pull AR days for your top four payers, insurance and patient separately, with a 3-month trend direction on each  If you cannot pull any of these cleanly from your system, that is the first thing to fix, not the business plan. A plan built on numbers you cannot verify is not a plan. It is a guess with formatting. And if you can pull them and the numbers surprise you, that surprise is worth more than any plan you would have built without looking. Take them to your accountant and your billing manager before you build anything else.   [Episode breakdown]  00:00  The three numbers  00:40  Why this matters before you build anything  02:30  Payer mix: what it actually is  05:10  The calculation that matters  06:40  Why 12 months and not 3 or 6  08:20  Net collection rate: the formula  11:00  How to pull it correctly  13:10  What a healthy number looks like  15:00  The number most practices are using is not this  17:00  AR days: insurance versus patient  19:20  What AR days does to a cash flow plan  21:30  What to do before you build anything  23:00  Next week on EP207 Practice Financial Health Dashboard for Physicians  The workbook version of this episode. Enter your payer mix, net collection rate and AR days and see each one against benchmark, in one place.  https://eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  RECOVER Diagnostic  Four minutes. Shows you which part of the revenue cycle is leaking before you go pull anything.  https://eligibility.natrevmd.com/recover-quiz-lp  30-Day Revenue Recovery Plan  For practices that already know something is off and want a sequence to work through rather than a diagnosis.  https://eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan  EP204: The Hidden Cost of Running Your Practice Without a Business Plan  The episode this one builds on. Why the plan matters before we talk about the inputs.  https://podcasts.apple.com/us/podcast/204-the-most-expensive-thing-in-your-practice-is-an-open-note/id1624182351?i=1000783299856 EP207: coming next week  What happens when these three numbers are quietly off in the optimistic direction.  https://natrevmd.com/podcast/

  2. 3 days ago

    #205 Your Practice Can Be Profitable and Still Run Out of Money

    Send us Fan Mail A practice hired a provider in January. The hire was right and she was generating revenue from day one. By March the practice was sixty thousand dollars short and could not make payroll, because nobody had modeled what cash looks like in month two when you are carrying a full salary and the claims are still in the pipeline. This episode builds the model that would have caught it, and it is not the binder kind.  In this episode:   The seven moments when a practice actually needs a financial model The six components that matter, and the ones you can skip How to calculate net revenue per visit and why everything else depends on it The cash flow projection that shows what a profit and loss statement cannot Break-even, translated into a daily schedule number The five numbers each seat in the practice needs to see RESOURCES FROM THIS EPISODE  1. Practice Financial Health Dashboard (free Excel workbook)  The workbook version of the model in this episode. Revenue per visit, the fixed and variable expense split, a 24 month cash flow projection with the payment lag already built in, and the break-even math. You enter your numbers, it does the arithmetic.  eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  2. The RECOVER Diagnostic (two minutes)  A short set of questions about how your practice runs. At the end you get a read on where the revenue is leaking and which fix we would put first if it were our practice.  eligibility.natrevmd.com/recover-quiz-lp  3. Protecting Your Visits From Downcoding (free live session, Wednesday August 26, 4:00 to 5:00 PM CST)  Stephanie Hilliard, CPC, on keeping visits from being downcoded and documenting medical decision making that supports a successful appeal. Every registrant gets the physician toolkit: the 90-Second MDM Note Builder, the Is This Really a Level 4 annotated casebook, an EHR SmartPhrase starter pack, the MDM or Time decision card, and the Hidden Work reference.  eligibility.natrevmd.com/em-downcoding-webinar  4. The 30-Day Revenue Recovery Plan (free PDF)  If the model says the practice should be fine and the cash still is not there, this is the first month of fixes we run, sequenced so you are not repairing six things at once.  eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan  SYSTEM 1: WHEN A PRACTICE ACTUALLY NEEDS A PLAN  Four triggers, not a continuous ritual. Starting the practice, adding a provider, opening a second location, adding a service line, seeking financing, a partnership or buy-in, and a sale or transition. The one owners skip most often is adding a provider, because the hire feels like a revenue decision. In the first sixty to a hundred and twenty days it is a cost decision: the salary starts on day one, the claims do not pay for thirty to forty five days, and full schedule utilization takes another sixty to a hundred and twenty days after that.  SYSTEM 2: THE SIX COMPONENTS THAT MATTER  The clinical model sets the ceiling on revenue. The revenue model converts capacity into cash through payer mix and net collection rate. The expense structure separates the fixed floor from the variable layer. The cash flow projection makes the payment lag visible month by month, which is what reveals a profitable practice running out of money. The break-even analysis turns the whole model into one daily schedule number. And the KPI dashboard is what keeps the plan alive after it is built.  SYSTEM 3: WHAT MAKES IT A DECISION TOOL  Three scenarios instead of one, and the downside case is the one that sets your reserve requirement. Stress tests on every assumption, because knowing which ones are high-sensitivity is how you know what to watch after launch. And an operating translation, so the model becomes three or four numbers each person in the practice can act on rather than a file nobody opens.  THE CALCULATION, WORKED IN FULL  Net revenue per visit $130.63 net revenue per visit  Break-even, for a practice with $180,000 in monthly fixed expenses:  $180,000 / $131 net revenue per visit = 1,374 visits per month  1,374 / 22 working days / 2 providers = 31 visits per provider per day to break even  THREE ACTIONS THIS WEEK  1. Calculate your net revenue per visit.   2. Calculate your break-even visit count. Total fixed monthly expenses divided by net revenue per visit, then divided by working days and providers. That is your daily target.  3. Before any significant decision this quarter, sketch a 90 day cash flow. New expense from day one, revenue with the payment lag applied. If the balance goes negative, you now know the reserve required to fund through it.  EPISODE BREAKDOWN  00:00 The hire that nearly broke a practice  00:40 What a business plan actually is  02:30 System 1: the four triggers  08:00 System 2: the six components that matter  09:30 Net revenue per visit  13:00 The cash flow projection  15:30 Break-even as a daily number  18:00 System 3: three scenarios  19:30 Stress-testing assumptions  21:00 The five numbers each seat needs  23:00 What to do this week

  3. 14 Aug

    #204 The Most Expensive Thing in Your Practice Is an Open Note

    Send us Fan Mail A full schedule is not the same thing as a healthy practice. Our guest this week walked into an independent family practice in Colorado to do finance work, was offered the practice manager role a few weeks later, and quickly found the gap: patients were coming in, the schedule was booked three to five months out, and the money still was not moving. What follows is the sequence she used to close that gap, and it starts nowhere near the billing office.  In this episode:  How to find the fire costing you the most money right now, and why you fix only that one  What a week working a role yourself reveals that no meeting ever will  The training-first sequence that makes accountability stick instead of driving turnover  The leaderboard and the 72-hour standard that moved a five-provider note backlog  The front desk scripts that turn a copay ask into a copay collected  RESOURCES FROM THIS EPISODE  1. The 30-Day Revenue Recovery Plan (free PDF)  The first month of fixes we run when a practice is fully booked and still short on cash. It sequences the work so you are not trying to repair six things at once: what to pull first, what to change next, and what can wait until the bleeding stops.  eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan  2. The RECOVER Diagnostic (two minutes)  A short set of questions about how your practice actually runs. At the end you get a read on where your revenue is leaking and which fix we would put first if it were our practice.  eligibility.natrevmd.com/recover-quiz-lp  3. Protecting Your Visits From Downcoding (free live session, Wednesday August 26, 4:00 to 5:00 PM CST)  Stephanie Hilliard, CPC, on keeping your visits from being downcoded and documenting medical decision making that supports a successful appeal. Every registrant gets the physician toolkit: the 90-Second MDM Note Builder, the Is This Really a Level 4 annotated casebook, an EHR SmartPhrase starter pack, the MDM or Time decision card, and the Hidden Work reference. Free, and nothing is expected of you afterward. eligibility.natrevmd.com/em-downcoding-webinar  4. Practice Financial Health Dashboard (free Excel workbook)  The tool version of what our guest did first: get the numbers in one place and look at them. Built for physicians who want the picture without building the spreadsheet themselves.  eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  5. Practice Revenue Leak Scorecard  A self-scored walk through the places money goes missing between the front desk and the deposit, so you can see which ones are yours.  eligibility.natrevmd.com/nrm-revenue-scorecard-v3  Delegation starts with doing the job yourself. When a front desk staffer needed a week off, she covered the desk for the full week instead of observing for an hour. Day one she describes as burnout. By day three she had a flow. What she came back with was not a complaint list, it was a map of what the team was capable of and what nobody had ever trained them to do.  Technology is a workload decision, not an IT decision. Ninety percent of inbound calls are not scheduling calls. They are refill requests and follow-up questions, and most of them belong in the patient portal. Push the portal and the text reminders and the phones quiet down, which gives the desk time to do the work that actually gets the practice paid.  Accountability comes after training, never before. Her rule is direct: you cannot hold someone accountable for a job they were never properly trained to do. So the checklists came first. Same steps at every check-in and every check-out, so the result is identical no matter who is at the desk. Once the tools exist, the excuses stop and the standard is fair.  Turnover in year one is a training problem. Nobody accepts a job without knowing the pay. So when someone leaves inside the first year, it is usually because they are unhappy or they do not know how to do what is being asked of them. Her nursing staff have been there fourteen and fifteen years. The front desk is where the churn lives, and that is a training signal, not a compensation one.  The front desk is where collections are won or lost. During her week at the desk, daily copay collections ran two to four thousand dollars against a normal range of eight hundred to a thousand. The difference was not effort, it was scripting. Not "would you like to pay today" but "how would you like to pay today." Not "do you want to book your wellness" but "who would you like to see for your wellness next year."  The leaderboard did what memos could not. A backlog of open provider notes was choking the revenue cycle, and reports alone had not moved it. She built a weekly leaderboard ranking providers by open notes, then layered a 72-hour closure policy on top with a real consequence attached, applied to owners and part-time providers alike. Fifteen days into the leaderboard the backlog had dropped by more than 150 notes.  Measure the standard, not just the pile. The tracker evolved past a raw count into a percentage: of the notes a provider has open, how many are still inside the 72-hour window. Below eighty percent and they hear from her directly. As Heather puts it, what you do not measure, you do not make progress on. THREE ACTIONS THIS WEEK 1. Pull your open encounter count and your AR over 90 days. Do not guess the number, print it. Most practices are surprised by it.  2. Pick one role and work it yourself for a full day, minimum. Not observation. Do the job.  3. Before you ask anyone for accountability, ask whether the training and the checklist actually exist. If they do not, that is this month's project.  EPISODE BREAKDOWN  00:00 Meet our guest and how she landed the role  02:30 Delegation starts with knowing what the job actually is  03:38 A full week working the front desk  08:47 Ninety percent of your calls are not scheduling calls  13:37 You cannot hold someone accountable to training they never got  19:58 Nobody quits in year one over pay  21:43 What one week at the desk did to daily copay collections  23:40 The scripts that changed the number  26:11 No job is above me or below me  27:52 The math was not mathing  30:28 The open note backlog and the leaderboard  31:40 The 72-hour policy, owners included  35:13 Measuring the standard, not just the backlog  36:44 Why we are not adding patients yet  38:10 One piece of advice for a practice that is stretched thin

  4. 11 Aug

    #203 She Never Missed a Monday. Her Collections Dropped Anyway

    Send us Fan Mail She never missed a Monday. Twelve months of weekly billing meetings, every number reviewed, every question answered. And by the end of that year her net collection rate had dropped four points, her ninety-plus AR was up forty percent, and her denial rate had climbed from six percent to eleven. The numbers were there every week. The report was accurate. Nothing changed, because the meeting was structured around reporting instead of around deciding.  System 1: the financial snapshot. Three numbers, charges, payments posted, and unlocked encounters, each compared to last week and month to date. Payments lag charges by 30 to 45 days, so a strong week reflects submissions from a month ago. And unlocked encounters, the number most owners skip, is the most controllable revenue lever on the report. On a practice doing $350,000 a month, each day of unsigned encounters at scale represents roughly $12,000 to $18,000 in claims that are not in the pipeline.  System 2: AR aging, denials, and stuck claims. AR aging by date of service is the patient-facing view. AR aging by claim date is the payer-facing view. The comparison between them is its own diagnostic: if date-of-service aging is older, you had a submission delay. If claim-date aging is drifting past 90 while date-of-service aging sits at 30 to 60, the payer is holding claims that went out promptly. Denials and rejections are also not the same problem: a rejection happens before adjudication and is a front-end fix, a denial happens after and carries appeal deadlines.  System 3: the accountability layer. Patient statements, four trackers, the rolling action item tracker, and the onshore manager review. The rolling tracker is the section that makes the meeting matter: eight fields, every item with one named owner and one due date, no item closed without a resolution note. Without it, the same problems get identified week after week and the meeting becomes a theater of accountability rather than a mechanism for it.  THE WEEKLY MEETING AGENDA  Financial Snapshot, 5 min. Charges, payments posted, unlocked encounters vs last week and MTD. Ask: did we move in the right direction and do we know why?  AR Aging by DOS, 5 min.  Ask: is the 90-plus bucket growing or shrinking week over week?  AR Aging by Claim Date, 3 min.  Ask: where are claims stalling after submission and which payer is holding them?  Denial Analysis, 7 min.  Ask: what is the root cause of the top denial and what closes it?  Rejection Analysis, 5 min.  Ask: what front-end information gap is generating these and who fixes it?  PM System Status, 3 min.  Ask: what is sitting in a status that should have moved by now?  Patient Statements, 3 min.  Ask: are we sending on schedule and is patient AR moving?  Tracker Updates, 5 min.  Ask: what is still open from last week and does it have a new owner or date?  Rolling Action Items, 5 min.  Ask: does every open item have one owner and one due date?  Manager Review, 4 min.  Ask: what is the team seeing that is not captured in the numbers? READING YOUR AR  90-plus growing week over week. Claims aging without resolution. Ask which payer and what status, and whether this is a follow-up gap or a payer dispute.  0 to 30 growing faster than payments. Strong submission, lagging cash. Ask whether this is normal lag or a specific payer slowing down.  120-plus unchanged for 3 or more weeks. Approaching or past timely filing. Ask which claims, what the appeal status is, and whether any need to be written off.  Claim date aging older than DOS aging. Submission delay. Ask what caused it and whether it is still happening on current claims.  Unlocked encounters climbing. Charts are not being signed. Ask which providers, how many days open, and who is following up today.  THREE ACTIONS THIS WEEK  1. Pull your unlocked encounter count today and bring it to Monday. If it is growing, that is the first conversation before any other section gets opened.  2. Ask your billing manager for the rolling action item tracker from the last four meetings. If it does not exist, that is the answer.  3. Write one specific question for each of the three main sections before your next meeting, and notice what changes when the meeting has a questioner in it.  EPISODE BREAKDOWN  She never missed a Monday | Reporting versus deciding | The financial snapshot | Unlocked encounters | AR aging, two views | Denials versus rejections | Claims status | Trackers and patient statements | The rolling action item tracker | The manager review | Three things to do this week Resources block  1. FREE: Practice Financial Health Dashboard, https://eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  2. FREE: Practice Revenue Leak Scorecard, https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3  3. Everything else we have built, in one place: https://natrevmd.com/trusted-resources/  4. Related listening, EP200 and EP201 on building the billing partnership and the shared operating model: EP200 and EP201

  5. 7 Aug

    #202 $144,000 a Year and Nobody Ever Escalates It

    Send us Fan Mail The most expensive billing relationship is not the one that is clearly failing. It is the one that is quietly not delivering. On a practice doing $400,000 a month, three points of net collection rate is $12,000 a month. Nobody escalates $12,000. It does not trigger a phone call. It just leaves, month after month, until somebody adds up a year of it and finds $144,000 that nobody ever fought for. This is Part 2 of a two-part series and it builds the operating model that catches it.  System 1: the day-to-day operating model. Every good billing partnership has a weekly rhythm and a monthly rhythm, both defined before the relationship starts rather than improvised after something goes wrong. The weekly rhythm is operational on the practice side and communicative on the billing side. The practices that feel most confident are almost always the ones with a short, consistent weekly touchpoint. Not because anything is wrong. Because nothing has had time to go quietly wrong.  The five-number report. Most monthly billing reports show collections by payer, claims submitted, and a denial percentage. That is activity data, not performance data. The report that tells you whether the value equation is moving has five numbers: net collection rate, denial rate by payer and reason code, AR days trending over three months, clean claim rate, and patient AR aging by segment.  System 2: how to know it is working. Three green flags. Denial root causes are getting identified and closed, not just worked. The practice side is getting easier over time rather than harder. And the leading indicators are moving before the headline numbers do. Three warning signals. The monthly report is not readable or not specific. Problems get explained after they compound instead of flagged before. And the same denial patterns appear month after month without root cause resolution.  System 3: what to do when something feels off. The right first move is almost never to start looking for a replacement. Most billing relationships that ended badly were relationships where the right conversation happened six months too late. There is exactly one situation where replacement is the right call: specific commitments were made by both sides with dates attached, and they were not kept after a fair period.  THE SHARED OPERATING MODEL  Chart Closure. Practice: providers sign charts within 24 to 48 hours of the encounter. Billing partner: tracks chart closure rate weekly and flags delays before they hit the claim cycle.  Front Desk Accuracy. Practice: verifies eligibility before every visit, collects copay at check-in, captures authorizations before the patient is seen. Billing partner: trains the front desk on what billing needs and provides feedback loops when errors surface in claims.  Denial Management. Practice: backs the billing partner on policy enforcement with payers when escalation requires physician involvement. Billing partner: owns denial follow-up completely, trends by payer and code, reports root causes monthly.  Patient Balances. Practice: communicates financial expectations at scheduling and check-in and supports the collections policy. Billing partner: provides a structured patient AR workflow and reports aging by segment.  Performance Visibility. Practice: reviews the monthly report and asks questions when numbers move. Billing partner: delivers a clear payer-level report monthly with denial rate, AR days, net collection rate, and trend direction.  Communication Rhythm. Practice: shows up to the weekly or bi-weekly review. Billing partner: runs the meeting with an agenda, flags problems before they compound, and proposes solutions rather than summaries.  THREE ACTIONS THIS WEEK  1. Ask your billing partner for the five-number report this week, not at the next scheduled review. How fast it arrives tells you as much as what is in it.  2. Check your own weekly rhythm: chart closure rate over the last seven days, eligibility verification rate at the front desk, copay collection rate at check-in.  3. If your billing relationship has been running more than 90 days and you have never run the four-variable review, schedule it this week and frame it as a calibration, not a performance review.  EPISODE BREAKDOWN  The $144,000 nobody escalates | Bridge from EP200 | Where quiet underperformance lives | The weekly and monthly rhythm | The five-number report | Three green flags | Three warning signals | What to do when something feels off | Three things to do this week  Resources block 1. FREE: Practice Financial Health Dashboard, https://eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  2. FREE: EMR / PM Evaluation Framework, https://eligibility.natrevmd.com/emp/pm-evaluation-framework  3. Part 1 of this series, EP200 Know Your Side of the Equation: https://podcasts.apple.com/us/podcast/200-your-performance-reviews-are-making-your-billing/id1624182351?i=1000779256351 4. Practice Revenue Leak Scorecard, https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3  5. Referenced in this series: $100M Offers by Alex Hormozi

  6. 4 Aug

    #201 You Are Half of Your Billing Company's Performance

    Send us Fan Mail A practice doing seven figures a month switches billing companies, and eighteen months later the denial rate is higher than the day they signed. Nobody lied. Both sides just walked in with a different picture of what good looked like. In this episode we run Alex Hormozi's value equation across a billing partnership, one variable at a time, and name exactly what each side owes the other.  Dream Outcome. A practice owner hears "we will improve your collections" and pictures denials dropping from 12 percent to 5, AR days under 35, and her team off the payer portals on Friday afternoons. The billing company is picturing a 3 to 5 point net collection improvement over twelve months. Both are honest. Neither is the same outcome. The fix is a written, numeric definition of success before the contract is signed.  Perceived Likelihood. The billing partner builds this with evidence: before-and-after denial rates in your specialty, AR trending over twelve months, retention data. The practice builds it with an honest read on its own history. A practice that says "our front desk eligibility rate has been inconsistent and we are ready to fix that" is a fundamentally different partner than one expecting the problem to be solved without any practice-side change.  Time Delay. Month one is almost entirely old AR, because new claims will not generate cash for 30 to 45 days. That is not a performance problem, it is how billing cash flow works. But if nobody said it before the relationship started, month one feels like nothing is happening. The ramp has to be mapped out loud, before the contract, not defended at the 60-day mark.  Effort and Sacrifice. Chart closure inside 24 to 48 hours. Eligibility verified before the visit. Patient balance expectations set at scheduling. A billing company can recover denials, but it cannot recover a claim that was never submitted because the chart was never signed. And on the other side: complete ownership of denial follow-up, a report a physician can read, and problems raised before they compound.  THE SHARED VALUE EQUATION  Dream Outcome. Practice: defines it specifically and measurably upfront. Billing partner: maps a realistic written path to it before the contract is signed.  Perceived Likelihood. Practice: consistent operational inputs, charts closed, front desk disciplined, patient balances engaged. Billing partner: track record, transparent reporting, accountability on their own performance.  Time Delay. Practice: patience through the 90 to 180 day ramp and commitment to the agreed timeline. Billing partner: weekly visibility, a clear map of the transition, no black boxes.  Effort and Sacrifice. Practice: willingness to change what needs changing on their side of the operating model. Billing partner: making their side of the change as easy as possible and owning it completely.  THREE ACTIONS THIS WEEK  1. Write down three to five specific, measurable targets that would tell you the relationship is working. Denial rate. AR days. Net collection rate. Chart closure rate. Clean claim rate.  2. Ask any prospective partner for before-and-after data from three practices in your specialty at a similar volume, and ask to speak with them directly.  3. Get the month one, month two, month three ramp in writing before the relationship starts, and reference it at every monthly review.  EPISODE BREAKDOWN  The switch that made things worse | The value equation and why every variable has two sides | Dream Outcome | Perceived Likelihood | Time Delay and the honest ramp | Effort and Sacrifice | Three things to do this week  Resources block  1. FREE: EMR / PM Evaluation Framework, https://eligibility.natrevmd.com/emp/pm-evaluation-framework  2. FREE: Practice Revenue Leak Scorecard, https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3  3. Everything else we have built, in one place: https://natrevmd.com/trusted-resources/  4. Referenced in this episode: $100M Offers by Alex Hormozi  5. Part 2 of this series, EP201 The Shared Operating Model: https://natrevmd.com/podcast/

  7. 31 Jul

    #200 Your Performance Reviews Are Making Your Billing Team Worse

    Send us Fan Mail 👉 Free 30-Day Revenue Recovery Plan: https://eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan The plan we would build with you if you walked into our office today. Take it home and run it yourself.  ────────────────  Your performance reviews are probably making your billing team worse. Not because you're giving bad feedback. Because the format itself is designed to produce defensiveness, not change. 95 percent of managers are dissatisfied with their review process, and 90 percent of HR leaders say it doesn't produce accurate performance information. And in an independent practice, it's usually worse than that: an annual conversation that changes nothing, a reaction to a problem that arrives too late, or no review at all.  In this episode we replace the annual review with three evidence-based tools. All of them work in a two-person billing office. None of them require an HR department.   Why the Traditional Review Fails.  Retrospective, evaluative, high-stakes formats activate self-protection, not development. The employee being evaluated for past performance is managing her reputation, not learning. The billing manager whose Friday claim-scrub pattern gets addressed in an annual review will comply for six weeks and drift back by week eight. Because the review addressed the behavior but not the cause.   The SBI Model.  Developed by the Center for Creative Leadership. Three parts, order matters. Situation (specific observable moment). Behavior (what happened, not who she is). Impact (specific consequence, ideally with a dollar figure). One SBI conversation takes about four minutes and can happen at a desk immediately after the event.   The GROW Model.  Four questions, in order, without skipping any. Goal (what does excellent look like, from her perspective). Reality (where is she now against that standard). Obstacles and Options (what is in the way, what could change). Way Forward (what specifically will she do, and by when). Compliance fades. Ownership compounds.   The IDP.  A one-page Individual Development Plan capturing the outcome of a GROW conversation. Goal, current reality, top obstacle, one specific commitment with a date. Reviewed together every two weeks. After three of these, the billing manager has a roadmap to excellent performance that she helped build.  Sticky Phrase: Coaching compounds. Compliance fades.  Three Actions This Week  Run one SBI conversation on a specific, recent, observable billing event. Under five minutes. Watch what happens.Run one GROW conversation with your highest-potential staff member. Fifteen minutes, four questions in order. Build a one-page IDP for your billing manager. One page, shared before the next meeting, reviewed biweekly. Episode breakdown  00:00 — Your reviews are making your team worse  03:00 — Why the traditional review fails  07:00 — The SBI model  13:30 — The GROW model  20:00 — The IDP  23:00 — Three actions this week  26:30 — Free resource + close  👉 30-Day Revenue Recovery Plan (free)  eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan   Website: natrevmd.com  Trusted Resources: natrevmd.com/trusted-resources/  Referenced in episode:  Center for Creative Leadership — SBI Feedback Model  Lattice — What Is the GROW Coaching Model  Coaching for Performance by John Whitmore (foundational GROW text)  The four-episode culture-and-people arc:  EP196 — Culture is a revenue decision: https://podcasts.apple.com/us/podcast/197-the-%2440-000-hire-with-the-perfect-resume/id1624182351?i=1000777698531 EP198 — The mindset you hire is the culture you build: https://podcasts.apple.com/us/podcast/198-%24300-000-in-old-ar-is-at-risk-during-your-next/id1624182351?i=1000778180219 EP199 — The first 90 days decide the next three years: https://podcasts.apple.com/us/podcast/199-you-are-destroying-half-the-value-of-every-hire-in-90-days/id1624182351?i=1000778687186 EP200 — This episode (series close)  Next episode: EP201 — The one payer contract negotiation move most independent practices never make. What the team you built can produce when the contracts underneath them are set correctly.

  8. 28 Jul

    #199 You Are Destroying Half the Value of Every Hire in 90 Days

    Send us Fan Mail 👉 Free RECOVER Diagnostic: eligibility.natrevmd.com/recover-diagnostic  The exact framework we use when we walk into a new practice. Takes five minutes. Results are immediate.  ────────────────  Only 12 percent of employees strongly agree that their organization does a great job of onboarding. Which means 88 percent of practices — including most independent ones — are spending real money to find the right person, and then handing them a login and a stack of pending items and calling that integration. SHRM data puts new-hire turnover as high as 50 percent inside 18 months. Replacing a billing manager at $55K a year costs between $27,500 and $41,250 per departure.  This is Part 3 of our four-episode arc. Culture is a revenue decision (EP195). The mindset you hire is the culture you build (EP196). Today we cover what happens after the hire is made.  Why Traditional Onboarding Fails.  The most common model in independent practice is "trial by immersion": the new hire arrives, gets a login and a senior employee who is supposed to train her when she has time. In hospital systems, the failure is the opposite — bureaucratic theater that produces compliance and nothing else. Both prioritize process over people and treat onboarding as an event rather than a journey. The urgent care group we describe in the episode lost three office managers in 18 months not because they hired badly — because their onboarding communicated, without meaning to, that they did not have a plan.  The 30-60-90 Structure.  Days 1-30 = foundation and orientation (not productivity). Days 31-60 = supervised contribution. Days 61-90 = integration and ownership. Ownership is not mastery. Mastery takes years. Ownership of a defined scope is achievable in 90 days with the right structure. The piece most practices skip: pre-boarding — a welcome message from the physician before day one that says "you were expected, we planned for you, you matter here."  Cultural Immersion vs Cultural Assumption.  The most important thing the first 90 days communicate is not operational. It is cultural. A new billing coordinator who reads the mission statement on day one and watches the physician dress down a staff member on day three has received two pieces of information. She will act on the second one.  The Five Elements of Intentional Cultural Onboarding  Physician welcome conversation — five minutes, day one, genuine A mentor or buddy from the existing team with explicit permission to prioritize onboarding A values-in-action story shared in the first two weeks (not the values statement — a story) Early wins by design — a real task completed and acknowledged in the first 30 days Structured 30/60/90 check-ins — three simple questions, not a performance review 30-60-90 Medical Practice Reference  Days 1–30 — Foundation & Orientation  Success looks like: knows the EMR, payer mix, and denial workflow. Has met every person whose work touches hers. Has reviewed the practice's top 10 denial reasons. Has NOT yet worked anything independently.  Days 31–60 — Skill Development & Contribution  Success looks like: is working her assigned queue independently with weekly review. Has completed one supervised denial audit. Can articulate the practice's clean claim rate target and where they currently stand.  Days 61–90 — Integration & Impact  Success looks like: has identified one billing pattern or workflow gap and brought it to her manager with a proposed fix. Is contributing to team meetings. Has set her first 90-day personal performance goal.  Sticky Phrase: The first 90 days decide the next three years.  Three Actions This Week  • Write a one-page onboarding roadmap for your highest-turnover role.  • Define the three cultural moments in the first 30 days that will communicate your culture most powerfully.  • Schedule the 30/60/90 check-ins on the calendar BEFORE the next new hire arrives.  Episode breakdown  00:00 — You are destroying half the value of every hire  03:00 — Why traditional onboarding fails  08:00 — The 30-60-90 structure  14:00 — Pre-boarding  16:30 — Cultural immersion vs cultural assumption  22:00 — The five elements  27:00 — Three actions this week  30:00 — Free resource + close  👉 RECOVER Diagnostic (free, 5 minutes)  eligibility.natrevmd.com/recover-diagnostic  Website: natrevmd.com  Trusted Resources: natrevmd.com/trusted-resources/  Referenced in episode:  Gallup — State of the American Workplace (onboarding data)  SHRM — new hire turnover research  Organizations with structured onboarding programs data (82% retention improvement, 70% productivity improvement)  The four-episode culture-and-people arc:  Part 1 — EP197 Culture is a revenue decision: https://podcasts.apple.com/us/podcast/197-the-%2440-000-hire-with-the-perfect-resume/id1624182351?i=1000777698531 Part 2 — EP198 The mindset you hire is the culture you build: https://podcasts.apple.com/us/podcast/198-%24300-000-in-old-ar-is-at-risk-during-your-next/id1624182351?i=1000778180219 Part 3 — EP199 This episode  Part 4 — EP200 (series close) The performance review nobody wants and how to replace it  Next episode: EP200 — the two conversation structures (SBI and GROW) that replace the annual performance review with something that actually changes behavior. Series close.

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About

Medical billing tips for healthcare professionals — by healthcare professionals.  This podcast is here to help private practices get paid what they’ve earned. We share real-world strategies for accurate coding, smoother billing workflows, and fewer denials — all from a team that’s been in your shoes. Whether you’re just getting started or trying to tighten up your revenue cycle, you’ll get practical advice you can actually use. Join the conversation in our Facebook Group: NatRevMDLearn more at www.natrevmd.com

Information

  • Creator
    NatRevMD
  • Years Active
    2022 - 2026
  • Episodes
    207
  • Rating
    Clean
  • Copyright
    © 2026 NatRevMD
  • Show Website
    NatRevMD

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