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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 recovered revenue actually comes from. 

The front-end gap 

Scheduling, eligibility, verification, and prior authorization are the number-one denial categories. A front-desk team in the middle of ringing phones and walk-ins cannot also run the strategic prep that prevents those denials. A dedicated VA can, and that is usually the first seat to delegate. 

The no-show math 

A practice can run 20% open availability from no-shows. Without someone working a waitlist to fill those slots, that is overhead the practice simply eats. A VA reaching out the day before, and pulling from a call list when a slot opens, both lifts the patient experience and recovers revenue. 

The back-end gap 

Statements go out, but nobody works them. A trained VA handles patient-balance collections and the AR backlog, using HIPAA-certified propensity-to-pay tools to make a genuinely hard conversation go as well as it can for the patient. 

Who not how 

Heather and Tim land on the same idea the most successful owners share: protect your zone of genius and delegate the rest. The framing comes from Who Not How by Dan Sullivan and Dr. Benjamin Hardy. Clerical work is the low-hanging fruit, and the first thing to hand off. 

How the right VA is hired 

Reva accepts roughly 5% of applicants. The practice interviews finalists one-on-one with Reva’s camera off, so the owner chooses who joins the team. SOPs are set up first, a client services manager reports daily or weekly, and the practice does not pay until the VA is trained and working. 

THREE ACTIONS THIS WEEK 

• Download the 30-Day Revenue Recovery Plan and start working it from day one this week. 
• Pull your no-show rate for last month and multiply it by your average visit value. That is your waitlist opportunity. 
• List the three clerical tasks eating your day that do not require a clinician. That is your first delegation. 

EPISODE BREAKDOWN 

• Tim’s path from pro hockey to healthcare sales 
• Why revenue leaks at the front desk 
• Letting go of control as a practice owner 
• The hiring and training process (the 5% filter) 
• Who Not How and your zone of genius 
• Back-end collections and the tough patient conversation 
• What it costs and what comes back 

RESOURCES

• 30-Day Revenue Recovery Plan — eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan 
• Book a Call with Heather — calendly.com/heather-natrevmd 
• Payment Posting Audit Checklist — eligibility.natrevmd.com/payment-posting-checklist 
• Practice Revenue Leak Scorecard — eligibility.natrevmd.com/nrm-revenue-scorecard-v3 
• RECOVER Diagnostic Quiz — natrevmd.com/quiz 
• Reva Global Medical — revaglobalmedical.com  |  Tim Boyle — [email protected] 
• Book referenced: Who Not How by Dan Sullivan and Dr. Benjamin Hardy 

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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 together or lets it fall apart. 

System 3 — The EHR and Billing Disconnect: 

Different front desks develop different habits. One site verifies eligibility morning-of. The other verifies the day before. One collects copay at check-in. The other sends a statement after. A practice doing $120,000/month at Location B with a 20% authorization miss rate sends $24,000/month into billing with incomplete data. Some claims get caught in scrubbing. Some get denied. Some sit in a gray zone no one can explain at month-end review. 

Front-End Gap Reference: 

• Authorization not captured → Denial or recoupment post-payment 
• Insurance not updated at visit → Claim sent to wrong payer 
• Copay not collected at check-in → Patient AR that rarely converts 
• Eligibility verified day-of only → Coverage lapses missed pre-visit 

System 4 — The Office Manager Problem at Scale: 

Location A has a strong office manager who has been there since the beginning. Location B has whoever was available when the site opened. The metrics look similar on paper. The difference shows up in the denial rate, days in AR, authorization miss rate, and the number of times the billing manager has to fix something that should have been caught at the front desk. A $90,000/month site with an underperforming office manager loses an estimated $8,000 to $15,000/month in avoidable billing delays. That is $180,000/year from one seat filled with the wrong person. 

Three actions this week: 

• Audit front-end protocol consistency — pull authorization miss rate and eligibility verification rate by site 
• Run a site-level office manager assessment — KPIs only, not by feel 
• Schedule weekly site-level KPI reviews — separate meetings, not consolidated 

Episode breakdown: 

00:00 Series callback: the gap the report will not show you 

02:00 The thread left open in Part 1 

04:30 System 3: The EHR and Billing Disconnect Across Sites 

08:00 The $24,000/month authorization miss scenario 

11:30 Who owns the front-end protocol fix 

14:00 System 4: The Office Manager Problem at Scale 

18:30 The $180,000/year gap from one wrong seat 

22:00 Who owns the accountability structure 

24:30 Three actions this week 

28:00 Free resource + next episode tease 

Resources Mentioned 

Payment Posting Audit Checklist (free): 

eligibility.natrevmd.com/payment-posting-checklist 

Practice Revenue Leak Scorecard (free): 

eligibility.natrevmd.com/nrm-revenue-scorecard-v3 

Book a free 30-minute audit call: 

calendly.com/heather-natrevmd 

RECOVER Diagnostic Quiz: 

natrevmd.com/quiz 

EP182 — Part 1 of this series: 

Link here

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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 as missing revenue no one can explain.

System 1 — The Credentialing Gap:
A provider sees patients at a new site before credentialing is finalized. The claims go out. The payer rejects them, or pays provisionally and recoups months later. One provider, 60 uncredentialed days, 15 patients per day at $180 per visit: $162,000 in claims at risk. The front desk who scheduled those patients had no idea.

System 2 — The Shared Billing Problem:
One billing team covers both locations. Denials get triaged by volume, not by site. The smaller location falls behind. Its AR days climb past 40, then 50. Six months of recoverable claims cross the timely filing window. A secondary site at $90,000/month with a 12% denial rate instead of the target 5% loses $6,300/month in unworked denials. Over a year: $75,600. That is the gap the report will not show you on a consolidated view.

Three actions this week:

• Build your credentialing matrix (one row per provider, one column per location, effective dates visible) 
• Pull a site-specific AR report — not consolidated, by site 
• Set a site-level denial threshold and define what triggers an immediate review meeting 

Episode breakdown:

00:00 The revenue gap no consolidated report will show you
02:00 Why multi-location growth is a systems problem
04:30 System 1: The Credentialing Gap
09:00 The $162,000 scenario
12:00 Who owns the credentialing matrix
14:30 System 2: The Shared Billing Problem
18:00 The $75,600/year site-level loss
21:00 Who owns the site-specific AR report
23:30 Three actions this week
27:00 Free resource + Part 2 preview

Credentialing Scenario Reference:
1 provider | 60 days | 15 pts/day | $180/visit = $162,000 at risk
2 providers | 30 days | 12 pts/day | $200/visit = $144,000 at risk
1 provider | 90 days | 10 pts/day | $150/visit = $135,000 at risk

Resources Mentioned:

Payment Posting Audit Checklist (free):
eligibility.natrevmd.com/payment-posting-checklist

Practice Revenue Leak Scorecard (free):
eligibility.natrevmd.com/nrm-revenue-scorecard-v3

Book a free 30-minute audit call:
calendly.com/heather-natrevmd

RECOVER Diagnostic Quiz:
natrevmd.com/quiz 

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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 move when you show up. 

The Leverage Framework: 

• Form 1 — Capital Leverage: why it's the highest-risk, lowest-compounding form 
• Form 2 — Labor Leverage: why 10x headcount creates 10x management complexity 
• Form 3 — Code/AI Leverage: what $15K–$25K/month in avoidable billing losses actually looks like 
• Form 4 — Media Leverage: the one asset that compounds while you sleep 
• The Lion Sprint Framework: why sprinting beats grinding — and what your three sprints are this week 

Episode breakdown: 

00:00 Opening question: what happens if you step away? 

02:30 Leveraged vs. un-leveraged — the real 2026 divide 

05:00 Form 1: Capital Leverage 

08:00 Form 2: Labor Leverage 

11:00 Form 3: Code/AI Leverage 

14:30 Form 4: Media Leverage 

18:00 The Lion Sprint Framework 

20:30 Sprint 1: Policy Sprint (Media Leverage) 

22:30 Sprint 2: Chart Closure Sprint (Code + Labor Leverage) 

24:30 Sprint 3: Eligibility Training Sprint (Labor + Media Leverage) 

27:00 Free resource + payer rule change tease

Resources Mentioned 

Payment Posting Audit Checklist (free): 

eligibility.natrevmd.com/payment-posting-checklist 

Practice Revenue Leak Scorecard (free): 

eligibility.natrevmd.com/nrm-revenue-scorecard-v3 

Book a free 30-minute audit call: 

calendly.com/heather-natrevmd 

RECOVER Diagnostic Quiz: 

natrevmd.com/quiz 

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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 will learn: 

• Why ambiguity in roles costs you hard dollars in denied claims 
• How running your revenue cycle on memory puts your cash flow at risk every single day 
• Why unsigned charts are delaying tens of thousands in billing every month 
• Three things you can do this week to assess exactly where you stand 

This is Part 1 of 2. Part 2 delivers the exact accountability chart structure, daily checklist templates, and provider productivity metrics to fix what Part 1 diagnoses. 

📊 Free Payment Posting Audit Checklist (free, no sign-up): 

https://eligibility.natrevmd.com/payment-posting-checklist

📅 Book a free 30-min call: 

calendly.com/heather-natrevmd

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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 collections manager, and the operations director all at once. 

You will learn: 

• How to take clinical knowledge out of one doctor's head and turn it into practice-wide standards 
• How to get daily financial visibility without waiting 30 days for a CPA report 
• How software hard-stops protect revenue even when your best staff member quits 
• How to benchmark provider productivity without having awkward conversations 
• How to give managers real decision-making authority without losing control of your margins 

📊 Free Practice Revenue Leak Scorecard (takes 3 minutes, free): 

eligibility.natrevmd.com/nrm-revenue-scorecard-v3 

📅 Book a free 30-min call: 

calendly.com/heather-natrevmd 

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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 learn:
• How to catch unapplied patient payments before they generate angry calls
• The ERA spot check that exposes systemic contractual adjustment errors
• How to find payer underpayments before your billing team writes them off
• The write-off audit that protects your revenue from unauthorized adjustments

This is the final episode in our four-part payment posting series. If you’ve been following along, you now have more visibility into your revenue cycle than most practice owners ever get.

📊 Free Payment Posting Audit Checklist:
https://eligibility.natrevmd.com/payment-posting-checklist

📅 Book a free 30-min call:
calendly.com/heather-natrevmd

Resources mentioned:

EP175 - What is Payment Posting?
EP176 - Insurance Side Mistakes
EP177 - Patient Payment Errors

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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 patient trust: 

• Unapplied patient credits — money in your bank, AR still open, patient gets billed again 
• Payer denials shifted to patients by mistake — poster doesn’t read the ERA denial code, patient gets a statement for money they don’t owe 
• Co-insurance misposted as a flat copay — wrong payment code at check-in, ledger breaks when the claim processes 
• Unauthorized write-offs — billers clearing their queue by wiping balances with no authorization or audit trail 

Each mistake has a fix you can implement this week. 

📋 Free Payment Posting Audit Checklist — the same framework we use in real practice audits: →https://eligibility.natrevmd.com/payment-posting-checklist

Resources mentioned:

1. Payment Posting Audit Checklist — https://eligibility.natrevmd.com/payment-posting-checklist

2. Book a revenue review — https://calendly.com/heather-natrevmd/

3. All episodes — natrevmd.com/podcast 

4. Subscribe on YouTube — https://www.youtube.com/@NatRevMD

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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 adjustments — the gap between billed and allowed sits in AR as uncollectible phantom money 
• Accepting underpayments as paid in full — payer shorts you on a contracted rate, poster writes off the difference without flagging it 
• Leaving zero-balance claims open — fully paid claims clogging your AR and inflating your workload 
• Duplicate posting — same ERA payment posted twice, creating phantom credits and balance chaos 

Each mistake has a fix you can implement this week. 

📋 Free Payment Posting Audit Checklist — the same framework we use in real practice audits: https://eligibility.natrevmd.com/payment-posting-checklist

Resource 1: Payment Posting Audit Checklist — https://eligibility.natrevmd.com/payment-posting-checklist

Resource 2: Book a revenue review — https://calendly.com/heather-natrevmd/

Resource 3: All episodes — natrevmd.com/podcast 

Resource 4: Subscribe on YouTube — youtube.com/@NatRevMD

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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 through what payment posting actually is, why getting it wrong silently inflates your AR, and the seven specific things that change in your practice when posting is done right. 

Inside the episode: 

• Why your AR report is a mirror of your team’s posting accuracy, not what you’re actually owed 
• How a $400K/month practice dropped their AR by 30% in two weeks — without collecting a dollar more 
• The 7 reasons clean payment posting transforms your revenue cycle 
• The audit moment we found 200+ accounts a week being reworked that were already paid in full 
• What’s coming in Episode 176: the most common insurance-side posting mistake we see in almost every audit 

If you’re a practice owner, billing lead, or operations director who has ever made a financial decision off an AR report — this is the foundation. 

Resources mentioned (Buzzsprout episode resources block) 

📊 Free Payment Posting Audit Checklist 

The exact framework we use when we audit a practice. Test your own team: https://eligibility.natrevmd.com/payment-posting-checklist 

📅 Book a call with Heather 

If your AR has been inflated by years of bad posting, that’s exactly what we fix at NatRevMD: https://calendly.com/heather-natrevmd/ 

🎧 More episodes 

natrevmd.com/podcast 

Buzzsprout chapter markers (paste in chapters field) 

0:00 Hook — the number that’s lying to you 

0:45 Why 20–40% of your AR may already be dead 

1:45 What payment posting actually is 

3:30 The $400K case study 

5:30 7 reasons posting matters 

12:30 Recap and what’s next