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Send us Fan MailFREE — SEE WHERE YOUR PRACTICE IS BLEEDING REVENUE IN 3 MINUTES Take the RECOVER Diagnostic Quiz: https://eligibility.natrevmd.com/recover-quiz-lp More free resources: https://natrevmd.com/trusted-resources/ Payment Posting Audit Checklist: https://eligibility.natrevmd.com/payment-posting-checklistWE ARE RE-AIRING THIS EPISODE BECAUSE IT MATTERS RIGHT NOW. On July 1, 2026, the Medicare GLP-1 Bridge went live. Every independent practice with Medicare patients on Wegovy, Zepbound KwikPen, or Foundayo for weight management is now facing retrospective prior authorizations routed through a central processor most billing teams have never worked with. The AMA released physician guidance on June 26. The workflow is new. The documentation burden is heavier than most practices have modeled. And prior auth was already the fastest-growing revenue threat independent practices face. In this episode Dr. Heather walks through: WHAT WE COVER Why prior auth denials are silently eating clinical time and revenue The dollar amount your practice is losing every month (and how to calculate it) The 5-step workflow to manage prior auth without drowning your team What every practice needs to change this week "Prior auth has a dollar amount attached to it. Most practices never calculate it." THREE ACTIONS THIS WEEK 1. Calculate what prior auth is costing your practice in staff hours, denied claims, and clinical time 2. Set up a central prior auth tracker (do not run this out of email threads) 3. Train the team on the Medicare GLP-1 Bridge central processor workflow before the backlog compounds

Send us Fan MailA household runs on clarity, not effort. So does a practice. Most performance problems in independent practices are clarity problems: somebody thought somebody else was handling it. This episode builds the RACI model (Responsible, Accountable, Consulted, Informed) into your billing workflow and your hiring. What RACI actually means.  Four roles, each assigned to a person for a task, with one hard rule: never more than one Accountable person. If two people are accountable, nobody is. Mapping RACI to your practice.  A denial slips through when the billing manager assumes the front desk verified eligibility and the front desk assumes the billing manager caught it at scrubbing. With RACI, every role is named and the gap disappears. An unowned weekly denial review at a $350K-a-month practice can run 3 to 5 percent above its potential clean claim rate, $10,500 to $17,500 a month lost in a gap nobody owned. Hiring into the RACI structure.  Define the RACI role before the job description. A person wired to execute will struggle in an Accountable seat that requires sitting with ambiguity. That is a role mismatch, not a character flaw.Three actions this week Map the RACI for your weekly denial review (if you cannot name the Accountable person in thirty seconds, the task has no owner). Audit your current team against the RACI role definitions: right role, right wiring? Use RACI in your next hire, before you write the job description. Resources 30-Day Revenue Recovery Plan (primary): eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan Book a call with Heather: calendly.com/heather-natrevmd Payment Posting Audit Checklist (supporting): eligibility.natrevmd.com/payment-posting-checklist Referenced: The Five Dysfunctions of a Team by Patrick Lencioni; High Output Management by Andy Grove. 

Send us Fan MailQ1 2027 cash flow crisis. That is what is waiting for every OB practice that does not have a plan in motion by October. Not because the codes are hard. Because the time ran out to prepare for them. Knowing what is changing and being ready for it are two completely different things. In the OB Global Coding Series finale, Dr. Heather Signorelli walks through the exact ninety-day month-by-month plan to be ready on January 1, 2027 — payer contracts in July, EHR templates and workflows in August, provider training and shadow audits in September, refinement through Q4. Month 1 · July · Payer contracts: Your contracts reference specific CPT codes. When 59400 and 59510 disappear January 1, those contracted rates disappear with them. Identify your top five payers by maternity volume. Reach out to each provider rep with a written timeline question. Model your current revenue per episode before negotiating. Use the ACOG payer advocacy toolkit. Submit written notice of intent to renegotiate before July 31 to get into the Q4 queue. Month 2 · August · EHR + workflows: Systems first, people second. Rebuild prenatal, postpartum (inpatient and outpatient), and labor management templates. The labor management templates are built from scratch since 59080 – 59083 have no legacy. Build the multi-provider attribution protocol, the same-day postpartum hard stop, and the modifier TH automation. Month 3 · September · Provider training + shadow audits: Mandatory training for all clinical staff. Show providers their own notes and the dollar difference between what they wrote and what they could have written. Run shadow audits monthly: twenty prenatal notes, ten labor management, ten postpartum rounding. Track results by provider. Brief the front desk on the patient-facing talking points. September 1 is the ACOG testing date — NOT a payer compliance deadline. Submit test claims to your top three payers and watch what comes back. Q4 · Refinement, not crisis: October: follow up with payers for written fee schedule confirmations. November: CMS finalizes RVUs — update your revenue model with real numbers. December: billing team readiness check. January 1: go live. The practices that did the Q3 work transition smoothly. The ones that did not are scrambling. The reframe: The elimination of the global OB codes is not a threat to your practice. It is a correction. OB/GYN has been undercompensated for the complexity of maternity care for thirty years. That ends January 2027, if you are prepared.RESOURCES BLOCK Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Full series playlist: EP188 · EP189 · EP190 · EP191 · EP192 (https://natrevmd.com/podcast/#) Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz 

Send us Fan MailDeliver at 11 PM Tuesday and round at 1 AM Wednesday: paid. Deliver at 8 AM Tuesday and round at 4 PM Tuesday: included in the delivery code, and billing it separately is a compliance violation. Same clinical work, two different outcomes. The only variable is the calendar. Starting January 1, 2027 postpartum care moves to E/M billing with hospital rounds, discharge management, and outpatient checkups all individually billable. Dr. Heather Signorelli walks through the code sets, the same-day trap, the multi-provider wrinkle, and the three-step workflow that catches it every time. The end of the postpartum bundle: Code 59430 (postpartum care only) is deleted January 1, 2027. All postpartum care moves to E/M billing. Two settings, two code sets: inpatient (hospital rounds) and outpatient (office visits). Inpatient postpartum codes: Subsequent hospital care: 99231, 99232, 99233 for daily rounding visits after the date of delivery. Discharge day management: 99238 (30 minutes or less) or 99239 (over 30 minutes). Every rounding day after delivery, on a new calendar date, is a separately billable E/M encounter. Documentation has to support the level. A one-liner does not support a 99233. Outpatient postpartum codes (with telehealth correction): Standard office E/M: 99212 through 99215 with modifier TH. Telehealth uses the same 99212 through 99215 codes with modifier 95 or GT, and place of service 02 or 10. There is no separate “98000” telehealth code set, contrary to earlier references in this series. Modifier TH on all postpartum E/M codes communicates the maternity context to the payer. The same-day rule: Postpartum E/M codes CANNOT be reported on the same calendar date as the delivery code. Same-day postpartum management is included in the delivery code. Calendar date means midnight to midnight, not twenty-four hours from delivery time. The multi-provider wrinkle: If Dr. Smith delivers at 8 AM and Dr. Jones rounds at 4 PM the same day, Dr. Jones cannot bill an E/M for that visit. The delivery code covers same-day postpartum regardless of which provider from the same group performs it. This requires an internal compensation and attribution policy, not just a billing rule. The workflow fix — three steps: Timestamp discipline on every delivery and rounding note Billing team hard stop: verify delivery date before dropping any postpartum E/M charge Daily L and D reconciliation: track delivery date, rounding date, and provider by patient, daily The revenue opportunity: Every hospital rounding day after the delivery date is a new billable E/M. Extended stays from complications (postpartum hemorrhage, severe preeclampsia, wound infection, NICU situations) all generate additional charges. Complexity matters for reimbursement. Outpatient two-week and six-week checks are now individually billable instead of absorbed into a global fee. The same-day rule is the risk. Everything after midnight is the opportunity. Quick Reference Table:Topic                                                                             What to knowDeleted postpartum code                            59430 — deleted Jan 1, 2027 Inpatient rounds                                             99231 – 99233 Discharge codes                                                      99238 (≤30 min) · 99239 (>30 min)Outpatient postpartum                                 99212 – 99215 + modifier TH Telehealth modifier                                        Modifier 95 or GT · POS 02 or 10                                                                             NOT a separate 98000     code set Same-day rule                                                           Postpartum E/M cannot be billed on the                                                                              same calendar date as the delivery Calendar definition                                        Midnight to midnight Multi-provider same-day                                    Delivery code covers regardless of                                                                                       which group provider roundsWorkflow fix                                                    Timestamps · billing hard stop · daily                                                                                    reconciliationRESOURCES BLOCK Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz Series Part 3 (EP191): https://podcasts.apple.com/us/podcast/191-labor-management-is-no-longer-invisible/id1624182351?i=1000775009191

Send us Fan MailUnder the global model, labor management was absorbed into the delivery code. Two hours or twenty-two, same payment. Starting January 1, 2027, the AMA introduces 59080 through 59083, the first dedicated labor management codes in CPT history. The work was always there. Now it gets paid. Dr. Heather Signorelli and Amy Hicks, CPC, COBGC, our AVP of Operations, walk through the codes, the documentation, the corrected delivery code framing, the midnight-spanning labor rule, the multi-provider attribution problem, and the three actions every OB practice should take this quarter. Why labor management was invisible: Under the global model, the cognitive work of managing labor was absorbed into the delivery code. Practices managing complicated labors (preeclampsia, GDM, category two tracings) have been subsidizing simple deliveries for decades. The four new labor management codes: 59080 (initial day, straightforward) · 59081 (initial day, complex) · 59082 (subsequent day, straightforward) · 59083 (subsequent day, complex). Codes bill per calendar date. One code per date per patient. Straightforward vs complex: the six-criteria test: All six straightforward criteria must be met: singleton vertex, routine monitoring, no FHR intervention required on that date, normal progression or routine induction without complication, stable medical conditions, no prior cesarean. Any one criterion not met means the labor is complex. Duration of labor alone is NOT complexity unless prolonged labor is formally diagnosed. What the complex note has to say: Explicitly name the complicating condition. Not just “patient has GDM,” but what about the GDM you managed today. Document MDM across multiple data sources, labs reviewed, monitoring strip interpreted, imaging assessed. Document additional monitoring or intervention beyond standard, what you did and why. Document multi-provider coordination if applicable that date. For 59083 (subsequent day complex), complexity must be re-established for EACH subsequent day. A single admission note does not carry forward. Delivery codes (corrected framing): The 2027 delivery codes separate vaginal from cesarean, not vaginal from operative. 59431 (vaginal, no prior cesarean) · 59432 (VBAC vaginal) · 59502 (primary cesarean) · 59503 (repeat cesarean). Vacuum and forceps are separately billable add-on procedures. Included in the delivery code: placenta, first and second degree laceration repair, same-day postpartum care. Separately billable add-ons: 59433 (third degree lac), 59434 (fourth degree lac), 59623 (uterine tamponade, new 2027 code), 59504 (hysterectomy with cesarean). Midnight-spanning labor (correcting the record): A continuous labor encounter spanning midnight is reported as ONE labor management service on ONE of the two calendar dates. The practice decides which date. Inpatient E/M codes (99221 through 99236) do NOT stack with labor management codes. They replace each other. Inpatient E/M applies before labor begins. Once active labor management starts, switch to 59080 through 59083. Multi-provider attribution: Each provider bills the service they personally performed. The labor management code goes to the provider who managed labor on that calendar date. The delivery code goes to the provider who delivered. If the delivering provider also managed labor on the delivery date, they can bill both. Two failure modes: the miss (no one drops the charge), and the double-bill (both providers drop the same charge). The solution is a daily reconciliation, not monthly. Three actions this quarter: Map your call and cross-coverage. Find where charges go unbilled today and where two providers could overlap. Build a daily L and D reconciliation process. Assign ownership. Reconcile before shift end, not at month end. Update EHR labor management templates to prompt for the six criteria, complicating conditions, MDM elements, and same-day decisions.  RESOURCES BLOCK Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz Series Part 2 (EP190): https://podcasts.apple.com/us/podcast/190-every-prenatal-visit-is-now-a-billable-event/id1624182351?i=1000774328121                                             

Send us Fan MailStarting January 1, 2027 every antepartum visit becomes its own billable E/M charge. The global OB code goes away. The seventeen deleted codes include 59400, 59510, 59425, and 59426. And the way most prenatal notes are written today supports a 99212 at best, even when the visit was genuinely a 99214. Dr. Heather Signorelli and Maria Reynoso, Director of RCM at NatRevMD, walk through what changes, what the notes have to say, and the three actions every OB practice should take this week. What changes January 1, 2027: Antepartum-only codes (59425, 59426) and global OB codes (59400, 59510) are deleted. Every prenatal visit is now a standard E/M visit with modifier TH. New patient 99202–99205. Established patient 99211–99215. What the notes actually look like today: Notes have been written for speed because the global model did not reward note detail. A typical 16-week prenatal note (BP, fundal height, FHTs, “patient doing well, return in 4 weeks”) supports a 99212. The provider did much more during that visit. None of it is in the note. Under 2027, that gap is real revenue. What a 99214 note has to say: ACOG's position: pregnancy is a chronic illness with exacerbation and progression for E/M purposes. The complexity is built in. The note has to reflect it. For a 99214, document the ongoing management of the pregnancy as a condition, the data reviewed with your interpretation, and moderate risk decisions like prescription management or monitoring a condition that could escalate. “Anatomy scan reviewed, normal” is a 99212. “Anatomy scan reviewed, normal four-chamber heart, no CNS abnormality, EFW consistent with dates, AFI normal, counseled patient” is a 99214. High-risk patients finally pay for the complexity of their care: Under the global model the complex patient and the low-risk patient paid the same. The new model fixes that two ways. Complex visits code at a higher level (99214 / 99215). And more frequent visits equal more claims. For 99215 the note needs the specific complicating diagnosis named, data reviewed with interpretation, the management decision and the reason behind it, and specialist coordination if applicable. Same-day procedures and modifier 25: Antepartum procedures (NSTs, ultrasounds, amniocentesis, CVS) still bill separately. The E/M visit on the same day is now also billable with modifier 25. The note must independently support the E/M, not just the procedure. Three actions this week: Audit twenty random prenatal notes against the 2021 E/M guidelines to set your baseline Rebuild EHR templates to prompt for MDM elements, not for speed Start documentation training in Q3, using providers' own notes side by side with the corrected version and the dollar difference Quick Reference Table:       Topic                                                                                    What to knowDeleted codes count                     -      17 codes deleted total Antepartum-only codes                  -       59425, 59426 — deleted Jan 1, 2027Global OB codes                                  -       59400, 59510 — deleted Jan 1, 2027 New patient E/M range                    -       99202–99205 + modifier TH Established patient E/M range    -       99211–99215 + modifier TH 99214 vs 99213                              -       ~$46 per visit at Medicare ratesModifier 25               -       On the E/M when a procedure is also billed same dayACOG test date         -September 1, 2026 — recommended start for test claimsRVU finalization       - CMS proposes July 2026, finalizes November 2026 RESOURCES BLOCK Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz Series Part 1 (EP188): https://podcasts.apple.com/us/podcast/188-17-ob-codes-just-got-deleted-your-real-deadline/id1624182351?i=1000773393336Coming next: EP191 · Phase 2 labor management codes (the codes that have never existed in CPT before) 

Send us Fan MailShow notes A physician built a solid, growing independent practice over six years, then got bored with the pace and chased three new ideas at once. None launched. The original practice still lost an estimated $180,000 in revenue degradation over twelve months, not from a bad decision, but from the boring work quietly going undone. This episode is the framework for staying in the room with it. The compounding cost of distraction.  The revenue cycle does not tolerate divided attention. When leadership focus drifts, performance does not collapse, it leaks. A $350K-a-month practice that drifts for six months can lose $84,000 in net collections that never gets recovered. The shiny idea did not cost the money. The distraction did. The patience advantage.  A boring denial-rate fix that recovers $8,000 to $12,000 a month compounds every month forward. A new service line that might add $5,000 a month creates complexity with no compounding. Patient money picks the boring fix every time. The boredom threshold.  James Clear calls boredom the greatest threat to success. When the practice is working, the work stops feeling like progress and starts feeling like maintenance. The reframe: the boring work is not maintenance, it is compounding. The Five Shiny Objects That Cost Practices the Most The Shiny Object   Adding a second location before ops are solid Switching EMR mid-growth Launching a new service line Hiring aggressively before systems exist Chasing a new payer vertical What It Feels Like Growth and scale Modernizing and streamlining Diversification and new revenue Team building and capacity Revenue diversification What It Actually Costs 2x overhead, fragmented leadership, billing gaps at both sites 6 to 12 months of workflow disruption, revenue dip during transition Core service attention drops, existing margin erodes Payroll grows faster than revenue, management overwhelm follows Credentialing lag, cash flow gap, billing team stretched thin Three actions this week Name the hard problem you have been avoiding, and write it down. Calculate what one boring fix is worth over twelve months (a 3% net collection lift on $300K a month is $108,000 a year). Schedule the boring meeting that keeps getting skipped: weekly, named owner, standing agenda. Resources 30-Day Revenue Recovery Plan (primary): eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan Book a call with Heather: calendly.com/heather-natrevmd Payment Posting Audit Checklist (supporting): eligibility.natrevmd.com/payment-posting-checklist Referenced: Atomic Habits by James Clear.

Send us Fan MailShow notes On January 1, 2027, every global OB code your practice has billed for the last thirty years is being deleted. Seventeen CPT codes. Gone. Replaced with a completely new structure for how every dollar of maternity revenue is earned, attributed, and collected. And the real deadline for your practice is not January 1, 2027. The real deadline is right now. What is actually going away For over thirty years, OB practices have lived in a bundled global world: one patient, one pregnancy, one code. Effective January 1, 2027, 17 global obstetric CPT codes (including 59400 for a global vaginal delivery and 59510 for a global C-section) are being deleted entirely. The AMA and ACOG determined the global model no longer reflects modern OB standard of care, and so the structure is being fully replaced, not patched. The four new phases of maternity billing Phase 1, Antepartum care. All bundled antepartum codes deleted. Every prenatal visit billed as individual E/M with TH modifier (99202 through 99215). Phase 2, Labor management. New dedicated code category for the first time in CPT history. Reported per calendar day, with straightforward vs complex management distinction. Phase 3, Delivery. Vaginal vs cesarean restructured. VBAC coded differently than first-time vaginal. Add-on procedures (3rd/4th degree laceration repair, uterine tamponade) now separately billable. Phase 4, Postpartum care. All existing postpartum codes deleted. Hospital care codes for inpatient day-after-delivery. Office E/M for outpatient follow-up. Same-date postpartum bundled into delivery. Why the real deadline is Q3 and Q4 2026 Cash flow in January 2027 will be decided this Q3 and Q4. Payer contracts reference CPT codes by number, so contracts that reference deleted codes need renegotiation now. Documentation habits have to change before the new codes go live, because every prenatal visit now needs to support E/M level selection. A 200-patient OB practice undercoding prenatal visits by even $40 each is leaving close to $100,000 a year on the table from day one. The multi-provider attribution problem Under the global model, attribution was easy: one practice, one fee, regardless of which provider saw which visit. Under the new model, every encounter is attributed to the individual provider who performed it. Practices with midlevels, hospitalists, or shared call need a clear protocol for labor management billing, on-call coverage, and cross-coverage now, or they will either double-bill (compliance risk) or miss charges (phantom revenue) from day one. Three actions this week Pull a payer contract audit. List every commercial contract referencing global OB codes that needs renegotiation before January 1. Run a prenatal documentation review. Pull 10 recent prenatal charts per provider and assess them against current 99213 and 99214 E/M standards. The gap is your single biggest revenue risk. Map your provider attribution workflow. Write out exactly how labor management, on-call coverage, cross-coverage, and same-day postpartum care will be tracked when every encounter is attributed individually. Episode breakdown 1. The 17 deleted codes 2. The four new phases of maternity billing 3. Why Q3 and Q4 of this year is your real deadline 4. The multi-provider attribution gap 5. What patients will see on their EOBs 6. Your 90-day action plan 7. What is ahead in the rest of the OB Global Coding Series Resources → Live OB Global Updates Webinar (PRIMARY): eligibility.natrevmd.com/obgyn-global-updates-webinar → Book a call with Heather: calendly.com/heather-natrevmd → Payment Posting Audit Checklist: eligibility.natrevmd.com/payment-posting-checklist → Practice Revenue Leak Scorecard: eligibility.natrevmd.com/nrm-revenue-scorecard-v3 → Coming next in the series: EP189 — How to Bill Antepartum Care Under the New E/M Model 

Show Notes Your fee schedule is a revenue ceiling. And for most independent practices doing over $3 million a year, that ceiling is set too low in ways that never generate a denial and never appear on a standard report. EP186 covers the five gaps that are quietly capping your revenue, the exact fix for each one, and three actions to run this week. Gap 1 — Billing Below Your Own Allowables: You negotiate a better payer contract. The billing system does not get updated. The payer pays what you billed, not what you are owed. A practice with 20 high-volume CPT codes averaging a $10 billing gap across 800 monthly claims is losing $8,000 a month, $96,000 a year, from a contract they already won. Gap 2 — Inconsistent Fee Schedules Across Locations: A secondary location runs on its legacy fee schedule from before acquisition. Location A bills $210 for a procedure. Location B bills $165 for the same code. A site doing 400 visits a month with a $35 average billing gap is under-billing $14,000 a month, $168,000 a year. Gap 3 — No Medicare Multiplier Anchor: Fees set by instinct drift downward every year while costs move in the opposite direction. The fix: anchor to 200–300% of the current Medicare allowable and recalculate every November when CMS publishes updated rates. Gap 4 — Suppressing Global Fees for Self-Pay Patients: A practice protecting 15% self-pay volume by keeping fees low inadvertently discounts 100% of encounters. 850 commercial patients billed $40 below the correct rate: $34,000 a month, $408,000 a year. The fix: raise the global fee schedule and implement a separate documented sliding fee scale for uninsured patients. Gap 5 — No Annual Fee Schedule Review: A fee schedule that is right in year one becomes the revenue leak of year five. A $4 million practice drifting 3% below where it should be loses $120,000 a year in collectible revenue. Over five years: $600,000. The Five Fee Schedule Gaps at a Glance: Billing below allowable → Payer pays billed charge, no alert → up to $8K/month Location fee inconsistency → Lower site appears compliant on reports → $3K–$15K/month No Medicare multiplier anchor → Fees drift, no logical update trigger → Compounds annually Artificially low global fee → Self-pay policy masks commercial discount loss → $5K–$20K/month No annual review → Costs rise, billed charges flat → 3–5% margin erosion per year Three actions this week: Run the top-20 CPT code comparison — billed charge vs. highest commercial contract allowable Anchor your fee schedule to the Medicare multiplier — recalculate for this year Put the annual fee schedule review on the Q4 calendar today — first week of November, billing manager named as owner Episode breakdown: 00:00 The fee schedule is a revenue ceiling 02:30 Why silence in billing costs more than denials 05:00 Gap 1: Billing below your own allowables 09:00 Gap 2: Inconsistent fee schedules across locations 13:00 Gap 3: No Medicare multiplier anchor 17:00 Gap 4: Suppressing global fees for self-pay patients 21:30 Gap 5: No annual fee schedule review 25:00 Three actions this week 29:00 Free resource + EP187 tease Resources Mentioned NEW LEAD MAGNET  Primary resource this episode: 30-Day Revenue Recovery Plan. Payment Posting Audit Checklist is tertiary. 30-Day Revenue Recovery Plan (free): eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan Book a free 30-minute call: calendly.com/heather-natrevmd Practice Revenue Leak Scorecard (free): eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist (tertiary): eligibility.natrevmd.com/payment-posting-checklist CMS Medicare Physician Fee Schedule: cms.gov (updated annually each November) 

Most practice owners think their billing problem is a billing problem. It usually is not. The denial showing up this month started 60 days ago at the front desk. In this episode, Dr. Heather Signorelli sits down with Josh Sauter, President and CEO of Staffing First, to unpack why hiring is the first domino in your billing cycle, what it costs you when that domino falls, and how to think about staffing and revenue cycle as one connected system instead of two separate problems. SEGMENTS The first domino Josh's core insight: the front desk is where the billing cycle actually begins. A bad fit, a thin onboarding, or a missed training step upstream creates downstream denials 30, 60, 90 days later. The denials almost always look like a billing problem. They almost never are. The 30/60/90 day lag Why billing problems usually trace back to hiring decisions made a quarter ago. The eligibility check that did not happen on day 30 is the denial that lands on day 60 and the cash flow gap on day 90. The hire-slow trap Why saving money on staffing costs more in the long run. The wage gap pushing practices to underhire is the same wage gap pushing candidates out within the first year. Josh's view after 17 years: cheap hires are the most expensive line item in a practice. Coordinating front office and billing What it actually takes to make sure front desk failures do not kill claim throughput downstream. Weekly huddles between front office, billing lead, and the practice manager. Clear escalation paths for eligibility failures and payer changes. A billing partner that flags denial patterns back upstream instead of just working the claims. What a real staffing partner does differently Josh's process: 10 to 12 candidates interviewed for every order, top 2 to 3 sent to the practice. Deep questions about culture and not just skill. Behavioral health background applied to candidate screening. The practice manager gets the time back that they were burning on bad-fit interviews. REFERENCE TABLE: THE 30/60/90 DAY FRONT DESK LAG Timeline  | What happens upstream  | Where it shows up Day 0  | New front office hire, undertrained or wrong cultural fit  | Looks fine on the surface Day 30  | Eligibility checks missed, demographics keyed wrong, payer changes not caught  | First denials start landing Day 60  | Patterns compound, claim rework volume rises, missed authorizations stack  | AR over 60 starts climbing Day 90  | Practice blames the billing department  | Billing partner gets fired and replaced, problem persists THREE ACTIONS THIS WEEK Pull your last 90 days of denials and tag every one that traces back to front office (eligibility, demographics, missing authorization). Patterns will reveal hiring or training gaps before they hit Q3 cash. Run one weekly 15-minute huddle between front office, billing lead, and practice manager. Cover the top three denial reasons that week. Every week. Book a 1:1 with Heather to map the front desk to billing handoff in your practice: calendly.com/heather-natrevmd/ RESOURCES 1. Book a 1:1 with Heather Signorelli, MD: calendly.com/heather-natrevmd/ 2. The 30-Day Revenue Recovery Plan: eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan 3. Talk to Josh Sauter at Staffing First: staffingfirst.net  |  jsauter@staffingfirst.net 4. Practice Revenue Leak Scorecard: eligibility.natrevmd.com/nrm-revenue-scorecard-v3 5. Payment Posting Audit Checklist: eligibility.natrevmd.com/payment-posting-checklist 6. RECOVER Diagnostic Quiz: natrevmd.com/quiz

Most independent practice owners know the practice and their personal life are supposed to be separate. Separate entities, separate accounts, separate tax returns. Almost none of them have built the structural separation that makes that true when things get hard. EP185 covers the three systems that explain why one bad quarter in the practice becomes a personal financial event, and the firewall that stops it. System 1 — The Entanglement: No formal salary. No distribution schedule. Whatever is left in the business account goes home with the owner. In a good month: $40,000. Mortgage, 529, investment contribution. In a bad month: $14,000, covered with personal savings. The savings account does not come back as fast as the practice does. System 2 — The Bad Quarter Multiplier: The cascade that runs from a billing disruption straight through to the owner's personal financial decisions. Collections drop. Distribution skipped. Mortgage still goes out. Investment contribution paused. Operational decisions made under financial stress — delay the hire, pull back on marketing, hold off on the software upgrade that would have fixed the billing gap that caused the problem. That practice is always one bad quarter away from making decisions a wealthier version of itself would never make. The Cascade in Numbers: Payer delays 45+ days → Operating account drops → Owner stops paying themselves first Denial rate spikes 5% to 14% → $28K/month delayed or lost → Personal savings tapped for household bills Key provider unexpected leave → Volume drops 30% → No distribution for 60 days Contract renegotiation stalls → 90 days cash flow uncertainty → Investment contributions paused indefinitely System 3 — The Firewall: A market-rate owner salary that does not move with revenue. A distribution schedule tied to net profit after a defined reserve threshold. Personal savings that build independent of what the practice has on hand. In a bad quarter: the salary still goes out, the distribution pauses, and the operational decisions come from strategy instead of personal financial pressure. Referenced: Profit First by Mike Michalowicz — the formula flip that makes the firewall mechanical. Three actions this week: Calculate your real owner salary — what you would pay someone else to do your job Define your operating reserve threshold — one month of payroll minimum, two months standard Schedule a financial separation review with your accountant — ask what a 30% revenue drop does to your personal finances Episode breakdown: 00:00 The $380K practice that one quarter turns 03:00 The big idea: revenue is not wealth 06:00 System 1: The Entanglement 10:30 Working vs. broken — the same practice, two outcomes 13:30 System 2: The Bad Quarter Multiplier 17:00 The cascade and what it actually costs 20:00 System 3: The Firewall 24:30 Profit First applied to a medical practice 27:00 Three actions this week 31:00 Free resource + EP185 tease Resources Mentioned Payment Posting Audit Checklist (free): eligibility.natrevmd.com/payment-posting-checklist Practice Revenue Leak Scorecard (free): eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Book a free 30-minute audit call: calendly.com/heather-natrevmd RECOVER Diagnostic Quiz: natrevmd.com/quiz Book referenced: Profit First by Mike Michalowicz 

Independent practices rarely lose money because the medicine is wrong. They lose it because the highest-paid person is buried in clerical work and the front desk is too deep in daily chaos to chase eligibility, fill cancelled slots, or collect patient balances. We sat down with Tim Boyle of Reva Global Medical to talk about medically trained virtual assistants, and where the recovered revenue actually comes from. The front-end gap Scheduling, eligibility, verification, and prior authorization are the number-one denial categories. A front-desk team in the middle of ringing phones and walk-ins cannot also run the strategic prep that prevents those denials. A dedicated VA can, and that is usually the first seat to delegate. The no-show math A practice can run 20% open availability from no-shows. Without someone working a waitlist to fill those slots, that is overhead the practice simply eats. A VA reaching out the day before, and pulling from a call list when a slot opens, both lifts the patient experience and recovers revenue. The back-end gap Statements go out, but nobody works them. A trained VA handles patient-balance collections and the AR backlog, using HIPAA-certified propensity-to-pay tools to make a genuinely hard conversation go as well as it can for the patient. Who not how Heather and Tim land on the same idea the most successful owners share: protect your zone of genius and delegate the rest. The framing comes from Who Not How by Dan Sullivan and Dr. Benjamin Hardy. Clerical work is the low-hanging fruit, and the first thing to hand off. How the right VA is hired Reva accepts roughly 5% of applicants. The practice interviews finalists one-on-one with Reva's camera off, so the owner chooses who joins the team. SOPs are set up first, a client services manager reports daily or weekly, and the practice does not pay until the VA is trained and working. THREE ACTIONS THIS WEEK Download the 30-Day Revenue Recovery Plan and start working it from day one this week. Pull your no-show rate for last month and multiply it by your average visit value. That is your waitlist opportunity. List the three clerical tasks eating your day that do not require a clinician. That is your first delegation. EPISODE BREAKDOWN Tim's path from pro hockey to healthcare sales Why revenue leaks at the front desk Letting go of control as a practice owner The hiring and training process (the 5% filter) Who Not How and your zone of genius Back-end collections and the tough patient conversation What it costs and what comes back RESOURCES30-Day Revenue Recovery Plan — eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan Book a Call with Heather — calendly.com/heather-natrevmd Payment Posting Audit Checklist — eligibility.natrevmd.com/payment-posting-checklist Practice Revenue Leak Scorecard — eligibility.natrevmd.com/nrm-revenue-scorecard-v3 RECOVER Diagnostic Quiz — natrevmd.com/quiz Reva Global Medical — revaglobalmedical.com  |  Tim Boyle — Tim@revaglobalmedical.com Book referenced: Who Not How by Dan Sullivan and Dr. Benjamin Hardy 

Part 2 of our multi-location revenue series. If you haven't listened to Part 1 (EP182) yet, start there — the systems in this episode build directly on what we covered last week. EP182: Click hereToday we cover the two structural problems that let the Part 1 gaps stay open: front-end data inconsistency across sites, and the one role that either holds a multi-site practice together or lets it fall apart. System 3 — The EHR and Billing Disconnect: Different front desks develop different habits. One site verifies eligibility morning-of. The other verifies the day before. One collects copay at check-in. The other sends a statement after. A practice doing $120,000/month at Location B with a 20% authorization miss rate sends $24,000/month into billing with incomplete data. Some claims get caught in scrubbing. Some get denied. Some sit in a gray zone no one can explain at month-end review. Front-End Gap Reference: Authorization not captured → Denial or recoupment post-payment Insurance not updated at visit → Claim sent to wrong payer Copay not collected at check-in → Patient AR that rarely converts Eligibility verified day-of only → Coverage lapses missed pre-visit System 4 — The Office Manager Problem at Scale: Location A has a strong office manager who has been there since the beginning. Location B has whoever was available when the site opened. The metrics look similar on paper. The difference shows up in the denial rate, days in AR, authorization miss rate, and the number of times the billing manager has to fix something that should have been caught at the front desk. A $90,000/month site with an underperforming office manager loses an estimated $8,000 to $15,000/month in avoidable billing delays. That is $180,000/year from one seat filled with the wrong person. Three actions this week: Audit front-end protocol consistency — pull authorization miss rate and eligibility verification rate by site Run a site-level office manager assessment — KPIs only, not by feel Schedule weekly site-level KPI reviews — separate meetings, not consolidated Episode breakdown: 00:00 Series callback: the gap the report will not show you 02:00 The thread left open in Part 1 04:30 System 3: The EHR and Billing Disconnect Across Sites 08:00 The $24,000/month authorization miss scenario 11:30 Who owns the front-end protocol fix 14:00 System 4: The Office Manager Problem at Scale 18:30 The $180,000/year gap from one wrong seat 22:00 Who owns the accountability structure 24:30 Three actions this week 28:00 Free resource + next episode tease Resources Mentioned Payment Posting Audit Checklist (free): eligibility.natrevmd.com/payment-posting-checklist Practice Revenue Leak Scorecard (free): eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Book a free 30-minute audit call: calendly.com/heather-natrevmd RECOVER Diagnostic Quiz: natrevmd.com/quiz EP182 — Part 1 of this series: Link here

You opened a second location because the first one was working. What no one told you: the moment you added that second site, you added a second set of revenue gaps. And most of them are invisible on a consolidated report. In Part 1, we cover the two most expensive gaps inside multi-location practices doing over $300,000 a month. Neither generates a single denial. They just show up as missing revenue no one can explain. System 1 — The Credentialing Gap: A provider sees patients at a new site before credentialing is finalized. The claims go out. The payer rejects them, or pays provisionally and recoups months later. One provider, 60 uncredentialed days, 15 patients per day at $180 per visit: $162,000 in claims at risk. The front desk who scheduled those patients had no idea. System 2 — The Shared Billing Problem: One billing team covers both locations. Denials get triaged by volume, not by site. The smaller location falls behind. Its AR days climb past 40, then 50. Six months of recoverable claims cross the timely filing window. A secondary site at $90,000/month with a 12% denial rate instead of the target 5% loses $6,300/month in unworked denials. Over a year: $75,600. That is the gap the report will not show you on a consolidated view. Three actions this week: Build your credentialing matrix (one row per provider, one column per location, effective dates visible) Pull a site-specific AR report — not consolidated, by site Set a site-level denial threshold and define what triggers an immediate review meeting Episode breakdown: 00:00 The revenue gap no consolidated report will show you 02:00 Why multi-location growth is a systems problem 04:30 System 1: The Credentialing Gap 09:00 The $162,000 scenario 12:00 Who owns the credentialing matrix 14:30 System 2: The Shared Billing Problem 18:00 The $75,600/year site-level loss 21:00 Who owns the site-specific AR report 23:30 Three actions this week 27:00 Free resource + Part 2 preview Credentialing Scenario Reference: 1 provider | 60 days | 15 pts/day | $180/visit = $162,000 at risk 2 providers | 30 days | 12 pts/day | $200/visit = $144,000 at risk 1 provider | 90 days | 10 pts/day | $150/visit = $135,000 at risk Resources Mentioned: Payment Posting Audit Checklist (free): eligibility.natrevmd.com/payment-posting-checklist Practice Revenue Leak Scorecard (free): eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Book a free 30-minute audit call: calendly.com/heather-natrevmd RECOVER Diagnostic Quiz: natrevmd.com/quiz 

If you stepped away from your practice for 30 days, what would happen to your revenue? If the honest answer is "it would fall apart" — you don't have a scalable practice. You have a high-paying job with employees. In this episode, Dr. Heather Signorelli breaks down the four forms of leverage that separate practices that grow on their own from the ones that only move when you show up. The Leverage Framework: Form 1 — Capital Leverage: why it's the highest-risk, lowest-compounding form Form 2 — Labor Leverage: why 10x headcount creates 10x management complexity Form 3 — Code/AI Leverage: what $15K–$25K/month in avoidable billing losses actually looks like Form 4 — Media Leverage: the one asset that compounds while you sleep The Lion Sprint Framework: why sprinting beats grinding — and what your three sprints are this week Episode breakdown: 00:00 Opening question: what happens if you step away? 02:30 Leveraged vs. un-leveraged — the real 2026 divide 05:00 Form 1: Capital Leverage 08:00 Form 2: Labor Leverage 11:00 Form 3: Code/AI Leverage 14:30 Form 4: Media Leverage 18:00 The Lion Sprint Framework 20:30 Sprint 1: Policy Sprint (Media Leverage) 22:30 Sprint 2: Chart Closure Sprint (Code + Labor Leverage) 24:30 Sprint 3: Eligibility Training Sprint (Labor + Media Leverage) 27:00 Free resource + payer rule change teaseResources Mentioned Payment Posting Audit Checklist (free): eligibility.natrevmd.com/payment-posting-checklist Practice Revenue Leak Scorecard (free): eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Book a free 30-minute audit call: calendly.com/heather-natrevmd RECOVER Diagnostic Quiz: natrevmd.com/quiz 

The difference between practices that scale and practices that stall is not clinical skill. It is operational structure. And most practices doing $250K to $500K a month have already outgrown theirs. In this episode, Dr. Heather Signorelli breaks down the three root causes of operational chaos that keep growing practices stuck at a revenue ceiling they cannot break through. You will learn: Why ambiguity in roles costs you hard dollars in denied claims How running your revenue cycle on memory puts your cash flow at risk every single day Why unsigned charts are delaying tens of thousands in billing every month Three things you can do this week to assess exactly where you stand This is Part 1 of 2. Part 2 delivers the exact accountability chart structure, daily checklist templates, and provider productivity metrics to fix what Part 1 diagnoses. 

Most physician owners we talk to took a vacation last year and spent half of it answering billing questions on their phone. That is not a staffing problem. That is a systems problem. In this episode, Dr. Heather Signorelli walks through the five operational and financial systems that allow a practice to generate and protect revenue without the owner acting as the lead biller, the collections manager, and the operations director all at once. You will learn: How to take clinical knowledge out of one doctor's head and turn it into practice-wide standards How to get daily financial visibility without waiting 30 days for a CPA report How software hard-stops protect revenue even when your best staff member quits How to benchmark provider productivity without having awkward conversations How to give managers real decision-making authority without losing control of your margins 

What if the biggest revenue leak in your practice isn't a denial or a payer contract problem - it's the person processing your payments? In this episode, Dr. Heather Signorelli breaks down the four-step payment posting audit we run on every practice we onboard - and why practices doing $300K+ a month are routinely losing $8,000 to $25,000 of it to undetected posting errors. You'll learn: • How to catch unapplied patient payments before they generate angry calls • The ERA spot check that exposes systemic contractual adjustment errors • How to find payer underpayments before your billing team writes them off • The write-off audit that protects your revenue from unauthorized adjustments This is the final episode in our four-part payment posting series. If you've been following along, you now have more visibility into your revenue cycle than most practice owners ever get.

When your patient AR report shows thousands in past-due balances, it's easy to blame high deductibles. But a lot of that money is already in your bank account sitting unapplied—or it's a phantom balance the patient never actually owed. In this episode (Part 3 of our Payment Posting series) we walk through the four patient payment posting mistakes that inflate AR and damage patient trust: Unapplied patient credits — money in your bank, AR still open, patient gets billed again Payer denials shifted to patients by mistake — poster doesn't read the ERA denial code, patient gets a statement for money they don't owe Co-insurance misposted as a flat copay — wrong payment code at check-in, ledger breaks when the claim processes Unauthorized write-offs — billers clearing their queue by wiping balances with no authorization or audit trail Each mistake has a fix you can implement this week. 

Your AR report says hundreds of thousands of dollars are coming in. But if your team is making these four insurance posting mistakes, a significant portion of that AR is phantom money that was never going to be collected. In this episode (Part 2 of our Payment Posting series) we walk through the four insurance-side mistakes that inflate AR and drain revenue: Ignoring contractual adjustments — the gap between billed and allowed sits in AR as uncollectible phantom money Accepting underpayments as paid in full — payer shorts you on a contracted rate, poster writes off the difference without flagging it Leaving zero-balance claims open — fully paid claims clogging your AR and inflating your workload Duplicate posting — same ERA payment posted twice, creating phantom credits and balance chaos Each mistake has a fix you can implement this week. 

There's a number in your practice that looks precise but lies to you every single month: your AR report. We routinely audit multi-provider practices showing $400K, $600K, even $1M in AR — and 20–40% of that “asset” is already dead. Not collectible. Just trash left behind by bad payment posting. In this episode — the first in a 4-part series on payment posting — Heather walks through what payment posting actually is, why getting it wrong silently inflates your AR, and the seven specific things that change in your practice when posting is done right. Inside the episode: Why your AR report is a mirror of your team's posting accuracy, not what you're actually owed How a $400K/month practice dropped their AR by 30% in two weeks — without collecting a dollar more The 7 reasons clean payment posting transforms your revenue cycle The audit moment we found 200+ accounts a week being reworked that were already paid in full What's coming in Episode 176: the most common insurance-side posting mistake we see in almost every audit If you're a practice owner, billing lead, or operations director who has ever made a financial decision off an AR report — this is the foundation. Resources mentioned (Buzzsprout episode resources block) 

Your CPA sends a P&L on the 20th of every month showing a positive bottom line. Then tax season hits — or partners ask for a distribution — and the cash isn't in the bank. Sound familiar? This episode breaks down why standard P&Ls fail private practices doing $150K+/month, and how to replace them with a live financial dashboard that tells you the truth in real time. RESOURCES MENTIONED IN THIS EPISODE

Resources mentioned Practice Revenue Leak Scorecard (free, ~60 seconds): https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3Book a call with our team: https://natrevmd.com/contact/Visit us: natrevmd.com Are your patient volumes climbing but your bank deposits flatlining? That's one of the most terrifying patterns in private practice  and the scariest part? Your reports might not show any of it. In this episode, we break down the 3 early warning signs that your billing is broken and give you a clear, actionable plan to diagnose the problem before it becomes a six-figure issue. If you're running an independent medical practice doing $250K+ a month, this is the gut check you need. What we cover Warning Sign #1: AR over 90 days creeping above 15–20% — and why your team might be "statussing" claims instead of resolving them Warning Sign #2: Lack of transparency from your billing team (in-house or outsourced) — what to ask for, and what their answer tells you Warning Sign #3: Receipts dropping while charges stay stable — the two most common causes A real example from a practice we work with — credentialing holds and why pulling the data first matters Your 3-step action plan to run this week Chapters (00:00) Charges up, deposits flat: the signal most owners miss (01:30) Free Practice Revenue Leak Scorecard (02:15) Warning Sign #1: AR >90 days (04:30) Warning Sign #2: Lack of transparency from your billing team (06:30) Warning Sign #3: Receipts drop while charges stay stable (08:30) Recap: the 3 key takeaways (09:30) Your 3-step action plan this week (11:30) Book a free revenue audit About NatRevMD We're a physician-led medical billing and revenue cycle management company built for independent medical practices. Founded by Dr. Heather Signorelli, we help private practices stop revenue leaks, fix broken billing operations, and protect their margins. 

If your practice has anywhere from $50,000 to $500,000 sitting in the 120+ day Accounts Receivable bucket, we have bad news: most of it isn't coming back. And the reason isn't what your billers are telling you. Old AR is rarely a payer problem. It's an accountability problem. We recently took over the AR for a multi-specialty group whose 120+ bucket had ballooned past $300,000. We didn't find complex coding disputes. We found unresolved eligibility issues, missing EOBs sitting on payer portals, ignored write-offs, and billers who were "statussing" claims instead of actually working them. In this episode, we break down the 6 real reasons claims go to die — and the top 3 strategic oversight actions you must put in place today to hold your billing team accountable and stop the bleeding. Stop guessing about your financial health. Take our free 60-second Practice Revenue Leak Scorecard to see exactly how much revenue your practice is leaving on the table: https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3 

Resources mentioned in this episode: Free Practice Revenue Leak Scorecard: https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3?hs_preview=hUmAzejh-210981640602  Subscribe on YouTube: https://youtube.com/@natrevmd  Join the conversation: https://natrevmd.com/community  Are you staring at a billing report that says your collection rate is 98%... but your bank account tells a completely different story? If you're running a practice doing over $250,000 a month, relying on surface-level billing reports is the fastest way to lose hundreds of thousands of dollars a year without even realizing it. In this episode, we're talking about revenue leaks. Not the obvious ones. The invisible ones. We break down the three biggest lies your standard AR reports are telling you, and exactly where to look to find the missing money today 

Free Resources Mentioned in This Episode: Get your personalized score of where your practice is losing revenue. Free Revenue Diagnostic Quiz — Find Your Biggest Billing Leaks in 60 Seconds —  get a personalized score showing exactly where your practice is losing revenue.  Are you an independent medical practice owner doing over $5M a year, but you feel like you have to oversee everything to get anything done right?  If your front desk is missing copays and your billing team is letting claims sit for months, you don't have a personnel problem—you have a process problem.  In this episode of NatRevMD, we break down the exact 5 Standard Operating Procedures (SOPs) you need to build unbreakable accountability in your practice.  Learn how to transition from managing people to managing processes with one-page SOPs for eligibility verification, financial scripts, claim submission, scorecard reviews, and clinical documentation. Stop putting out fires and start scaling your practice today. 

Thinking about outsourcing your medical billing? Before you make a decision, you need to listen to this episode. We hear the same three fears from practice owners every single day: "It's going to be too much work to transition," "It's going to cost too much," and "What if the next team is just as bad as my current team?" In this episode, we break down those fears honestly. We aren't here to pitch you — we're here to give you a decision guide. We cover the exact signs that tell you your practice is ready to outsource, and just as importantly, the 3 signs that you are not ready to make the switch.  If you are an OB/GYN or Urgent Care practice owner who is tired of guessing about your revenue, this episode will help you decide if an RCM partner is the right next step for your growth. We cover: The real math behind the cost of an in-house biller vs. an outsourced team What a successful transition actually looks like (hint: you shouldn't be doing the heavy lifting) Why having a strong Office Manager is the #1 requirement for outsourcing success The 3 operational red flags that mean you should keep your billing in-house  Free Practice Resources: Download the Free Eligibility Verification Guide: https://natrevmd.com/eligibility-billing-verification/ Get the 2026 Margin Protection Playbook: https://natrevmd.com/margin-playbook Want to see if you qualify for a billing metric audit? Check us out here: https://natrevmd.com 

If you feel like you have to have your hands in every single part of your practice just to make sure things get done right, you don't have a staffing problem. You have a systems problem. In Part 1 of this two-part series, we break down three specific, high-yield frameworks you can implement in your practice right now to build unbreakable accountability and eliminate micromanagement forever.  We cover: Why your org chart is useless, and how to build an Accountability Chart insteadThe exact 5-15 numbers that need to be on your weekly KPI Scorecard (with industry benchmarks)How to delegate effectively using the "Who Not How" framework Resources mentioned in this episode: Traction by Gino Wickman Who Not How by Dan Sullivan Free Eligibility Verification Guide: https://natrevmd.com/eligibility-billing-verification/ 2026 Margin Protection Playbook: https://natrevmd.com/margin-playbook 

Are you afraid to switch billing companies because you don't want the pain of a transition? Or worse, are you worried the next team will be just as bad as the last? Most practices that come to us aren't failing—they are just leaving money on the table. But the pain of unknown or lost revenue doesn't get better on its own.  In this episode, we pull back the curtain and show you exactly what it looks like to partner with NatRevMD. From our 2-to-4-week onboarding process and daily payment posting, to why we manage denials to the root cause instead of just "statusing" them.  We also share why we don't work with everyone—and why your front office is the key to unlocking a 20-30% revenue increase. Resources Mentioned: 2026 Margin Protection Playbook Free Eligibility and Billing Verification Guide Complimentary Billing Metric Audit 

Every practice faces operational hurdles—from complex coding rules to clunky EMRs. But for a high-volume clinic, these everyday challenges can quietly add up to a six-figure revenue gap by year-end. In this episode, we break down common billing pain points that impact your bottom line. We explore typical front office and billing hurdles—like cautious undercoding, unauthorized write-offs, and building true AR accountability—and share actionable ways to empower your team and safeguard your revenue. Resources Mentioned: 2026 Margin Protection Playbook Free Eligibility and Billing Verification Guide Complimentary Billing Metric Audit 

Resources Mentioned: Free Eligibility Checker 2026 Margin Protection Playbook You know how to practice medicine. But do you know how to get paid for it? The gap between your clinical work and the codes on a claim is where most practices lose revenue. This episode is for you. We translate 10 common clinical scenarios into the language of billing. Learn how your documentation for prescription management, injections, and high-acuity visits directly impacts your practice's revenue. This is a practical guide for clinicians who want to understand the "why" behind the codes and confidently capture the full value of their work. 

Are you tired of being underpaid by insurance companies? For years, payers have held all the cards in contract negotiations, forcing independent practices to accept low reimbursement rates. But the game has changed. In this episode, we reveal how your practice can use new, federally mandated price transparency data to negotiate a rate increase. We provide a step-by-step playbook for building a data-driven case, initiating the negotiation, and securing the rates you deserve. Stop leaving money on the table. It's time to fight back. 

Resources Mentioned: Eligibility Verification GuideMargin Protection Playbook High-deductible health plans are crushing your practice's cash flow. If you're still using old-school patient collection methods, you're leaving thousands on the table every single month. In this episode, we break down nine specific, actionable strategies that top-performing practices are using right now to collect more patient balances, faster. No fluff, no theory—just a practical playbook for getting paid in 2026. 

Resources Mentioned: Free Eligibility and Billing Verification Guide 2026 Margin Protection Playbook Complimentary Billing Metric Audit The single biggest hiring mistake a medical practice can make is hiring front desk staff for their resume and not their attitude. Research shows 89% of hiring failures are due to attitude, not a lack of skills. Yet most practices continue to hire for EHR experience and hope for the best. This is the root cause of the revolving door at your front desk. In this episode, we share a proven framework to stop the churn. Learn how to hire for attitude and train for skill, using behavioral interview questions and a structured hiring process. We also cover five data-backed tactics from the MGMA for retaining the great people you hire, including creating career ladders and effective onboarding. Stop wasting time and money on bad hires. This episode will show you how. 

Free Guides Mentioned in This Episode: 2026 Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ Prior authorization has officially changed and medical practices need to act now.As of January 1, 2026, new CMS prior authorization rules are in effect, including faster Medicare Advantage decision timelines, new prior auth requirements for 17 traditional Medicare services, and a shift away from fax-based workflows toward electronic APIs.In this episode, we break down the three biggest prior authorization changes for 2026 and share a simple 3-step action plan to help OB/GYN, urgent care, and specialty practices reduce denials and protect cash flow.

Free Guides Mentioned in This Episode: 2026 Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ What if your OB/GYN practice could generate an additional $70,000+ in revenue without adding more patient visits?In this episode, Dr. Heather Signorelli breaks down Advanced Primary Care Management (APCM)—a new set of Medicare codes introduced in 2025 that reimburse practices for the ongoing care management many providers are already delivering.From care coordination and medication management to managing complex or high-risk patients, OB/GYN practices often perform significant work outside of office visits that historically hasn't been reimbursed.Dr. Signorelli explains how APCM works, why OB/GYN practices may qualify, and how implementing this program could unlock new revenue opportunities for your practice.

Free Guides Mentioned in This Episode: 2026 Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ In the final installment of The Practice Health Scorecard, we're talking about the most important part of your practice: growth. A profitable, efficient practice is wonderful, but it's worthless if the flywheel isn't spinning. If you're not consistently bringing in new patients and retaining the ones you have, your practice will eventually stagnate and decline. Ready for a change in RCM services? Check us out at NatRevMD.com 

Free Guides Mentioned in This Episode: 2026 Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ In Part 2 of our series we're moving from revenue to efficiency metrics. A profitable practice is great, but if your daily operations are inefficient, you're leaving a massive amount of money on the table. For practices, where patient relationships and complex care pathways are critical, operational efficiency is the key to providing excellent care while remaining profitable. 

Free Guides Mentioned in This Episode: Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ Is your OB/GYN practice busy, or is it profitable? They are not the same thing. A full schedule and high billing numbers can mask deep, underlying profitability issues. In Part 1 of our 3-part series, we explore the three most important metrics that drive your practice's profitability. We move beyond vanity metrics to give you a clear, actionable framework for understanding the true financial health of your practice.  

Free Guides Mentioned in This Episode: Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ Right now, your practice's billing data is being run through an AI model and compared to every other practice in your state. That AI is looking for one thing: outliers. Are you one of them? And if you are, do you even know it? In this episode, we pull back the curtain on exactly what payers are scrutinizing most aggressively in 2026. This isn't guesswork. This is based on the latest CMS RAC audit targets, payment integrity trends, and real-world audit data. Listen now to find out where you're most exposed. 

Free Guides Mentioned in This Episode: Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ Your stomach drops. You check the mail and there it is: a certified letter from your biggest payer demanding medical records. You have 30 days to respond. Where do you even start? If this is the first time you're thinking about an audit, it's already too late to fix the charts they want. The practices that survive audits—and avoid six-figure paybacks—are the ones that live in a state of constant readiness. In this episode, Dr. Heather Signorelli walks you through the different types of audits (Payer, RAC, TPE) and explains why the old "wait and see" approach is financial suicide in an era of data-mining payers. 

Free Guides Mentioned in This Episode: Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ You have a billing team, but do you have a strategic partner?  You assume they're managing your revenue. They're submitting claims and posting payments, but are they truly protecting your profit margin?  Most billing teams are just claims-filers. The real, high-value work is being completely ignored. We recently found $40,000 in unposted cash for a new client that their previous billing company had missed entirely. In this episode, we expose the 8 critical, high-value functions your current billing team is likely not performing, and how these gaps are silently draining your practice's bank account. It's time to find out if you have a claims-filer or a true revenue partner. 

Free Guides Mentioned in This Episode:  Margin Protection Playbook: https://natrevmd.com/margin-playbook Eligibility & Billing Verification Guide: https://natrevmd.com/eligibility-billing-verification/ Why is doubling your practice revenue so exhausting? Because you're playing the wrong game. In this episode, we break down the counterintuitive principles from the book "10x Is Easier Than 2x" and apply them directly to your medical practice. Learn why aiming for 10x growth forces you to do LESS, not more, and how to identify the 20% of your practice that drives 80% of your results. Stop chasing incremental gains. It's time to change the game. 

Recent Resources 2026 Margin Protection Playbook: https://natrevmd.com/2026-margin-protection-playbook/ Eligibility Billing Verification Checklist: https://natrevmd.com/eligibility-billing-verification/ If your practice feels stuck in gossip, silos, passive resistance, or quiet resentment—this episode is for you.In today's episode, Dr. Heather Signorelli breaks down Patrick Lencioni's The 5 Dysfunctions of a Team and explains how culture issues directly impact practice revenue, turnover, accountability, and operational efficiency.You'll learn:• Why absence of trust is the foundation of every team problem • How fear of conflict leads to hallway conversations and poor buy-in • Why lack of commitment sabotages major decisions like EMR changes • How avoidance of peer accountability delays billing and hurts cash flow • What “inattention to results” looks like in a medical practice • Practical strategies to rebuild trust, encourage healthy conflict, and align your teamCulture is not just a leadership concept—it's a financial one. Dysfunctional teams lead to dysfunctional metrics.If you want to reduce eligibility denials, improve chart sign-offs, increase buy-in, and drive better results—this episode gives you the framework to start.Interested in a free practice analysis? Visit natrevmd.com 

Did you stop offering telehealth because the rules keep changing? You're not alone. But you're leaving revenue on the table.Congress keeps extending telehealth flexibilities through 2027, but most practices have either abandoned telehealth entirely or started charging deposits because they're worried about patient responsibility nightmares.There's a better way.In this episode, we break down the latest CMS telehealth info and give you the exact billing workflow to keep seeing patients virtually while protecting yourself from collections chaos.You will learn:Why abandoning telehealth is costing you The pre-visit insurance verification script that eliminates surprise bills.How to update your consent forms to protect against patient disputes.The billing follow-up process that gets telehealth claims paid faster.Don't let uncertainty stop you from generating revenue. Just do it the smart way.

If you're not tracking the right numbers, you're guessing, and guessing costs practices real revenue.In this re-run episode, we break down the core metrics every medical practice should be watching to understand financial health, operational efficiency, and growth opportunities. Plus, we share an important announcement about our 8-week Medical Billing Course, built to help practices tighten systems and improve performance with confidence.

Recent Resources 2026 Margin Protection Playbook: https://natrevmd.com/2026-margin-protection-playbook/ Eligibility Billing Verification Checklist: https://natrevmd.com/eligibility-billing-verification/ Your practice runs on dozens of small, critical tasks. When even one gets missed, the result is chaos: delayed payments, frustrated patients, and stressed-out staff. What if you could catch every potential problem before it happens? You can. This isn't about another long meeting. This is about a 15-minute tactical huddle that functions as a pre-flight checklist for your day. We walk through the 8 specific points your team must cover every morning to ensure a smooth, profitable day. Stop managing chaos. Start running a well-oiled machine. This is the operational playbook you've been missing. 

Resources Mentioned: 2026 Margin Protection Playbook: https://natrevmd.com/2026-margin-protection-playbook/ Eligibility Billing Verification Checklist: https://natrevmd.com/eligibility-billing-verification/ Book a Call: https://natrevmd.com/ For years, primary care practices have been stuck in a broken system. You've been forced to choose between different care management programs, each with its own administrative headaches and low margins. You're doing the work, but you're not getting paid for it. That all changes in 2026. In this episode, we give you the ultimate guide to the new 2026 care management billing landscape. We break down the revolutionary new APCM + BHI add-on codes that allow you to bill for both primary care management and behavioral health integration, for the same patient, in the same month, without the time-tracking burden. This episode will show you how to: Compare all care management billing models head-to-head Calculate the $1.1M+ annual revenue opportunity for your practice Choose the right model for your specific situation Eliminate time-tracking and administrative burden This is the most important podcast episode you'll listen to all year. It's your roadmap to a more profitable, more scalable, and more impactful practice.  

Resources Mentioned: Margin Protection Playbook: https://natrevmd.com/2026-margin-protection-playbook/ Eligibility Billing Verification Checklist: https://natrevmd.com/eligibility-billing-verification/ Book a Call: https://natrevmd.com/ What if I told you that focusing only on RPM in 2026 means you may be leaving massive revenue completely untouched. In this episode, we give you the 2026 Revenue Roadmap. We're going to uncover four specific, high-margin revenue opportunities that go beyond standard RPM. These are the operator moves that the top 1% of practices are making right now to prepare for a more profitable year. Stop thinking in codes. Start thinking in systems. This episode will show you how. 

Is your practice thriving—or just surviving? In this power-packed episode, Dr. Heather Signorelli breaks down the key skills every successful practice masters. From hiring the right team and aligning them with your mission, to building systems that reduce chaos and boost efficiency, this episode is your blueprint for real-world practice growth.Whether you're a physician, practice owner, or office manager, these strategies will help you: ✅ Attract and retain top talent ✅ Streamline operations and patient flow ✅ Strengthen financial health and revenue ✅ Build a team culture that drives resultsTune in for actionable insights, practical tips, and strategies you can implement this week to move your practice from “busy” to thriving.