Q: I do not know where to start

Monday. Quiet deposit. Same denials again. Front desk shrugs. Everything feels urgent. Pick the one thing that bothers you most this week. Light deposits. Same claims bouncing. Bank and reports that do not match. Work that never turns into money. Start with that one thing. Leave the other fires alone for an hour.

Q: Reports look fine but the bank feels quiet

The packet looked fine. The deposit still feels light. Visits look steady. The account does not. Trust the bank. Reports can look healthy while cash stays thin. When the two disagree, the bank wins the next decision.

Q: Is this billing or insurance?

Billing blames insurance. Insurance blames the claim. Nobody owns the mess. Look at your side first. Did the visit become a charge? Did the claim leave and get accepted? Did payment or a denial get posted? Call the insurance company after those answers are clear. A lot of "they never pay" starts before the claim ever left.

Q: What should I check before I hire, fire, or outsource?

The urge is to add people, cut people, or hand it off. That feels like progress. It often is not. Before you change the team or a vendor, know three numbers: how many days of cash you have, how long money takes to land after a visit, and whether the bank matches what you billed. Get those clear first. Then decide on people.

Q: Is the money stuck here or stuck with the insurance company?

Some dollars never left your building. Some left and sit with a payer. Those are different problems. If the claim never went out clean, that is on you. If it went out, got accepted, and then sat, that is a payer clock. Sort a handful of unpaid visits into those two buckets before you start calling.

Q: We look profitable but I still feel broke

The P&L looks fine. Your draw does not. "Profitable" keeps coming up in meetings. The account stays thin. Profit on paper is not money in the bank. You can look fine in the report and still feel broke if cash takes forever to land, or if work never gets billed. Put last month's deposits next to what you billed. That gap is the story.

Q: Aging looks fine but cash is late

Aging looks mostly current. Deposits still lag. Someone says aging is fine. The bank says otherwise. Aging is not the whole story. Unbilled work never shows. Old claims can look young after a resubmit. If deposits lag while aging looks fine, dig into what never got billed and what is sitting after "accepted."

Q: Do I need more people?

The backlog looks like a staffing problem. Everyone is tired. Another biller feels like the answer. Often it is not. If the same mistakes keep making the same stuck claims, a new hire just gets the same mess. Every week look at three things: bank, billed, unfinished. Hire when those show you are truly short on hands, not when you are guessing.

Q: What does "good" look like?

You want a plain yes or no without a long presentation. Vendors wave averages. You need your own read. Good means money lands after a visit in fewer days than it does now, and that number does not bounce all over the place week to week. Most of the wait is usually in your house: notes, claims out the door, denials worked, payments posted.

Q: Where do I go next?

You know which worry is yours. Do not open every page. Pick one and stay there: Payroll and cash when the deposit or Friday is the fire Denials and unpaid claims when claims keep coming back or payers go quiet AR aging and money from visit to bank when aging looks fine and cash still lags FAQ hub if you need a different door

Question 1

Where do I start when cash feels wrong?

Accepted Answer

Start where your reports say the least. The first stretch is everything before the patient sits down: the insurance check, the patient’s share, and any approval the insurance company requires. The second is the time between a signed note and a claim going out. Both leak money without any alert, and both sit entirely inside your own office, so you can fix them yourself.

How Revenue Oversight Works: Eleven Rules, and the Bad Tuesdays That Wrote Them

Question 2

Is the money stuck in our office or with the insurance company?

Accepted Answer

Sort a sample of unpaid visits by the last thing that happened to each one. Visits with no charge, and claims built but never sent, are stuck in your office. Claims the insurance company never acknowledged point to routing or enrollment, the paperwork that lets you bill that insurer electronically. Claims it answered with a denial need your team’s next move.

Where Medical Claims Get Stuck (And the Map That Shows It)

Question 3

What numbers should a medical practice owner watch?

Accepted Answer

Ten, split by how fast they change. Every week: work that can’t bill yet, claims sent against visits delivered, denials as a named list, cash expected against cash that arrived, and patient balances by age. Every month: the share of claims paid on the first try, days from visit to cash, no-shows and rebooking, revenue per clinician day, and any number that moved without explanation.

The Ten Numbers a Medical Practice Owner Should Watch

Question 4

What does good look like for a medical practice?

Accepted Answer

Here's the bar, from the practices we ran. Money arrives between 9 and 13 days after the visit on average across all insurance companies, against an industry norm of 45 to 60 days. At least 95% of claims are paid the first time they're sent. Operating profit before interest, taxes, and depreciation (EBITDA) runs 16 to 20%, against 6 to 10% for the industry.

Question 5

Should I fix billing before I hire, fire, or outsource?

Accepted Answer

First find which step is slow: for a closed month, compare completed appointments with charges created, then charges with claims actually sent. A gap there sits inside your office, and no new hire or billing company will touch it. If both comparisons are tight, the delay comes after the claim goes out, and changing who works the claims can help.

Find Your Billing Delay First

Question 6

What is revenue oversight?

Accepted Answer

It's the daily job of watching every visit from the booked appointment to money in the bank. A visit can stop in twelve places on that trip, and at least half of them wait on someone inside your practice. Oversight finds where each dollar stopped and puts it on a short list, ranked by dollars, with a name and a due date on each line.

Where to start when medical practice cash feels wrong