8. Is Your Billing Company Helping or Hurting Your Bottom Line?

Let's be honest—cash flow isn't the topic that gets most physicians excited. You went into medicine to treat patients, not to pore over billing reports and insurance negotiations. But here's what I've learned from working with my clients: while you're focused on patient care, your billing company could be quietly bleeding your practice dry through delayed payments, missed collections, and poor insurance negotiations.

The scary part? Most physicians have no idea it's happening until they're scrambling to make payroll or watching their profit sit in someone else's bank account for months. I've seen practices with packed schedules still stress about cash flow simply because their billing relationship was broken.

Your billing company should be working as hard for your practice as you do for your patients. When that partnership is running well, you stop losing sleep over money and start focusing on what you do best: practicing medicine.

In this post, I'll break down how to evaluate your billing partnership using the same three-part framework I use with my clients. You'll learn how to spot the red flags that are costing you money—and how to turn your billing company into the business partner your practice truly deserves.

Why Cash Flow Matters More Than You Think

Before we dive into the evaluation framework, let's talk about why this matters so much. Without steady cash flow, practices end up juggling bills and relying on credit—what I call playing a shell game with their finances.You delay payments to vendors, hoping insurance money comes in before your next payroll cycle.

This isn't sustainable. Eventually, you run out of moves, and in the worst-case scenario, you face the nightmare of missing payroll. The government doesn't look kindly at businesses that don't make payroll—you're looking at penalties, fees, and potentially court proceedings.

I've worked with oncology practices where hundreds of thousands of dollars would go out every month for drugs, staff, and overhead, but insurance companies would take three months or more to pay. These practices needed over a million dollars in capital just to stay afloat while waiting for reimbursements.

That's an extreme example, but it illustrates how your profit can get locked up when your billing processes aren't running smoothly.

The Three-Part Billing Evaluation Framework

When I work with clients, I evaluate their billing relationships across three critical areas:

1. Negotiation and Contracting

Your billing company often handles more than just claims processing—they help get you credentialed with insurance companies and negotiate your rates. This is where many practices leave serious money on the table.

What to evaluate:

• Are they negotiating rates that are at least as good as Medicare, preferably better?
• Do they understand what's reasonable for your specialty and state?
• If you're a single provider, are they realistic about your negotiating power versus larger groups?

The reality is that if you're a solo practitioner, you have less leverage than a multi-provider clinic. But your billing company should still be fighting for the best rates possible and be transparent about what's achievable.

2. Billing Performance and Efficiency

This is where you can measure actual performance in concrete terms: days and percentages.

Key metrics to track:

• Timeline from service to payment: How many days from when you see a patient until cash hits your account?
• Clean claims percentage: What percentage of claims go through without errors or rejections? You want this as close to 100% as possible.
• Accounts receivable aging: How much money is sitting in different time buckets (0-30 days, 30-60 days, 60-90 days, 90+ days)?

If you have significant amounts in your 90+ days category, that's a red flag. Money that's been outstanding for over three months needs immediate attention.

Red flags to watch for:

• Claims consistently getting rejected for the same errors
• Long delays between receiving your information and submitting to insurance
• Poor communication about claim status or issues
• Reports that are hard to understand or missing key data

3. Business Insights and Reporting

A good billing company doesn't just process claims—they provide insights that help you run your practice better.

What they should provide:

• Average revenue by provider, insurance company, and CPT code
• Trend analysis comparing month-to-month and year-over-year performance
• Seasonal patterns in your practice
• Proactive alerts about policy changes or potential issues

This data is a goldmine for understanding your practice patterns. For example, I've had clients discover through billing reports that some providers were consistently under-coding visits, leaving money on the table. Others learned about seasonal patterns that helped them better manage cash flow during slower months.

How to Improve Your Billing Relationship

Find Your Go-To Person

If possible, identify the best biller at your company and try to get your account assigned to them. I've had clients visit billing offices with brownies and donuts to meet the team and identify the most competent person. It doesn't always work, but it's worth asking.

Take a "Trust But Verify" Approach

Your billing company is incentivized to help you succeed—they make money when you make money. But that doesn't mean you should ignore the details.

• Dig into your monthly reports
• Ask questions if you don't understand something
• Double-check their work—billers are human and make mistakes
• Address issues immediately and directly

If a billing company makes you feel dumb for asking questions about your own money, that's a red flag. Find someone else.

Ask for the Data You Need

If your reports don't have the information you need to make good decisions, ask for it. You might discover that a particular insurance company consistently pays poorly, or that certain CPT codes aren't being processed correctly.

Real-World Impact

I've seen practices transform their financial health just by optimizing their billing relationships. One client discovered their providers were systematically under-coding visits and missing out on thousands in revenue. Another identified seasonal patterns that helped them budget for slower months instead of panicking about cash flow dips.

Your billing company relationship isn't just about processing claims—it's about understanding and optimizing your entire revenue cycle.

Cash flow problems in medical practices are rarely about not seeing enough patients or charging too little. They're usually about money getting stuck somewhere in the system between the time you provide care and when you get paid.

Your billing company should be your partner in ensuring that money flows smoothly and predictably into your practice. When that relationship is working correctly, you stop worrying about payroll and start focusing on what you trained for: taking excellent care of your patients.

If you're currently stressed about cash flow despite having a busy practice, it's time to take a hard look at your billing relationship. Use this framework to identify where the problems are, and don't be afraid to make changes. Your practice's financial health—and your peace of mind—depend on it.

If you're struggling with billing relationships or other cash flow challenges in your clinic, I'd love to help. You can email me at [email protected] or book a free discovery call at www.amandasabicer.com. Let's talk about how to optimize your billing partnerships and build systems that support steady, predictable cash flow—so you can focus on practicing medicine instead of worrying about money.