Edition two.
Here’s what we saw across the practices and payers we work with, and one operator question answered straight. Five minutes, then back to you on Friday!
THE FIELD
What we saw move this month, and what it means for you.
The experienced-biller seat is getting harder to fill.
When a long-tenured biller retires or leaves, the search is running longer than owners expect. The resumes that come in are mostly clinic generalists. The people with real surgical and specialty depth are already employed, usually by someone who knows exactly what losing them would cost. A generation that learned this work over decades is aging out faster than replacements are being trained.
What it means for you: succession planning just became revenue planning. If one person holds your billing knowledge, the time to document her workflows and cross-train a second pair of hands is while she's still in the seat. One question to ask yourself this week: if she gave notice on Friday, what does Monday look like?
Everyone is pitching AI billing. We ran our own tests.
The AI pitch is everywhere in revenue cycle right now, so we tested it ourselves, inside our own operation, on phone-heavy AR follow-up work. If it made the work better, we'd want it first.
What we found so far: the savings are thinner than the sales decks suggest, and the compliance questions are real enough that we've kept humans on the calls.
What it means for you: when a vendor leads with AI, ask two questions. What human follow-up does it replace, and who works the claim when it bounces? Speed on the front end is easy to automate. Collecting the money on the back end still takes a person who picks up the phone.
“IS IT NORMAL?”
One real question from a practice operator, answered straight. Identities stay out of it.
“Our biller has been with us for nine years. She's loyal, she's always busy, and I honestly have no idea if she's good. Is that normal?”
Very normal. It might be the most common unspoken worry in practice ownership, and almost nobody says it out loud, because it feels disloyal to a person who's given you nine years.
So let's separate two things. Busy is real, but busy is also invisible as a measure of results, because effort and effectiveness look identical from the doorway. And nine years cuts both ways: it means deep knowledge, and it also means nine years of nobody checking, which is a structural problem, never a person problem.
Three checks that require zero billing expertise:
Ask for the same three numbers every month:
Collections against what was billed
AR over 90 days
Top denial reasons
Specific numbers arriving on time is itself the test. Vague summaries are an answer too, just a different one.
Watch the AR over 90 days as a trend across a quarter or half year. Shrinking or steady means the follow-up work is getting done. Growing means it's falling behind, whatever the effort level looks like.
Pick any denial and ask what happened and what changed because of it. A good biller answers in specifics, and honestly, the good ones enjoy being asked.
Then say the sentence that makes all of it safe: this is about me sleeping better, and it has nothing to do with doubting you. If she's as good as nine years suggests, the numbers will show it, and she finally gets the credit she's owed.
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 audit files. The three problems we find most often when we open up a practice's revenue cycle, across every specialty we serve.