It Is Not Always a Billing Problem
Your payments are low. Your aging claims are climbing. Your instinct says the billing is broken.
Sometimes it is. Often it is not. Some of the most expensive leaks in a practice have nothing to do with billing at all.
Leak one: the contract. Reimbursement is not what the payer decides. It is what your contract says. Contracts vary widely for the same code in the same market, and most owners have never compared theirs. Do you know your contracted rate for your top five CPT codes? Have you checked them against the market in the last two years? You cannot negotiate what you cannot measure. That is not a billing problem. That is a contract problem, and contract problems are solved with data, not hope.
Leak two: follow-up. If more than 20% of your aging claims sits past 90 days, you do not have a payer problem. You have a follow-up problem. MGMA benchmarks say under 15% past 90 days is the standard. Aging claims do not resolve themselves. They respond to ownership: every bucket gets a person, every person gets a cadence. Thirty, sixty, ninety, one-twenty. Most practices work aging "when somebody has time." That is why the over-90 bucket keeps growing.
Leak three: the resubmission loop. The payer denied the claim for a reason. Sending the identical claim again manufactures a duplicate denial. Each trip through the loop costs $52.74 in rework, according to the 2026 Availity Abrasion Index. Real follow-up starts with the why: read the denial, fix the root cause upstream, resubmit once, clean. Anything else is expensive hope.
Leak four: the benchmark gap. MGMA draws the lines: clean claim rate 90% or better, denial rate under 5%, aging claims past 90 days under 15%. If you do not know your numbers, you are guessing. If you know them and they miss the lines, you have a roadmap. Either way, the benchmarks turn a vague worry into a specific job.
Now count the cost of waiting. Take your denials per week and multiply by $52.74. That is your weekly rework bill. Annualize it. Add the write-offs, the claims aging past 120 days, the Friday nights. That total is what "we will get to it" costs you.
Here is the one useful idea for this week. Pick the cheapest leak to find: your contracts. Pull your top five CPT codes and your contracted rates. If you cannot find them in under ten minutes, you found leak number one. If you find them and they sit well below market, you found leak number one with a dollar sign on it.
Finding the leaks is step one. Fixing all of them is what our Practice Health Check does. It is an annual physical for your revenue cycle. A Practice Wellness Expert spends 2 to 5 days taking your practice's vitals across all seven stages: Credentialing, Human Resources, Patient Registration, Eligibility and Benefits, Payment Posting, Aging Follow-Up, and Claim Submission. You get a wellness score plus a detailed report of what is working, what is missing, and exactly what to fix.
On Thursday, October 29, 2026, from 12:00 to 1:00 PM Eastern, I am teaching the full six-stage billing system live and free in the Group Practice Billing Blueprint webinar. Thirty minutes on the system, fifteen minutes on the Practice Health Check, fifteen minutes of live Q and A. Every attendee gets a free copy of my book, The Billing Blueprint, and attendees get 15% off a Practice Health Check.
Stop guessing where the money goes. Measure it. Then fix it for good.
This is a helpful reminder that improving revenue requires more than just fixing billing errors. Tracking denial rates, reviewing contracts, and following up on unpaid claims can make a real difference. Just like NatWest emphasizes the importance of managing finances effectively, healthcare practices also benefit from monitoring their numbers and planning ahead.