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Send us Fan Mail How many AI billing tools have you been pitched in the last few months? If you are like most practice owners, more than any other vendor in years. Some of these tools are very good, and we are piloting one ourselves. But if your billing process is not clean, adding AI on top of it will only break it faster. In this episode, Dr. Heather Signorelli shares how we are running our own AI pilot alongside our billing team. She also gives you a simple framework to decide where AI belongs in your revenue cycle and how to evaluate any vendor before you sign. Fix the process first. If eligibility breaks because the right information is not captured at the front desk, a tool will not fix it. Get workflows out of people’s heads and onto paper, with one set of policies, trainings and checklists across every location. Then decide what to automate. Automate the work, keep the judgment with your people. AI fits high-volume, rules-based, repetitive work where the right answer is known. Complex denials, judgment calls and quality assurance stay with humans. Run a controlled pilot. Start with one painful process in one or two practices. Check 100% of the AI’s work at the start and track how fast the review time comes down. If your team has to recheck everything forever, that is not automation. Define success before you start. Know your denial rate, clean claim rate, eligibility issues and claim speed today. Decide what accuracy the tool must hit and who on your team owns the evaluation. Ask the hard questions. Ask about accuracy on claims like yours, who catches the errors, what the contract says about performance, and what an exit looks like if the vendor is sold. Where AI fits in billing today: Eligibility and benefits: work clearinghouse failures, check payer portals, escalate what it cannot fixClaim scrubbing: check every claim against payer rules and coding editsPayment posting: handle checks that fail auto posting and pull missing EOBsA/R follow up: claim status review and the first layer of denial workPayer contracts: prepare the data and test offers against the CPT codes you actually billYour one action this week: if you are evaluating an AI vendor, ask them which of your billing metrics their tool will move, and by how much. RESOURCES Free Metrics Audit Review (a physician-led second opinion on your numbers): https://eligibility.natrevmd.com/metrics-audit-natrevmdFree Billing Performance Scorecard (six numbers, green, yellow or red, plus a one-page 90-day plan): https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-planNatRevMD AI Kit (prompts and tools for using AI in your practice): https://eligibility.natrevmd.com/natrevmd-ai-kit-toolWebsite: https://natrevmd.comIN THIS EPISODE Why every practice is getting pitched AI right nowAI on a broken process just breaks it fasterMulti-site practices: getting the process out of people’s headsHow we are running our own AI pilotWhere AI fits, and where humans still winHow to evaluate an AI vendor and define successContracts, performance terms and your exit planRed flags that the tool is not working

Send us Fan Mail Most practices don't have a lead problem. They have a follow-up problem. Dr. Mona Sodhi, DO, co-founder of Super Doc Tech, built her own direct-pay obesity medicine practice from scratch and found herself running ten disconnected tools on top of seeing patients. In this episode, she and Dr. Heather Signorelli talk about why interested patients slip away, why your CEO time matters as much as your clinical time, and what it takes to build a system that turns interest into booked patients. What we cover: The Disjointed System Website in one place, newsletter in another, networking cards lost under a car seat. None of it talks to each other, so you never know what happens after you meet a potential patient. Most people need about seven touches before they decide to book, and one ask is rarely enough. The Perfectionist Trap Medical training teaches us we can't afford a mistake. Carry that into marketing and most physicians freeze and do nothing. Business is flexible. Lives are not on the line when you build a business. Make Time to Be the CEO Dr. Mona and her co-founder block four hours a week, just the two of them, to work on the business. If it isn't on the calendar, it doesn't happen. The Leaky Bucket Calls that never get returned, contact forms that go nowhere, Instagram automations with no follow-up. Heather shares her own experience trying to find a new physician and never hearing back. Speed to lead matters, and plugging the leak is easier than chasing new patients. A VA Executes. A Thought Partner Builds Revenue. Why outsourcing marketing tasks is not the same as having someone ask whether each newsletter, automation and CRM step is actually driving revenue. Three actions this week: - Put one recurring CEO block on your calendar and protect it like a patient visit. - Check how every new patient inquiry gets answered today, and how fast. - Map the follow-up a new patient receives after the first contact. If it ends after one touch, start there. Episode breakdown: 00:00 Welcome Dr. Mona Sodhi 00:53 From obesity medicine practice to tech company 02:09 Disjointed systems that never talk to each other 05:11 Why running a practice feels so hard for physicians 07:17 How to find time to be the CEO 11:02 Calendar blocking everything 12:28 What practices struggle with most 15:53 Why a VA is not a thought partner 16:33 Heather's unanswered contact form 19:06 A CRM built around revenue 21:43 How to work with Super Doc Tech Free resources from NatRevMD: Billing Performance Scorecard: see where your billing stands in 20 minutes https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan Free Metrics Audit Review: for practices with 2+ red flags https://eligibility.natrevmd.com/metrics-audit-natrevmd Connect with Dr. Mona Sodhi and Super Doc Tech: Website: https://superdoctech.com Instagram: https://www.instagram.com/superdoctech/ Facebook: https://www.facebook.com/superdoctech/ LinkedIn: https://www.linkedin.com/in/superdoctech/ YouTube: https://www.youtube.com/channel/UCGcVrEsMu7vjjRP5y-iAi9g Listen to her podcast: Super Doc Stories Connect with NatRevMD: https://natrevmd.com https://www.linkedin.com/company/79500978/

Send us Fan Mail Last week a bill was introduced in Congress to stop corporate takeovers of physician practices. Some people are calling it reform. Dr. Heather Signorelli read the actual text, and in this episode she walks through what the bill says, what it leaves out, and why she thinks it misses the root cause of what’s squeezing independent practices. This is not a political episode. It’s a briefing for practice owners, physicians and healthcare executives who want to understand what’s moving before they’re asked for an opinion on it. What the bill actually does Practices would have to be majority owned and majority governed by licensed clinicians, including NPs and PAs. Private equity, insurers and for-profit corporations could not own or control a practice. MSOs could still handle billing, payroll and IT, but not hiring, schedules, pay, billing policy or payer contracts. Non-competes, NDAs and non-disparagement clauses would be void for clinicians, except those who own 25% or more of the practice. The exemption nobody is talking about The ownership ban exempts hospitals, all of them. By the sponsors’ own numbers, over 80% of physicians are corporately employed, and roughly 60% of them work for hospitals. That means the ownership rule reaches only about 20% of physicians. The non-compete ban and clinical autonomy protections do apply to everyone, which could be a big change for hospital-employed physicians. Autonomy without a payment rule The bill says no one can pressure a doctor on time with patients, orders or coding. But a payer still reimburses an office visit built for 15 minutes. The bill protects the 40-minute visit. It doesn’t pay for it. Where Heather thinks the real problem sits Low reimbursement, denials, prior auth fights and same-day bundling cuts are what push practices toward volume over patient needs. Ownership structure doesn’t change any of that. She also covers the Texas Attorney General’s action against UnitedHealthcare and how IPAs give independent physicians negotiating leverage, a thread from EP227 with Ben Phillips. Three takeaways for practice owners Know what the bill does and doesn’t touch: ownership and contracts, not payment, denials or admin burden.If you employ clinicians under non-competes, watch this space. That provision applies broadly.Your negotiating position with payers matters more than who owns you. Pooling with other independents is one way to strengthen it.Episode breakdown 00:00 What the bill is and why it caught our attention 01:54 What the bill actually says 04:05 Enforcement, divestiture and the odds it passes 05:30 The Texas AG vs UnitedHealthcare and the pushback on payers 07:28 What the bill doesn’t touch: payment, denials and admin burden 09:48 IPAs and negotiating as a group (EP227 with Ben Phillips) 10:30 The hospital exemption 13:44 Clinical autonomy vs the 15-minute visit 17:21 Fixing payment at the root: coverage tied to standard of care 19:40 Final thoughts Resources Billing Performance Scorecard: see where your billing stands in minutes. https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-planFree Metrics Audit Review: if your scorecard shows 2 or more reds, we review your numbers with you. https://eligibility.natrevmd.com/metrics-audit-natrevmdListen to EP227 with Ben Phillips on IPAs, ACOs and payer leverage: [EP227 link]Learn more about NatRevMD: https://natrevmd.com

Send us Fan Mail Over the last two weeks I have been interviewing candidates, and I asked every one of them the same question: why are you leaving? The top answer was not money, PTO or benefits. It was career growth. In this episode I share what that means for your practice and how we run our own hiring process. Build a career ladder for every role. Growth does not have to mean management. Front Desk Coordinator I, II and Lead Front Desk give people a next step. The same works for MAs, NPs moving toward partnership, and physicians on a partner track. Map year one, two and three. Start people where they are, then add skills like eligibility, prior auths and patient workflow so year three still feels challenging. Often those tasks come off your plate or your office manager’s. Tie raises to responsibility. Instead of an automatic 2% raise every year, attach a small raise to mastering the next level. Culture matters too: trust, autonomy and input keep people. Give tech-savvy staff a real project. Evaluating AI vendors or automation, or running HIPAA-compliant social media and website updates. Carve out the time so it is real. Hire in two interviews. We use an Indeed automation, a short VideoAsk screen with four or five questions to see presence and communication style, then the top three meet me and our leadership panel. Three actions this week: List every role in your practice and write the next level for each onePick one tech-savvy team member and give them one defined project with protected timeAdd a short video screening step before your first live interviewEpisode breakdown: 0:00 Why we are talking about hiring0:32 The number one reason candidates leave1:25 What career growth really means1:54 Building a career ladder for front desk and MAs2:51 Mapping year one, two and three3:21 Tie raises to mastery, not the calendar3:47 Culture: trust, autonomy and input4:46 Give tech-savvy staff an AI project5:40 Leveraging social media skills (HIPAA-safe)6:06 Our hiring process: Indeed automation6:34 Screening with VideoAsk7:31 Two interviews and a panel8:00 Wrap upFree resources: Billing Performance Scorecard: https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-planTwo or more reds? Free Metrics Audit Review: https://eligibility.natrevmd.com/metrics-audit-natrevmdNatRevMD AI Kit: https://eligibility.natrevmd.com/natrevmd-ai-kit-toolWebsite: https://natrevmd.com

Send us Fan Mail Most independent practices sign the payer contract they are handed. One or two doctors alone are not on a health plan's radar, so the rate stays low and the practice works harder to make up the difference. This week Dr. Heather Signorelli sits down with Ben Phillips, CEO of Nivano Physicians, an independent physician association in Northern California, and host of Healthcare Uncut. Together they break down how small practices build the leverage the big systems already have. ACOs vs IPAs. ACOs are built to lower the total cost of care, and physicians share in the savings, usually paid the following year. IPAs bring independent doctors together to negotiate managed care contracts as one group, often on a capitated, delegated model. No IPA in your area? Throw a pizza party. Ben's advice is literal: invite the independent doctors in your community, across specialties, to dinner and ask whether everyone is struggling with the same rates. That conversation is how an IPA starts. How to judge an IPA. Look at it like any business you would join: its contracts, its stars rating, whether physicians have a real voice, and whether you are a shareholder or just a member. Brand is leverage. The bigger institution gets better rates because of the patients it brings. A practice that grows its patient base and shows a health plan where it saves money earns a stronger seat at the table. THE IPA INTERVIEW: QUESTIONS TO ASK BEFORE YOU JOIN - Contracts: Which payers do you hold, long-standing plans or startups? What are the rates? - Quality: How many stars do you have? How do you track HEDIS? - Patients: Can patients get in on time, get follow-up care and a call on lab results? - Voice: Is my voice as a physician expected, encouraged or dismissed? - Ownership: Am I a shareholder or just a member? - Network: Which hospitals and surgery centers do you partner with? - Community: Are local doctors of every specialty represented? THREE ACTIONS THIS WEEK - Pull your current commercial rates and compare them to Medicare for your top codes - Ask the independent doctors near you whether they belong to an IPA, and which one - Score your billing on six numbers before your next payer conversation FREE RESOURCES Billing Performance Scorecard: six numbers in, green, yellow or red on each, the dollar value of every red, and a one-page 90-day plan. https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan Two or more reds? Get a free physician-led Metrics Audit Review: https://eligibility.natrevmd.com/metrics-audit-natrevmd 2027 Revenue Impact Brief: where 2027 changes will hit your revenue. https://eligibility.natrevmd.com/know-where-2027-will-impact-your-practices-revenue-free-brief-natrevmd 2027 CONFERENCE Heather and Ben are planning a 2027 conference for independent practices. Send topic ideas to [email protected] CONNECT WITH BEN LinkedIn: https://www.linkedin.com/in/bpsf Healthcare Uncut on YouTube, LinkedIn and Facebook CONNECT WITH NATREVMD Website: https://natrevmd.com LinkedIn: https://www.linkedin.com/company/79500978/ YouTube: https://www.youtube.com/@NatRevMD

Send us Fan Mail 📊 Free Billing Performance Scorecard: see where your billing team stands on six numbers, with the dollar value of every red and a one-page 90-day plan → https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan 🔍 Two or more reds? Get a Free Metrics Audit Review → https://eligibility.natrevmd.com/metrics-audit-natrevmd Your billing team submits claims and posts payments. But is anyone actually watching your margin? Most practices have a claims-filing team, not a revenue partner. The work that protects your bottom line usually falls through the cracks: auditing follow-up, reconciling deposits, chasing down why AR is aging. During one bank reconciliation, our team found tens of thousands of dollars in checks that had been posted but never deposited. They were sitting at the post office. In this episode, Dr. Heather Signorelli walks through 8 signs your billing team is only filing claims: 1. Payer follow-up: nobody audits how often claims are touched or whether denials get resolved. 2. AR management: insurance AR over 90 days sits above 20% and nobody fixes the root cause. 3. Bank reconciliation: deposits are not matched to ERAs, so cash goes missing or AR looks inflated. 4. Capitation: lump sum and wrap payments are never checked against qualifying claims. 5. Eligibility: front desk issues get one email and then sit in AR. 6. Patient collections: statements go out, but nobody owns patient AR over 90 days. 7. Metric review: reports arrive, but nobody sits down to act on what is out of benchmark. 8. Workflow: the billing office and the clinic never connect on the front-end process. Three actions this week: - Ask your team how often each open claim was touched in the last 30 days.- Pull your insurance AR over 90 days and compare it to 20%.- Ask who matches bank deposits to posted payments, and how often. Want a second set of eyes on your numbers? Request a metric review at natrevmd.com.

Send us Fan Mail Your physician goes out on leave, you bring in a covering doctor, and the claims go out under the absent physician's NPI. Everything seems fine. Then, months later, an audit notice arrives: the claims went out under the wrong NPI, without the right modifier, or past the time limit. Those claims can be pulled back. In this solo episode, Dr. Heather Signorelli walks practice owners, managers and billing teams through locum tenens billing: what the Q6 modifier tells the payer, how the 60-day rule works, and why a new hire waiting on credentialing is never a locum situation. FREE METRICS AUDIT REVIEW https://eligibility.natrevmd.com/metrics-audit-natrevmd Send us your monthly numbers and Dr. Signorelli personally reviews them, with a read on what the pattern is saying and where we would look first. If a change isn't needed, we'll tell you. FREE BILLING PERFORMANCE SCORECARD https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan Enter six numbers from the system you already use and each one turns green, yellow or red, with a one-page 90-day action plan. IN THIS EPISODE - What locum tenens billing is, and why temporary is the key word - What the Q6 modifier tells the payer, and how a locum claim is built - How the 60-day rule works, and when the covering physician needs their own Medicare enrollment - Why Q6 never applies to a new physician waiting on credentialing - Your real options when a new hire starts before credentialing is complete - The written agreement and records your billing team needs - Why commercial payers may not follow Medicare's rules THE LOCUM CHECKLIST - A written agreement with the covering physician or their agency - The arrangement's start date: day one is the first patient the substitute sees - A day 45 internal flag to decide whether coverage ends or enrollment starts - A 60-day hard stop - The substitute's name and NPI documented in every record - Q6 on every locum claim, billed under the absent physician's NPI - Documentation of the regular physician's absence and the reason for it - A check of each commercial payer's policy before billing non-Medicare claims WHEN A NEW HIRE STARTS BEFORE CREDENTIALING - Start credentialing the day the offer is signed, not on their first day - Schedule only patients from payers they are already credentialed with, and add more as each payer comes through - If you hold claims until credentialing is complete, watch every payer's timely filing limit - Incident-to has strict requirements and does not fit every service or provider THE FOUR MOST COMMON LOCUM MISTAKES 1. Billing locum visits without Q6 2. Using Q6 for a new hire waiting on credentialing 3. Going past 60 days without enrolling the covering physician 4. Assuming commercial payers follow Medicare's rules CONNECT WITH NATREVMD Website: https://natrevmd.com LinkedIn: https://www.linkedin.com/company/natrevmd/ YouTube: https://www.youtube.com/@NatRevMD

Send us Fan Mail Most revenue leaks before the patient ever walks in. And billing usually gets the blame for problems the front desk could have prevented. Dr. Heather Signorelli sits down with Alejandro (Alex) Fernandez, CEO of Synergy Orthopedic Specialists, a 25-physician, 60-provider orthopedic group with 15 sites across Southern California, including an ASC, imaging, physical therapy and DME. Alex started his career at a front desk in Miami more than 35 years ago, and he runs the business with that perspective: everyone in the practice is part of delivering care, and every role affects revenue. FREE BILLING PERFORMANCE SCORECARD https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan Enter six numbers from the system you already use and each one turns green, yellow or red, with a score out of 12, the dollar value of each yellow and red, and a one-page 90-day action plan. TWO OR MORE REDS? FREE METRICS AUDIT REVIEW https://eligibility.natrevmd.com/metrics-audit-natrevmd Send us your monthly numbers and get a physician-led read on what the pattern is saying and where we would look first. IN THIS EPISODE - How to grow responsibly: start with your own data, test demand before you build, then execute small - Why ancillary services you already refer out are often the easiest growth to add - The front desk checks that protect revenue before the visit - Why billing teams and the front desk need shared accountability, not separate blame - How a 60-provider group is using AI today, and why Alex only buys AI that fixes a specific, measurable bottleneck - Why you should fix your P&L and know your KPIs before adding complexity - Grow from your strengths, not to escape a weakness THE FRONT DESK CHECKS ALEX'S TEAM RELIES ON - Verify eligibility 48 to 72 hours before the visit - Scan the insurance card into the EHR so everyone can find it - Confirm prior authorization, not just eligibility, especially for imaging, injections and surgery - Collect everything owed at checkout, not just the copay at check-in - Re-verify demographics for established patients every visit HOW ALEX EVALUATES AI - Imaging access: faster MRI scans mean more add-on patients without overbooking - Phone answering: AI answers and books calls, with live operators one button away - Training: policies, procedures and onboarding in one living playbook instead of a binder that is outdated the day it is printed "Don't implement AI into a broken system. It will just break it faster." THREE STEPS BEFORE YOU ADD A LOCATION OR SERVICE LINE 1. Look at your data: referral and zip code reports show where you send business out 2. Test the demand: sublease space from a non-competitor before you build 3. Execute small, and scale only once the test proves the need CONNECT WITH ALEX LinkedIn: https://www.linkedin.com/in/alexfernandezmba Instagram, Facebook and YouTube: Alex Fernandez MBA CONNECT WITH NATREVMD Website: https://natrevmd.com LinkedIn: https://www.linkedin.com/company/natrevmd/ YouTube: https://www.youtube.com/@NatRevMD

Send us Fan Mail Unhappy with your billing but afraid to switch? You are not the only practice in that middle. The numbers feel off, but a past transition (yours or a colleague's) meant months of slow cash, an overwhelmed front desk and frustrated providers. So you stay, and the cost shows up as a slow drift instead of one bad quarter. In this solo episode, Dr. Heather Signorelli shows practice owners and managers how to tell whether billing is really the problem, how to improve it with the team you already have, and how to switch without losing money if the numbers say it is time. Decide from your numbers, not your nerves. FREE BILLING PERFORMANCE SCORECARD https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan Enter six numbers from your current system and each one turns green, yellow or red, with a score out of 12. You also get the dollar value of every yellow and red, a ready-to-send email asking your billing team for these numbers every month, and a one-page 90-day action plan. Nothing to switch. TWO OR MORE REDS? FREE METRICS AUDIT REVIEW https://eligibility.natrevmd.com/metrics-audit-natrevmd Send us your monthly numbers and get a physician-led read on what the pattern is saying and where we would look first. IN THIS EPISODE  Why billing transitions go wrong: the five places cash gets stuck (credentialing, ERA/EFT, charge lag, old A/R and people) Why one strong month of collections is not proof of a healthy revenue cycle The six numbers that tell you if your billing is working How to improve billing without switching companies What a safer transition looks like if you do switch-The two objections practices raise before a change THE SIX NUMBERS (use a three-month average) Net collection rate: Green 95%+ | Yellow 90 to 94% | Red under 90%Denial rate (first submission): Green under 5% | Yellow 5 to 10% | Red over 10%Insurance A/R over 90 (share of insurance A/R): Green under 10% | Yellow 10 to 15% | Red over 15%Patient A/R over 90 (vs. 3 months ago): Green down | Yellow flat | Red upDays in A/R: Green under 35 | Yellow 35 to 50 | Red over 50Charge lag (date of service to claim sent): Green 3 days or less | Yellow 4 to 7 | Red over 7Score: 2 points per green, 1 per yellow, 0 for red or unknown. Max 12. Two or more reds: get a second set of eyes before deciding anything. Ranges are working comparison points, not universal benchmarks. IF YOU DO SWITCH: TRANSITION CHECKLIST - Credentialing and payer enrollment confirmed for every provider, started first - Software contract reviewed: who works old dates of service, and for how long - Admin access to every payer portal held by the practice, with the list saved - ERA and EFT routing mapped, first remittances verified - Clean cutover by date of service - Old A/R run as its own project, with an owner and a weekly report - Front desk trained before go-live; short change list for providers - A patient statement plan for old dates of service - Charge lag and denial rate reviewed weekly for the first 90 days THREE ACTIONS THIS WEEK - Score your six numbers. Write "unknown" where you cannot get one. - Send your billing company one email asking for the six numbers every month, with a three-month trend and the detail behind every red. The scorecard writes it for you. - Pick your one or two biggest reds and put a 90-day review on the calendar. COMPANION EPISODE EP222: The $150,000 a Year Nobody Bills You For: Score Your Practice in 20 Minutes CONNECT WITH NATREVMD Website: https://natrevmd.com LinkedIn: https://www.linkedin.com/company/natrevmd/ YouTube: https://www.youtube.com/@NatRevMD

Send us Fan Mail Most practices run on the bank balance and a sense of how busy things feel. In this working episode, Dr. Heather Signorelli takes your practice's vitals: seven numbers, four scored, about 20 minutes. Grab a pen.  FREE RESOURCES  Free Metrics Audit Review: send the seven monthly averages from this episode and get a physician-led read on what the pattern is saying and where to look first. https://eligibility.natrevmd.com/metrics-audit-natrevmd  Practice Financial Health Dashboard: free Excel workbook that calculates and color-codes your KPIs every month, with 3-month and YTD trends. https://eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  Everything we publish: https://natrevmd.com  Claims and charges: the raw material. Claims are the denominator under almost every rate. Divide charges by claims and watch that average for silent charge-capture drops.  Adjustments: where good numbers go to hide. Split contractual from everything else. If timely filing write-offs are coded as contractual, a 94 percent collection rate can look like 100.  Net collection rate: receipts divided by charges minus contractual adjustments. About 95 percent is the common comparison point. A green you cannot verify is not a green yet.  Denial rate: the front desk number everyone blames on billing. Use first-submission denials and keep rejections and prior auth denials out of it.  Insurance A/R over 90: the money quietly becoming a write-off. Break it out by payer. One payer owning most of the old money is a payer problem, not a billing problem.  Patient A/R over 90: scored on trend. The biggest factor is when you first tell the patient what they owe.   Three actions this week:  • Finish your scorecard with a three-month average. Write unknown where you cannot get a number.  • Give your lowest vital one owner and one 30-day question.  • Put the seven numbers on your monthly meeting agenda, same order, every month.  Episode breakdown: The $150,000 nobody bills you for | Your practice's vitals | How the test works | Claims, charges, adjustments | Net collection rate | Denial rate | Insurance A/R over 90 | Patient A/R over 90 | Add it up | Your plan this week

Send us Fan Mail Free resource: Practice Financial Health Dashboard for Physicians.  What you get: a free Excel workbook built for physician owners to track the practice's revenue, expenses, and billing health month over month, in one place. → https://eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  Free Metrics Audit: a free 20-minute live read of six numbers from your last full month (charges, claims, adjustments, denials, A/R, net collections) to find where revenue is leaking. No patient data, no system access. Built for practices collecting $150K or more a month. → https://eligibility.natrevmd.com/metrics-audit-natrevmd  More from us: natrevmd.com  Preston Alexander, Forward Slash / Health: https://forwardslashhealth.com | LinkedIn: https://www.linkedin.com/in/preston-alexander | The Healthcare Breakdown on Substack  _______________________________________________________________________________________________ Most practice owners check one financial number: the bank balance. Preston Alexander, writer of The Healthcare Breakdown, calls it management by bank account. In this conversation with Dr. Heather Signorelli, he explains why it keeps good practices one slow month away from the line of credit.  Cash timing is the hidden problem. A practice that opens on February 2 should not expect meaningful insurance payments until April or May. Credentialing and billing setup take time, even for experienced teams. Practices that never planned for those months often spend years operating from behind.  Revenue and expenses are one conversation. Billing metrics and the expense side usually live in separate places. Preston's team looks at CPT-level profitability, overhead allocation, and expense timing month by month so owners see the whole picture.  Stable is not the same as healthy. Heather describes practices where billing is finally dialed in and payroll is still tight, usually because compensation was set before the revenue was forecast. Options include a smaller base with a bonus on what is left.  The second location trap. A new address creates billing issues even under the same TIN, so Preston plans for about six months of near-zero revenue. Market fit matters just as much: referral patterns, the dominant health system, and payer mix. Heather adds that a drop from $175 to $140 revenue per visit changes what volume you need and what you can afford to spend.  Three actions this week:  • Pull your last 12 months of financials and ask why each line that grew went up  • Ask one vendor you have paid on time for years for longer payment terms  • Block one hour a week to review revenue and expenses side by side

Send us Fan Mail Resources  Free Metrics Audit: a free 20-minute live read of six numbers from your last full month (charges, claims, adjustments, denials, A/R, net collections) to find where revenue is leaking. No patient data, no system access. Built for practices collecting $150K or more a month. → https://eligibility.natrevmd.com/metrics-audit-natrevmd  Practice Financial Health Dashboard for Physicians: a free Excel workbook built around the same six numbers, so you can track them month over month on your own. → https://eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd  More from us: natrevmd.com  Coming soon: Our episodes with the CEO of a large independent practice and with an IPA leader The end of September is the moment to start planning your first quarter of 2027. What you collect in January through March is mostly decided by what you do now. Dr. Heather Signorelli covers the five areas every owner, CEO, COO, or practice manager should review before the year closes.  Your net collection rate. Gross collection rate compares what you collect to what you charge. Net collection rate removes contractual adjustments, so it shows what your team is writing off that it should be chasing: timely filing, bad debt, patient balances. Heather notes most practices sit in the mid to high 90s. Know your number and why it is where it is.  A growth plan for 2027. Set revenue goals in the first week of October. Use this year's average reimbursement per visit (claims through June should be paid by now) to work out the patient volume you need, whether you need to hire, and whether services you refer out, like PT, subspecialty care, or lab work, have a business case to come in-house.  Payer contracts. When did you last negotiate? Are any credentialing denials still open? Starting in October gives new rates the best chance of loading early.  IPA options. An independent physician association can strengthen your contracting position, but there are good and bad ones. Look at who they serve, how fast claims get paid, quality metrics, and shared savings before you join.  A coding audit. If it has been years, get one. Check levels, modifiers, and incident-to billing, and make sure your documentation supports the codes. OB practices in particular need to be ready for the 2027 code changes. Three actions this week:  • Pull your net collection rate and ask your billing team what is behind every non-contractual write-off  • Put a two-hour 2027 planning session with your leadership team on the calendar for the first week of October  • List every payer contract with the date it was last negotiated

Send us Fan Mail Most practices don't have a billing problem. They have a not-knowing problem. Dr. Heather Signorelli walks through the three numbers that actually tell you whether your revenue cycle is healthy, and introduces the free Second Opinion Program built to give any practice an independent read.  Denial Rate Isn't the Full Story: A five percent denial rate sounds fine until you ask why those denials are happening, and whether they cluster around one payer, one code family, or one provider.  A/R Over 90 Days, Reported vs Real: “A/R is being worked” and “A/R is moving” are two different claims. Most owners only see the summary number, not the aging bucket broken out by payer.  Payer Mix Trend: A quiet shift in payer mix shows up differently for patients (confusion about what they owe), front desk (more phone calls), and owners (a dip they can't explain three months later).  Introducing the Second Opinion Program: A free, twenty-minute, physician-led review of these same numbers, independent of whoever currently handles a practice's billing. No pressure to switch, no disruption to the current team.  Three Actions This Week  •  Pull your denial rate by payer, not just the overall number, and ask why on the top two categories.  •  Pull your real A/R aging over 90 days, broken out by payer, not the summary line.  •  Compare this quarter's payer mix to last quarter's, and flag anything that moved more than a few points.  Resources  1. Book My Second Opinion →: eligibility.natrevmd.com/natrevmd-get-a-second-opinion  2. Not ready to book? Free resources: natrevmd.com/trusted-resources

Send us Fan Mail Dr. Una, founder of EntreMD and mentor to hundreds of physician entrepreneurs, joins Dr. Heather Signorelli to talk about what actually drives practice growth without burnout, and shares an unscripted story about why her own practice now trusts NatRevMD with its billing.  Growth Problems Are Rarely About Billing: Dr. Una explains why the real lever for growth is almost always the evolution of the physician into the CEO of their own practice, not the team, the market, or the numbers themselves.  Replace Yourself Three Times: Every practice owner plays three roles: technician, manager, and owner. Growth stalls hard the moment a physician replaces the technician role by hiring other providers but never replaces themselves as the manager.  The Four Business Algorithms Every Physician Needs: Dr. Una walks through the four areas physicians have to learn like a clinical protocol: how to grow revenue, how to build a brand, how to fill the schedule, and how to build a genuinely profitable team.  What Changes Past Five Million: At the five to ten million dollar mark, the game becomes about leadership across producers, managers, and leaders, plus obsessing over granular profitability data the way an ICU doctor watches vitals.  You Cannot Resist Your Environment: Dr. Una explains why EntreMD is built on mentorship, accountability, and community rather than one-on-one coaching, including a real example of a client growing revenue 71 percent while taking eight weeks off.  A Full Circle Story: Dr. Una's own practice switched its billing to NatRevMD after years of her practice administrator being unable to find a fit. Her verdict: “your billing department is your aorta. It is not a place you can afford to leak from.”  Reference tables: None this episode.  Three Actions This Week  •  Write down the four numbers you are currently avoiding in your practice (AR, profit and loss, revenue per provider, schedule fill rate), and commit to reviewing them weekly.  •  Name which of the three roles, technician, manager, or owner, you personally have not replaced yourself in yet, and pick one system or hire that starts that process.  •  If nobody outside your practice has ever looked closely at your billing, watch our free briefing and see what your own aorta actually looks like.  Resources (CTA priority order, MOFU)  1. 30-Day Revenue Recovery Plan: eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan  2. Watch the NatRevMD Briefing (VSL): eligibility.natrevmd.com/vsl  3. Payment Posting Audit Checklist: eligibility.natrevmd.com/payment-posting-checklist  4. Guest resource: The Profitable Private Practice Playbook, EntreMD.com/privatepracticeplaybook  Books referenced: Eat That Frog by Brian Tracy, The E-Myth Physician by Michael Gerber (both referenced by Dr. Una as early turning points). Series: not applicable, standalone episode.

Send us Fan Mail Two health plans sat fifty dollars apart in monthly premium. One covered forty percent of an inpatient stay, the other seventy five percent. Dr. Heather Signorelli walks through the exact process she used to shop for her own team's health insurance this year, and the mistakes worth skipping if you are doing this too.  Where we started looking: QuickBooks and brokers got us close to eighty plan options, but neither felt flexible or fast to compare on our own. Finding a third way: a platform called Thatch, built around an ICHRA (individual coverage health reimbursement arrangement) model. The trade-offs: how a fifty dollar premium gap can hide a thirty five point coinsurance swing, and why network type (HMO/EPO vs. PPO) matters as much as price. Cost-sharing plans: why healthcare sharing ministries are not regulated insurance, and the questions to ask before joining one. Catastrophic coverage and HSAs: pairing lower routine coverage with real protection against the worst case. Business or personal: why the tax treatment question belongs to your CPA, not a guess. Three Actions This Week  Decide what you are actually protecting against before you compare a single plan. Understand whether you are choosing a group plan or an allowance-based model like an ICHRA. Get your CPA on the phone before deciding business vs. personal. Episode Breakdown  Same chapter list as the YouTube description above (timestamps to be added after recording).  Resources  Free second opinion / Metrics Audit VSL (primary): eligibility.natrevmd.com/metrics-audit-natrevmd Practice Revenue Leak Scorecard (secondary): eligibility.natrevmd.com/nrm-revenue-scorecard-v3