NatRevMD
Medical billing tips for healthcare professionals — by healthcare professionals. This podcast is here to help private practices get paid what they’ve earned. We share real-world strategies for accurate coding, smoother billing workflows, and fewer denials — all from a team that’s been in your shoes. Whether you’re just getting started or trying to tighten up your revenue cycle, you’ll get practical advice you can actually use.Join the conversation in our Facebook Group: NatRevMDLearn more at www.natrevmd.com
#229 The Bill to Stop Corporate Takeovers of Medical Practices: What It Covers and What It Leaves Out
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Last week a bill was introduced in Congress to stop corporate takeovers of physician practices. Some people are calling it reform. Dr. Heather Signorelli read the actual text, and in this episode she walks through what the bill says, what it leaves out, and why she thinks it misses the root cause of what’s squeezing independent practices.
This is not a political episode. It’s a briefing for practice owners, physicians and healthcare executives who want to understand what’s moving before they’re asked for an opinion on it.
...
#228 Your Best Staff Aren’t Leaving for Money
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Over the last two weeks I have been interviewing candidates, and I asked every one of them the same question: why are you leaving? The top answer was not money, PTO or benefits. It was career growth. In this episode I share what that means for your practice and how we run our own hiring process.
Build a career ladder for every role. Growth does not have to mean management. Front Desk Coordinator I, II and Lead Front Desk give people a next step. The same works for MAs...
#227 Your Payer Rates Are Low Because You Negotiate Alone
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Most independent practices sign the payer contract they are handed. One or two doctors alone are not on a health plan's radar, so the rate stays low and the practice works harder to make up the difference.
This week Dr. Heather Signorelli sits down with Ben Phillips, CEO of Nivano Physicians, an independent physician association in Northern California, and host of Healthcare Uncut. Together they break down how small practices build the leverage the big systems already have.
ACOs vs IPAs. ACOs are built to lower the total cost...
#226 Is Your Billing Team Just Filing Claims? 8 Signs You Need a Revenue Partner
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📊 Free Billing Performance Scorecard: see where your billing team stands on six numbers, with the dollar value of every red and a one-page 90-day plan →
https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan
🔍 Two or more reds? Get a Free Metrics Audit Review →
https://eligibility.natrevmd.com/metrics-audit-natrevmd
Your billing team submits claims and posts payments. But is anyone actually watching your margin?
Most practices have a claims-filing team, not a revenue partner. The work that protects your bottom line usually falls through the cracks: auditing follow-up...
Doctor Out or New Hire Not Credentialed Yet? Bill It Right or Pay It Back
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Your physician goes out on leave, you bring in a covering doctor, and the claims go out under the absent physician's NPI. Everything seems fine. Then, months later, an audit notice arrives: the claims went out under the wrong NPI, without the right modifier, or past the time limit. Those claims can be pulled back.
In this solo episode, Dr. Heather Signorelli walks practice owners, managers and billing teams through locum tenens billing: what the Q6 modifier tells the payer, how the 60-day rule works, and why a new hire waiting...
Your Practice Loses Money Before the Patient Walks In, with Alex Fernandez, MBA
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Most revenue leaks before the patient ever walks in. And billing usually gets the blame for problems the front desk could have prevented.
Dr. Heather Signorelli sits down with Alejandro (Alex) Fernandez, CEO of Synergy Orthopedic Specialists, a 25-physician, 60-provider orthopedic group with 15 sites across Southern California, including an ASC, imaging, physical therapy and DME. Alex started his career at a front desk in Miami more than 35 years ago, and he runs the business with that perspective: everyone in the practice is part of delivering care, and every role affects revenue.<...
Unhappy With Your Billing but Afraid to Switch? Start Here.
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Unhappy with your billing but afraid to switch? You are not the only practice in that middle. The numbers feel off, but a past transition (yours or a colleague's) meant months of slow cash, an overwhelmed front desk and frustrated providers. So you stay, and the cost shows up as a slow drift instead of one bad quarter.
In this solo episode, Dr. Heather Signorelli shows practice owners and managers how to tell whether billing is really the problem, how to improve it with the team you already have, and how...
#222 - The $150,000 a Year Nobody Bills You For: Score Your Practice in 20 Minutes
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Most practices run on the bank balance and a sense of how busy things feel. In this working episode, Dr. Heather Signorelli takes your practice's vitals: seven numbers, four scored, about 20 minutes. Grab a pen.
FREE RESOURCES
Free Metrics Audit Review: send the seven monthly averages from this episode and get a physician-led read on what the pattern is saying and where to look first. https://eligibility.natrevmd.com/metrics-audit-natrevmd
Practice Financial Health Dashboard: free Excel workbook that calculates and...
#221 Stop Managing Your Practice by Bank Account
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Free resource: Practice Financial Health Dashboard for Physicians.
What you get: a free Excel workbook built for physician owners to track the practice's revenue, expenses, and billing health month over month, in one place. → https://eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd
Free Metrics Audit: a free 20-minute live read of six numbers from your last full month (charges, claims, adjustments, denials, A/R, net collections) to find where revenue is leaking. No patient data, no system access. Built for practices collecting $150K or more a month. → https...
#220 Your Q1 2027 Is Being Decided Right Now
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Resources
Free Metrics Audit: a free 20-minute live read of six numbers from your last full month (charges, claims, adjustments, denials, A/R, net collections) to find where revenue is leaking. No patient data, no system access. Built for practices collecting $150K or more a month. → https://eligibility.natrevmd.com/metrics-audit-natrevmd
Practice Financial Health Dashboard for Physicians: a free Excel workbook built around the same six numbers, so you can track them month over month on your own. → https://eligibility.natrev...
#219 You Don't Have to Fire Your RCM Company to Get a Second Opinion
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Most practices don't have a billing problem. They have a not-knowing problem. Dr. Heather Signorelli walks through the three numbers that actually tell you whether your revenue cycle is healthy, and introduces the free Second Opinion Program built to give any practice an independent read.
Denial Rate Isn't the Full Story: A five percent denial rate sounds fine until you ask why those denials are happening, and whether they cluster around one payer, one code family, or one provider.
A/R Over 90 Days, Reported vs Real: ...
#218 Your Billing Department Is Your Aorta
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Dr. Una, founder of EntreMD and mentor to hundreds of physician entrepreneurs, joins Dr. Heather Signorelli to talk about what actually drives practice growth without burnout, and shares an unscripted story about why her own practice now trusts NatRevMD with its billing.
Growth Problems Are Rarely About Billing: Dr. Una explains why the real lever for growth is almost always the evolution of the physician into the CEO of their own practice, not the team, the market, or the numbers themselves.
Replace Yourself Three Times: Ev...
#217 The Fifty-Dollar Premium Gap That Could Cost You Six Figures
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Two health plans sat fifty dollars apart in monthly premium. One covered forty percent of an inpatient stay, the other seventy five percent. Dr. Heather Signorelli walks through the exact process she used to shop for her own team's health insurance this year, and the mistakes worth skipping if you are doing this too.
Where we started looking: QuickBooks and brokers got us close to eighty plan options, but neither felt flexible or fast to compare on our own. Finding a third way: a platform called Thatch, built around an ICHRA (individual co...#216 We Tested AI on our Own Billing. It Backfired Once
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We've spent a lot of time meeting with AI companies and testing technology in our own billing process. The lesson wasn't that AI can't help, it's that a tool solving one task can still make the whole revenue cycle harder without a designed handoff.
Lesson 1, fragmentation: Most AI vendors do one part of the job. The handoff to the next owner is what makes or breaks the value. Lesson 2, implementation tax: A demo shows minutes of clean workflow. A live practice needs configuration, training, and an exception process. L...#215 The AI Billing Trap No One Warns You About
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A lot of practices are quietly paying for an AI tool and the staff it was supposed to replace. Same problem, double the cost. In this episode, Dr. Heather Signorelli talks with Simon (Dorien Simon) of Narrows Advisors about where AI actually works in medical billing right now, where it does not, and how to avoid the mistakes that waste the most budget.
The Last Mile Gap: EHRs and most AI vendors handle a large share of a workflow automatically, but the final action (officially submitting an appeal, adding t...
#214 $44,400 a Year, Just From One Code
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Most payer negotiations start with a feeling. This one starts with a number: percentage of local Medicare, the single most useful tool for comparing payer rates.
The one number: Percentage of local Medicare turns a raw dollar amount into something comparable across payers, localities, and codes. Step 1: Pull 12 months of paid-claim data by payer and CPT/HCPCS code, using allowed amounts and units, not charges. Step 2: Rank opportunities by payer, CPT, annual units, and revenue gap, not by frustration. Step 3: Build a focused, five to t...#213 The 2027 Reimbursement Change That Isn't a Fee Cut
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2027 is not one reimbursement change. It's multiple changes moving at different speeds, some proposed, some confirmed, and the most expensive mistake is treating all of them like the same fee-schedule cut.
Change 1, Medicare rates: CMS has proposed two 2027 conversion factors. The headline percentage is never your practice's percentage. Model your own top codes. Change 2, global procedures: Same-day E/M billed with a global procedure is getting more scrutiny. Documentation, not billing habit, decides whether it survives an audit. Change 3, specialty codes: New 2027 OB/GYN coding replaces the...#212 High Income Is Not the Same as Wealth: What Physician Owners Must Decide Before Their Next Dollar Arrives
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Resources
MoneyFitMD: moneyfitmd.com natrevmd.comDr. Latifat never learned anything about money in medical school, and by her own account avoided it entirely until fear of ending up like her burned-out attendings forced her to face it. She paid off $200,000 in student loans in about two and a half years without extra shifts, then built MoneyFitMD to help other women physicians do the same.
Why physicians pay themselves last
Most physician owners don't set out to skip their own paycheck. Dr. Latifat point...
#211 $1.3 Million and 18 Days: What a Cyberattack Actually Costs an Independent Practice
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Resources
Cybersecurity Incident Response Checklist: https://eligibility.natrevmd.com/natrevmd-cybersecurity-checklist natrevmd.com Trusted Resources: https://natrevmd.com/trusted-resources/A healthcare record sells for 10 to 40 times more than a credit card number on criminal markets, and it cannot be cancelled the way a card can. Independent practices hold that data with the least defense in the entire healthcare system: one IT contractor, a server in a closet, and no one whose job it is to think about security. Attackers know it.
Why independent practices are the target <...
#210 1 in 5 Modifier 25 Claims Might Not Survive an Audit
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Resources
RECOVER Diagnostic: https://eligibility.natrevmd.com/recover-quiz-lp natrevmd.com Payment Posting Audit Checklist: https://eligibility.natrevmd.com/payment-posting-checklistShow notes
A provider sees a patient for a scheduled procedure. A separate problem comes up mid-visit, gets evaluated, and the practice bills both services with Modifier 25 attached. The claim pays, and everyone moves on, until that same claim gets swept into a targeted payer audit because the documentation never actually supported a separate, significant E/M service.
The three failure patterns
#209 She Left the Colonoscopy Treadmill. Here Is How She Gets Paid Now
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Dr. Emily Ward knew in March 2020 that she was done. She left her gastroenterology partnership in 2023. The reason for the gap was not fear. The practice worked, the money was good, and staying was the rational choice every morning until it was not. She joins Heather to walk through what she built after that, and the part nobody puts in the announcement post: how you actually get paid once you step outside the systems that normally do the paying.
THE BACKGROUND
Board certified in internal medicine and ped...
#208 The Medicare Rule That Means You Cannot Bill for Half the Lab Tests You Order
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Part two of two. If you send a specimen to an outside lab and they bill you eighteen dollars for it, eighteen dollars is the most you can bill Medicare. Not your contracted rate. That is the anti-markup rule, and it is one of two things that quietly rewrite the math on in-office lab.
What to pull first. Start from your last 90 days of reference lab orders, grouped by test name and CPT code. That is demand, not a projection. Then map each test to its PAMA rate from t...
#207 Medicare Pays $18 for a Strep Test. Here Is What That Means for In-Office Lab
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In-office lab is one of the most common ancillary additions practices consider, and one of the easiest to get expensively wrong. Part one of two: the framework that decides everything before you spend a dollar.
What CLIA is. The Clinical Laboratory Improvement Amendments, passed in 1988 and administered by CMS, govern all lab testing on human specimens. Every test your practice runs on a patient sample requires a certificate. Which certificate you need depends on the complexity of the test, not on what you would like to do.
...
#206 $12,000 a Month in Revenue You Do Not Actually Have
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Before you build a business case for anything, a new hire, a second location, a new service line, three numbers have to be right. Payer mix. Net collection rate. AR days. Most owners have all three. Almost nobody has calculated them correctly in the last two years. This episode is how to fix that, in about twenty minutes, using your own system.
[Payer mix]
The payer mix on your billing dashboard is almost always built on charges, meaning what you billed. What you need is payer mix by...
#205 Your Practice Can Be Profitable and Still Run Out of Money
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A practice hired a provider in January. The hire was right and she was generating revenue from day one. By March the practice was sixty thousand dollars short and could not make payroll, because nobody had modeled what cash looks like in month two when you are carrying a full salary and the claims are still in the pipeline. This episode builds the model that would have caught it, and it is not the binder kind.
In this episode:
The seven moments when a practice actually needs a fin...#204 The Most Expensive Thing in Your Practice Is an Open Note
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A full schedule is not the same thing as a healthy practice. Our guest this week walked into an independent family practice in Colorado to do finance work, was offered the practice manager role a few weeks later, and quickly found the gap: patients were coming in, the schedule was booked three to five months out, and the money still was not moving. What follows is the sequence she used to close that gap, and it starts nowhere near the billing office.
In this episode:
How to fi...
#203 She Never Missed a Monday. Her Collections Dropped Anyway
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She never missed a Monday. Twelve months of weekly billing meetings, every number reviewed, every question answered. And by the end of that year her net collection rate had dropped four points, her ninety-plus AR was up forty percent, and her denial rate had climbed from six percent to eleven. The numbers were there every week. The report was accurate. Nothing changed, because the meeting was structured around reporting instead of around deciding.
System 1: the financial snapshot. Three numbers, charges, payments posted, and unlocked encounters, each compared to last w...
#202 $144,000 a Year and Nobody Ever Escalates It
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The most expensive billing relationship is not the one that is clearly failing. It is the one that is quietly not delivering. On a practice doing $400,000 a month, three points of net collection rate is $12,000 a month. Nobody escalates $12,000. It does not trigger a phone call. It just leaves, month after month, until somebody adds up a year of it and finds $144,000 that nobody ever fought for. This is Part 2 of a two-part series and it builds the operating model that catches it.
System 1: the day-to-day operating model. Every g...
#201 You Are Half of Your Billing Company's Performance
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A practice doing seven figures a month switches billing companies, and eighteen months later the denial rate is higher than the day they signed. Nobody lied. Both sides just walked in with a different picture of what good looked like. In this episode we run Alex Hormozi's value equation across a billing partnership, one variable at a time, and name exactly what each side owes the other.
Dream Outcome. A practice owner hears "we will improve your collections" and pictures denials dropping from 12 percent to 5, AR days under 35, and h...
#200 Your Performance Reviews Are Making Your Billing Team Worse
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👉 Free 30-Day Revenue Recovery Plan: https://eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan
The plan we would build with you if you walked into our office today. Take it home and run it yourself.
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Your performance reviews are probably making your billing team worse. Not because you're giving bad feedback. Because the format itself is designed to produce defensiveness, not change. 95 percent of managers are dissatisfied with their review process, and 90 percent of HR leaders say it doesn't produce accurate performance information. And in an independent practice, it's usually worse than tha...
#199 You Are Destroying Half the Value of Every Hire in 90 Days
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👉 Free RECOVER Diagnostic: eligibility.natrevmd.com/recover-diagnostic
The exact framework we use when we walk into a new practice. Takes five minutes. Results are immediate.
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Only 12 percent of employees strongly agree that their organization does a great job of onboarding. Which means 88 percent of practices — including most independent ones — are spending real money to find the right person, and then handing them a login and a stack of pending items and calling that integration. SHRM data puts new-hire turnover as high as 50 percent inside 18 months. Replacing a billing manager at $55K a year costs betwe...
#198 $300,000 in Old AR Is at Risk During Your Next Billing Transition
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There is a revenue cliff hiding inside the billing transition most independent practices are planning right now. Not from the change itself. From the order of it. In this episode we walk through why the money in your bank account during month one of a new billing arrangement is almost entirely old AR, why simultaneous service and software change is the fastest way to lose that money, and the three questions you have to answer before any sequencing decision makes sense.
Three questions before you sequence anything: Are you r...
#197 The $40,000 Hire With the Perfect Resume
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👉 Free RECOVER Diagnostic: eligibility.natrevmd.com/recover-diagnostic
The exact framework we use when we walk into a new practice. Takes five minutes. Results are immediate.
Missed Part 1? EP196: https://podcasts.apple.com/us/podcast/196-%24112-000-buried-by-a-billing-manager-who-was/id1624182351?i=1000777197553
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A billing manager with seven years of experience and a certified coding credential took a job at an independent practice doing $300,000 a month. Six months later she was gone. The practice was $40,000 short. Not because she lacked skills. Because the moment she hit a problem she had not seen before...
#196 $112,000 Buried by a Billing Manager Who Was Afraid to Speak Up
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👉 Free RECOVER Diagnostic: eligibility.natrevmd.com/recover-diagnostic
The exact diagnostic we use when we walk into a new practice. Takes five minutes. Results are immediate.
A billing manager at a family medicine group found an $8,000-per-month denial pattern in her first month. She never said anything. It ran for fourteen months before a billing audit caught it. $112,000 in leaked revenue, not from a system failure, but from a management culture that made staying quiet the safer choice.
This episode is not about...
#195 The GLP-1 Bridge Just Broke Your Prior Auth Workflow
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FREE — 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 AM...
#194 Who Does What, Who Answers, and Who Just Needs to Know
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A 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 deni...
#193 The 90-Day Plan for 2027 OB Billing
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Q1 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...
#192 The Postpartum Same-Day Trap
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Deliver 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 t...
#191 Labor Management Is No Longer Invisible
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Under 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:
...#190 Every Prenatal Visit Is Now a Billable Event
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Starting 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. Ev...
