Revenue Cycle Insights Helping Small and Mid-Size Medical Practices Flourish
For small and mid-size medical practices — especially in specialties like podiatry and mental health — sustainable growth requires more than seeing patients and submitting claims. It thrives on financial precision, smooth workflow alignment and insight-driven decisions — elements that can be enhanced with additional support, if needed, alongside your internal team.
After more than 30 years helping practices strengthen their revenue cycles, we’ve learned that what holds many providers back isn’t just missed codes or late claims — it’s a lack of strategic visibility into why those issues happen in the first place.
Here are some insights that can help your practice flourish — not by adding more to your team’s plate, but by focusing your efforts where they’ll make the greatest financial impact.
1. Lag Days & Timely Filing Deadlines Can Quietly Cost You
Most practices track charges and collections — but fewer track lag days, the time between the date of service and the date of claim submission. For small practices with limited staff, this often averages 10+ days, which doesn’t just slow down cash flow — it increases the risk of missing payer filing deadlines altogether. And in this case, missing the deadline usually means losing all revenue for that service.
In many small and mid-size practices, claims can linger in draft mode or bounce between clinical and billing teams while waiting for documentation. The longer they sit, the greater the chance they’ll miss the submission window.
What to do: Monitor your average lag by provider and service type and keep a system to flag unbilled charges weekly. If certain visits — say, mental health intake appointments or complex podiatry procedures — are consistently delayed, it may be a sign of workflow breakdowns. These are often fixable through process changes, automation or by outsourcing billing to a partner who can take full accountability for getting claims out on time.
2. Underbilling Happens More Than Overbilling
In the name of compliance, many providers under-code visits out of fear of audits — especially in behavioral health. But chronic underbilling leads to major revenue loss over time. We often find that mental health providers use 90834 (45-minute therapy) even when 90837 (60-minute therapy) is clinically supported and documented.
Tip: Do a periodic CPT code utilization review across your providers. Comparing it to national specialty benchmarks can reveal underutilized codes, missed add-ons (like 99072 or G2212), or modifiers you’re not applying when you should.
3. EOB Patterns Can Predict Workflow Gaps
Don’t just file Explanation of Benefits (EOBs) away—mine them for trends. A sudden increase in patient responsibility, partial payments or bundling adjustments often points to billing errors, authorization issues or eligibility gaps.
We recommend: Categorizing EOB remarks monthly and mapping them back to where the issue likely originated (e.g., front desk, provider documentation, coding). This allows you to fix the root problem rather than chasing the symptom through appeals.
4. Insurance Mix Can Make or Break Small Practices
Payer contracts don’t just impact reimbursement rates — they shape your entire revenue cycle. We’ve seen practices with 40% of patients on a single low-paying plan struggle to stay afloat, even with perfect billing.
What to examine: Your payer mix by revenue, not just volume. A high number of Medicaid patients, for instance, may seem manageable — until you factor in denial rates, administrative burden and reimbursement delays. With this knowledge, you can make more informed decisions about marketing, scheduling and even future provider hires.
5. AR Over 90 Days Isn’t Just a Collections Problem — It’s a Process Problem
It’s tempting to blame old AR on non-paying patients or slow insurers, but that’s rarely the full story. Claims over 90 days often reflect missed follow-up steps, delayed denials or workflow bottlenecks — especially in smaller practices where roles overlap and priorities shift quickly.
Recommendation: Segment your aging AR by reason (e.g., appeal pending, patient balance, claim never followed up). Then ask: Is this a staffing issue? A process gap? Or simply too much volume for the systems you have in place?
Don’t Just Work Harder — Bill Smarter. Medical billing shouldn’t be reactive. With the right insights and tools, small and mid-size practices can bill with greater accuracy, collect faster and make more strategic decisions — fueling both financial health and practice success.