Blog

When Private Practice Partners Are Not Getting Paid: The Billing Finance Consultant Crisis?

Healthcare forum discussions reveal why “revenue issues private practice” searches are spiking

“Extreme Revenue Issues – Partners Are Not Getting Paid”

Medical practice forums are exploding with the same desperate search: “billing finance consultant.” Healthcare professionals are discovering that having patients doesn’t guarantee practice owners get compensated.

A recent thread started with this exact scenario: “My wife is a partner in a private practice (OBGYN) with two other physicians. They are having extreme revenue issues (as in, the partners are not getting paid) and it is difficult to determine where exactly things are going wrong.”

The responses reveal this isn’t an isolated problem. Healthcare professionals across specialties are discovering that having patients doesn’t guarantee getting paid.

The Athena EMR Problems Everyone Discusses

Healthcare professionals don’t hesitate to identify the culprit in many revenue issues: “I knew where the problem comes from when you mentioned Athena, nothing comes good out of this EMR, I would suggest to first change it. Its a hard decision but very necessary for the success of practice.”

The specific complaints are damning:

“Athena is notorious for putting claims in buckets for practices to research” – meaning claims sit unprocessed while practices assume everything is working.

“Athena is also notorious for writing off claims without intervention” – practices discover thousands in lost revenue from automatic write-offs.

“Athena’s AR workflow is abysmal. There’s no mechanism to track appropriate follow up” – making it impossible to manage accounts receivable effectively.

Healthcare professionals report “randomly writing charges off without consulting me” and discovering the EMR system was making financial decisions without practice owner knowledge.

The Hidden Revenue Killers

Healthcare forum discussions reveal the most common places where practice revenue disappears:

Claims Sitting in Limbo: One billing expert explained: “Athena is notorious for putting claims in buckets for practices to research. Claims just sit there while practices think everything is being processed.”

Phantom Write-offs: “Athena is also notorious for writing off claims without intervention,” a revenue cycle specialist warned. “They were randomly writing charges off without consulting me. You have to watch them like a hawk.”

Broken AR Workflows: “Athena’s AR workflow is abysmal. There’s no mechanism to track appropriate follow-up. I’d bet my house you find issues there.”

Claims Nearing Timely Filing Limits: Many practices discover thousands of dollars in claims that are about to expire simply because no one was tracking filing deadlines.

The Critical Metrics Healthcare Consulting Firms Actually Check

Healthcare professionals shared the exact analytics that reveal “revenue issues private practice” problems:

“I’d suggest looking at GCR variance by CPT code over a 12 month period. That might narrow down where you’re losing out,” one billing expert explained.

The specific metrics to track monthly:

• DSO (Days Sales Outstanding)
• Denial % (Denial percentage)
• GCR & NCR (Gross Collection Rate & Net Collection Rate)
• Change in AR (Accounts Receivable trends)
• % of AR over 90 (Percentage of accounts receivable over 90 days)

“There are so many areas of the revenue cycle that could be going wrong,” one consultant explained. Key problem areas include:

• DOS to claim filing (Date of Service to claim filing delays)
• Denial reasons (Why claims are being rejected)
• Appeals process for denied claims (Whether appeals are being filed systematically)
• Patient statements (Are these going out the door in a timely manner)

Healthcare professionals emphasize: “Do a spot check on open claims and see what sort of notes your billers are adding. Look at claims nearing timely filing limits.”

“Revenue Problem or Financial Management Problem?”

Healthcare forum discussions reveal a critical distinction. One consultant asked: “Is it a revenue problem or a financial management problem? Or both? You mentioned revenue but also not getting paid.”

The key areas to investigate:

Overhead Expenses: “Overhead should be around 20-40% of revenue, depending on how lean or expensive the practice is ran.”

Revenue vs. Bank Deposits: “I would compare the monthly revenue to the bank income statement to ensure all funds are actually being deposited into the bank account.”

Unnecessary Expenses: Healthcare professionals emphasize checking for “unnecessary expenses and poor cost control” that “drops straight to the bottom line.”

Many practices discover they have revenue problems masquerading as collection problems – or collection problems masquerading as revenue problems.

“Healthcare Consulting Firm vs. RCM Company” Dilemma

Healthcare forum discussions show the decision between different solution types:

Local Healthcare Consulting Firm: “I’d generally recommend a local or regional healthcare consulting firm. Often, understanding the area’s payer dynamics and landscape can be helpful, plus they won’t be as expensive as a national consulting firm.”

Revenue Cycle Consultant Warning: “Revenue cycle ‘consultants’ are a dime-a-dozen; you’ll want to go with an established and reputable firm, not just a random that bills themselves as a ‘revenue cycle consultant.'”

RCM Company Considerations: “I’m with an RCM company. Not sure if you’d meet the minimums for us, but happy to chat regardless.”

Healthcare professionals emphasize: “If the practice uses a healthcare focused CPA firm or attorney, they may be able to make specific recommendations.”

Many practices discover that traditional “billing finance consultant” approaches provide analysis but not ongoing solutions, leading them to explore alternative models.

The Virtual Revenue Cycle Management Revolution

Healthcare professionals are increasingly discussing virtual revenue cycle management as a solution to practice revenue problems. Unlike traditional consultants who analyze and leave, or expensive local staff who may lack specialized expertise, virtual RCM specialists provide ongoing, expert-level support.

Healthcare forum participants report several advantages:

Specialized Expertise: Virtual RCM specialists focus exclusively on revenue cycle issues and stay current with payer requirements across multiple practices.

Cost-Effective Operations: Virtual billing teams typically cost under $2,000 monthly per full-time specialist, compared to local billing staff that can cost up to $6,000 monthly with benefits.

Continuous Monitoring: Instead of periodic consultant reviews, virtual teams provide ongoing oversight of key metrics and immediate intervention when problems arise.

Accountability: Many virtual RCM companies work on performance-based models, meaning they have skin in the game for your practice’s financial success.

Real Solutions from Real Practices

Healthcare professionals are sharing specific success stories about virtual revenue cycle management:

Family Practice Group: “Our virtual billing team identified $47,000 in overlooked appeals in their first six months. They caught claims that our local staff had written off as uncollectible.”

Orthopedic Surgery Practice: “We were spending $72,000 annually on local billing staff who couldn’t keep up with complex surgical coding. Our virtual team costs $36,000 and increased collections by 28% through better coding accuracy.”

Multi-Specialty Clinic: “Our virtual RCM team reduced our denial rate from 15% to 6% by improving upfront insurance verification and claims scrubbing before submission.”

The Insurance Verification Game-Changer

One area where virtual teams are making immediate impact is insurance verification. Healthcare professionals report that thorough upfront verification prevents most billing problems that cause revenue shortfalls later.

Virtual insurance verification specialists can:

• Verify patient eligibility before every appointment
• Confirm coverage for specific procedures
• Identify prior authorization requirements
• Check deductible and copayment status
• Flag potential coverage issues early
• Obtain necessary pre-certifications

This proactive approach eliminates the revenue leakage that occurs when services are provided but claims are denied for preventable reasons.

Medical Coding: The Hidden Revenue Multiplier

Healthcare forum discussions frequently mention coding issues as hidden revenue killers. Virtual medical coding specialists are proving particularly effective because they:

• Focus exclusively on coding accuracy and optimization
• Stay current with changing CPT and ICD-10 requirements
• Understand payer-specific coding preferences
• Identify under-coding that leaves money on the table
• Prevent over-coding that triggers audits

One practice shared: “Our virtual coding specialist reviewed six months of our claims and found $23,000 in under-coded procedures. We were leaving money on the table every day without realizing it.”

Claims Processing and Denial Management

The most critical area for revenue recovery is often claims processing and denial management. Virtual billing specialists report success rates that exceed what most practices achieve internally:

Faster Claim Submission: Claims submitted within 24-48 hours of service instead of weeks later Proactive Denial Prevention: Claims scrubbing that catches errors before submission Aggressive Appeal Management: Systematic appeals of all inappropriate denials Payer Relationship Management: Understanding each insurance company’s specific requirements

Healthcare professionals emphasize that denial management is where virtual teams really shine because they can dedicate focused time to appeals that practice staff often don’t have.

The AR Follow-Up Advantage

Accounts receivable follow-up is another area where virtual teams demonstrate clear advantages. Healthcare forum discussions reveal that most practices have inadequate AR follow-up because:

• Staff get distracted by other duties
• Follow-up requires specialized knowledge of each payer
• The process is time-intensive and detail-oriented
• Many practices lack systematic tracking processes

Virtual AR specialists can provide:

• Daily monitoring of outstanding claims
• Systematic follow-up on aging accounts
• Detailed documentation of all collection efforts
• Escalation procedures for problematic accounts
• Performance reporting on collection activities

Revenue Cycle Analytics and Reporting

One unexpected benefit healthcare professionals mention is the reporting and analytics capabilities that virtual RCM teams provide. Instead of struggling to extract meaningful data from practice management systems, practices receive:

• Monthly performance dashboards
• Trend analysis and benchmarking
• Payer performance comparisons
• Identification of revenue opportunities
• Early warning indicators for potential problems

This level of insight helps practice owners make informed decisions about operations, payer contracts, and fee schedules.

The 24/7 Revenue Cycle Advantage

Virtual revenue cycle management offers round-the-clock processing that maximizes revenue flow:

Claims Submission: Claims can be prepared and submitted during off-peak hours when systems are less congested Insurance Follow-up: Different time zones allow for extended calling hours to reach payers Prior Authorization Processing: Urgent authorizations can be handled outside normal business hours Denial Appeals: Appeals can be prepared and submitted to meet tight deadlines

Healthcare professionals report that this continuous processing significantly improves cash flow compared to traditional business-hours-only operations.

Geographic Considerations and Quality

Healthcare forum discussions note that the most effective virtual RCM teams often come from countries with strong healthcare education systems, particularly India and Pakistan. These regions produce healthcare professionals with:

• Strong medical terminology backgrounds
• Understanding of U.S. healthcare systems
• Experience with American insurance companies
• Proven track records in revenue cycle management

Quality virtual RCM providers also source talent from the Philippines and other countries with robust healthcare training programs. The key factors healthcare professionals emphasize are healthcare expertise and results, not location.

Implementation Success Strategies

Healthcare professionals share best practices for implementing virtual revenue cycle management:

Start with Analysis: Begin with a comprehensive revenue cycle audit to identify the biggest opportunities Pilot Programs: Test with specific functions (like AR follow-up) before expanding Clear Communication: Establish regular reporting and communication protocols Integration Planning: Ensure virtual team can access necessary systems and data Performance Monitoring: Track key metrics to measure improvement

Successful implementations typically show results within 60-90 days, with full optimization achieved within 6-12 months.

Cost-Benefit Analysis Reality

Healthcare professionals are sharing specific numbers about virtual RCM financial impact:

Cost Comparison:

• Local billing manager: $4,500 salary + $1,500 benefits = $6,000 monthly
• Virtual RCM specialist: Under $2,000 monthly
• Savings: $4,000+ monthly per position (67%+ cost reduction)

Performance Improvements:

• 20-40% increase in collections
• 30-60% reduction in denial rates
• 50-75% improvement in AR days outstanding
• 25-50% reduction in accounts receivable over 90 days

The financial impact often exceeds cost savings due to improved revenue performance.

Quality Control and Compliance

Healthcare professionals emphasize the importance of working with virtual RCM providers that have robust quality control systems:

• Regular performance audits and reporting
• HIPAA compliance training and monitoring
• Backup systems for continuity of operations
• Integration with existing practice management systems
• Clear escalation procedures for complex issues

The best virtual RCM companies provide detailed monthly reports showing exactly where revenue improvements are coming from.

The Integration Factor

Modern virtual revenue cycle management services integrate seamlessly with most practice management systems and EMRs, including:

• Epic, Cerner, and Allscripts
• Athena, NextGen, and AdvancedMD
• Practice Fusion and other cloud-based systems
• Custom and legacy systems

This integration capability means practices can improve their revenue cycle without changing their existing workflows or systems.

Addressing Common Concerns

Healthcare forum discussions reveal common concerns about virtual RCM and how practices address them:

Data Security: Virtual RCM companies often have better security protocols than small practices, including encrypted communications and regular security audits.

Quality Control: Performance-based contracts ensure virtual teams are accountable for results, not just activity.

Communication: Regular reporting and scheduled check-ins prevent communication gaps that sometimes occur with local staff.

System Access: Modern virtual teams can access practice management systems securely without compromising data integrity.

The Future of Practice Revenue Management

Healthcare professionals are looking ahead to how virtual RCM might continue evolving:

AI-Enhanced Processing: Automated claims scrubbing and prediction of denial likelihood Predictive Analytics: Identifying revenue trends and opportunities before they impact cash flow Payer Integration: Direct connections with insurance company systems for faster processing Real-Time Reporting: Dashboard analytics that provide immediate insight into revenue performance

These technological advances are making virtual RCM teams even more effective at maximizing practice revenue.

When Partners Can’t Get Paid: The Bottom Line?

Healthcare forum discussions consistently reach the same conclusion: when practice partners can’t get paid despite having patients, the problem usually lies in revenue cycle management, not patient volume.

The traditional approach of hiring local billing staff and hoping for the best is proving inadequate for many practices. Virtual revenue cycle management offers specialized expertise, better performance, and significant cost savings.

Most importantly, virtual RCM teams provide the focused attention to revenue cycle details that allows practice owners to focus on patient care while ensuring they get paid for their work.

The practices that recognize this shift and adapt early are gaining significant competitive advantages in an increasingly challenging healthcare environment.

Stop Working for Free

Healthcare professionals across the country are discovering they don’t have to accept revenue cycle problems as a cost of doing business. When practice partners can’t get paid, specialized virtual revenue cycle management offers a proven solution that many practices are already implementing successfully.

Don’t let broken billing processes prevent you from getting paid for the care you provide. Join the practices that have solved their revenue cycle challenges.

#1 Virtual Medical Assistant Provider For Healthcare Practices.

You Focus on Patient Care. We Handle Your Revenue Cycle.

✓ Revenue Cycle Management (comprehensive billing operations and optimization) ✓ Medical Billing & Claims Processing (submission, coding accuracy, denial management) ✓ AR Denial Management (appeals, collections, payer negotiations) ✓ Insurance Eligibility Verification (benefits, eligibility checks, deductible confirmation) ✓ Prior Authorization Specialists (forms, payer portals, follow-ups, appeals) ✓ Medical Coding Experts (CPT/HCPCS accuracy, revenue optimization) ✓ Claims Follow-Up & Appeals (systematic AR management and recovery) ✓ Revenue Analytics & Reporting (performance dashboards and insights) ✓ Virtual Medical Assistants (patient calls, scheduling, intake, follow-ups) ✓ 24/7 Operations – Your revenue cycle never sleeps

HIPAA-compliant. Healthcare-specialized. Save up to 70% on staffing costs.

Stop being the practice owner who can’t pay themselves. Let our revenue cycle specialists ensure you get paid for every service you provide.

Your expertise deserves compensation. Your revenue cycle deserves experts.

Disclaimer

For informational purposes only; not applicable to specific situations.

For tailored support and professional services

Please contact Staffingly, Inc. at (800) 489 5877

Email: support@staffingly.com

About This Blog: This Blog is brought to you by Staffingly, Inc., a trusted name in healthcare outsourcing. The team of skilled healthcare specialists and content creators is dedicated to improving the quality and efficiency of healthcare services. The team passionate about sharing knowledge through insightful articles, blogs, and other educational resources.