NatRevMD

Send us Fan Mail 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 t...

Send us Fan Mail 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 mon...

Send us Fan Mail 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...

Send us Fan Mail 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,...

Send us Fan Mail 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 throu...

Send us Fan Mail Show 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...

Send us Fan Mail Show 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 actuall...

Send us Fan Mail 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...

Send us Fan Mail 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...

Send us Fan Mail 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, a...

Send us Fan Mail 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 recov...

Send us Fan Mail 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 here Today 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 t...

Send us Fan Mail 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...

Send us Fan Mail 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 mo...

Send us Fan Mail 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 w...

Send us Fan Mail 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...

Send us Fan Mail 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...

Send us Fan Mail 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 patien...

Send us Fan Mail 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...

Send us Fan Mail 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 thr...

Send us Fan Mail 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. R...

Send us Fan Mail Resources mentioned  Practice Revenue Leak Scorecard (free, ~60 seconds): https://eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Book 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 repo...

Send us Fan Mail 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...

Send us Fan Mail 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 tell...

Send us Fan Mail 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...