Welcome to the first edition of The Practice Operator.
Some of you work with us every day. Some of you grabbed one of our guides and stuck around. Either way, you run the operational side of a practice, and you do it from inside one building, with no view of what's happening in anyone else's.
We have that view. We work across dozens of practices and surgery centers, and our team watches the payers, the rules, and the patterns full time. Every other Friday, this is where we hand you what we saw. It reads in five minutes.
THE FIELD
What we saw move this month, and what it means for you.
Medicare's July update landed.
New quarter, revised edits, adjusted rates, changed rules for specific codes. If you run a surgery center, the ASC payment system update touches your facility rates directly, and commercial payers push their own mid-year changes on roughly the same rhythm.
What it means for you: somewhere in those bulletins is a code your providers bill routinely that now carries a new requirement, and practices that miss it find out through denials in September. Someone needs to own the bulletins by name.
Your patients' deductibles are mostly met.
By July, the money in a typical visit shifts: less patient responsibility, more payer responsibility, and that changes the character of your collections for the rest of the year.
What it means for you: a front desk tuned for January, where the patient owes most of the bill, is over-collecting conversations and under-watching payer behavior by August. The second half of the year is payer season. Watch the remittances, not just the checkout line.
“IS IT NORMAL?”
One real question from a practice operator, answered straight. Identities stay out of it.
“We're at five providers, and we still do our billing in-house. Is that normal? Everyone keeps telling me there's a size where you're supposed to switch.”
It's normal, and everyone telling you about the magic size is wrong. There isn't one. We work with solo providers who outsource everything and larger groups who keep it all in the building. Provider count was never the test.
Two things are.
First: what happens when one biller is out for a week? If the honest answer is that claims stop and follow-up stops, your operation runs on attendance, and that's true at two providers or ten.
Second: your fully loaded cost. Salaries, benefits, software, management time, and what turnover costs you every time you retrain. Most practices compare an outside invoice against an in-house number they've never actually added up.
Answer those two honestly, and the decision usually makes itself, whichever direction it points.
Have one of these questions yourself, the kind you've been staring at alone? Hit reply. Every edition answers one, and nobody will know it was yours.
Talk soon,
Dr. Tarek Shahbandar
Co-founder, Expert Medical Billing · Practicing physician, 25+ years
NEXT EDITION: The biller market. What we're seeing in the hiring market for experienced billers, and why filling that seat is harder than it was three years ago.