Michael Isaacs | OptionPath Partners LLC | October 21, 2026
When collections disappoint, physician owners often turn first to the billing team. That is understandable. Billing is where unpaid claims become visible, and the people working those claims are usually the ones asked to explain the shortfall. Yet the conditions that produced the problem may have developed well before a claim reached their desks.
A practice can deliver excellent care and still struggle to turn that work into reliable cash. Scheduling, eligibility, required authorizations, documentation and claim submission all influence the result. Each step may have a capable person responsible for it. The difficulty arises when those steps are managed separately and no one has responsibility for how the whole process performs.
For physician owners, revenue cycle deserves attention as part of running the practice. Its performance affects staffing commitments, owner distributions and the resources available for growth. Understanding that connection changes the conversation from asking why billing has not collected more to examining where the practice creates avoidable delay or rework.
Follow the work before assigning the problem
Consider a group whose collections have fallen behind while visits remain steady. The billing manager reports a growing queue of claims that require correction. Front office staff are checking coverage, clinicians are completing their notes, and the billing team is following up. Everyone can point to work being done. The owners still cannot see why the backlog keeps growing.
A review of several recurring issues may reveal that new appointment types were added without updating the information collected before the visit. Documentation questions remain unresolved because no one has established a reliable way to reach the right clinician. A change in payer requirements was understood by billing but never incorporated into the scheduling workflow. These are examples of how separate tasks can fail to connect.
Following a representative set of cases through the process helps locate the friction. Where does information become incomplete? How long does a question wait for a response? Who can change the process that creates the exception? The aim is to understand recurring causes well enough to prevent them, while continuing to resolve the unpaid work already in the queue.
Make responsibility extend across the handoffs
A billing manager may have authority to improve claim follow-up and still lack the ability to change registration practices or secure timely documentation. Holding that person accountable for the entire collection result without addressing those limits leaves the practice dependent on escalation and persuasion. The same issue remains unresolved, even when the individual works harder.
The administrator needs a way to bring the relevant people together, with a physician leader available for decisions that require clinical participation. That does not mean owners should personally resolve every rejected claim. It means they should clarify expectations, support a workable process for answering questions and authorize changes that cross departmental boundaries.
An outside billing company does not remove these responsibilities. The agreement may define services, reporting and performance expectations, but the practice still owns the information and decisions it must supply. Before replacing a vendor, owners should understand which problems the vendor can address and which require changes inside the group. Otherwise, a new company may inherit the same unresolved constraints.
Use the review to make decisions
A monthly revenue cycle review should connect the collection results to the work behind them. Owners need to understand whether cash received reflects current activity or the recovery of older balances, where unpaid amounts are accumulating, and which recurring issues are consuming staff time. A practice-wide average can obscure a problem concentrated in one payer, location or service.
Measures should be defined consistently so comparisons mean something. A change in how a report groups balances can look like improvement without changing what has been collected. The review should also distinguish a temporary timing issue from a recurring operating problem. Those situations call for different responses and different expectations for cash.
When a pattern warrants action, the meeting should end with a specific change, a responsible person and a date to assess the result. If a documentation question repeatedly stalls claims, for example, the response might establish a clear route and time commitment for resolving that question. The next review should examine whether the waiting time and affected backlog actually changed.
At OptionPath Partners LLC, we see these connections as part of executive leadership alongside the physician owners and administrator. The objective is a practice that understands how its work becomes cash and can act when that process breaks down. Reliable collections give owners a firmer basis for decisions about the organization they want to build.
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