The Questions Owners Actually Ask
These are the questions that come up on the first call, in the order they usually come up, answered the way they’d get answered across a desk. No warm-up. If you’re reading this at the end of a month where the P&L looked fine and the account didn’t, start with the first one.
Why is my practice profitable on paper but always tight on cash?
Because profit and cash are two different clocks, and yours have drifted apart. The P&L books revenue when it’s earned. The bank account only fills when the money actually arrives. In between sits everything that slows the money down or stops it entirely: work that never got billed, claims moving in weekly batches, patient balances aging into statements, underpayments nobody caught. A practice can be genuinely profitable and genuinely cash-starved at the same time when enough revenue is stuck in transit. The four places it hides are laid out in the hidden cash guide.
How fast should money actually move?
Faster than it does now, almost certainly. The number that matters is the days between delivering care and having the cash in the account, and most practices have never measured it as a single figure. When you do measure it, and then watch it, it turns out to be movable in ways that surprise people: the delay is mostly made of process decisions, not payer behavior, and process decisions are yours to change. Daily submission instead of weekly is a schedule choice that pulls the whole timeline in without asking anyone’s permission.
What should I measure every week?
A short list, read on a schedule, owned by name. First-pass claim rate. Days from visit to cash. Unsigned notes. Patient responsibility captured at the visit. Denials by cause. No-show rate. The point isn’t the length of the list; it’s the rhythm. A number read weekly catches a problem while it’s small. The same number read quarterly catches it after it’s cost you a season. The starter set is the owner’s ten.
Why do the same denials keep coming back?
Because they’re being worked, not prevented. Working a denial gets one claim paid. It does nothing about the registration field, the eligibility timing, or the expired authorization that manufactured it, so next month the same cause produces the same denial with new claim numbers. Killing the cause is a different job than working the claim, and until someone does it, you’re paying rent. And if the denials keep changing shape no matter what you fix, the machinery on the payer’s side has changed too, which is the payer AI teardown.
Should I hire another biller?
Usually not yet. Another biller makes you faster at handling volume, but most cash problems aren’t a volume problem, they’re a defect problem: the team is working hard on rework that shouldn’t exist. Hiring against rework buys you a faster version of the same leak. Find and shut the sources of the rework first, and you often discover the team you have was never the constraint. If you’re still capacity-bound after that, then hire, and the new person walks into a clean process instead of a treadmill.
What does fixed actually look like?
Cash lands close to the care that earned it. The weekly numbers sit where they should and someone notices the day one drifts. Denials trend down because their causes are getting shut off one a week. The account stops disagreeing with the P&L. And none of it depends on heroics or on any single person remembering to run a report, because the watching is built into the operation instead of carried by a hero who eventually leaves.
Where do I start?
Measure visit-to-cash once, honestly, and pull the four hidden-cash numbers; between them you’ll know where your money actually is. Then grab 30 minutes with us. Prep nothing. We’ll show you these views running in real operations, cash timing and the weekly numbers, and you’ll see the gap between a healthy P&L and a full account priced out.