EPISODE SUMMARY

Jeremy and Dr. Dylan Ross explore the "back door" of managed healthcare, tracing Dylan's journey from direct care delivery to the high-level strategic world of major payers. They dive deep into the current "recalibration" of behavioral health—where stigma is eroding and utilization is up, but the backend business models are struggling to keep pace. Dylan explains why payers are often "blind" to whether patients are actually getting better and how Measurement-Based Care (MBC) is the key to unlocking better reimbursement and clinical outcomes. They also discuss how AI scribing and a reimagined EHR are helping independent practices fight back against administrative burnout.

KEYWORDS

Measurement-Based Care (MBC), Revenue Cycle Management (RCM), AI Scribing, Value-Based Care, Clinician Burnout, Outcome Data, Behavioral Health Innovation

TAKEAWAYS

The Data Gap in RCM: Unlike physical health, where "vital signs" like blood pressure are standard, behavioral health has historically lacked a lab-equivalent data point. 

The Power of Measurement-Based Care: Aggregating patient-reported outcome data doesn't just help the clinical dyad; it allows practices to "tier" their value to payers and secure better contracts. 

Fighting the "Tyranny of the Urgent": Administrative tasks, documentation, and fighting clawbacks are eating the "widget" of healthcare: Time. 

AI as a Clinical Ally: Modern tools like Blueprint's AI scribe are saving clinicians 7–10 hours per week, allowing them to focus on high-quality care rather than staring at a screen. 

Reimagining the EHR: Most current systems were built for physical health and "duct-taped" together for therapists. The future is a bottoms-up EHR built specifically for the behavioral health workflow. 

CHAPTERS

00:00 Introduction: Dr. Dylan Ross and the Systems Behind Behavioral Health

12:03 Navigating the Healthcare Landscape: Insights from Experience

23:48 Reality Checks in the Insurance Industry

30:24 The Data Gap Holding Back Value-Based Behavioral Health

35:17 How Blueprint Is Changing Measurement in Private Practice

39:33 Above the Red Line: Where Measurement-Based Care Actually Happens

46:21 The Future of Blueprint and EHR Innovations

56:27 Conclusion: Using Technology to Reclaim Time, Purpose, and Autonomy

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

Jeremy introduces the fourth billing domain, Payment Posting, and explains why it must follow eligibility and benefits. He defines posting as the reconciliation of your expectations (contracts and CPT codes) versus reality (what the payer actually sends). The episode covers the four macro-moves of the territory: Receipt, Posting, Denial Capture, and KPIs. You'll learn the difference between paper EOBs and electronic ERAs, the dangers of "bucket posting," and why a zero-dollar payment is one of the most important transactions you’ll ever document.

KEYWORDS

EOB, CARC, ERA, Payment Posting, Private Practice, Insurance Billing, Medical Billing, Eligibility and Benefits, Insurance Denials, Claim Denials

TAKEAWAYS

Move Beyond "Monopoly Money": Don't just high-five when money hits the bank. Without meticulous posting, you might only be collecting 60-85% of what you're actually owed. 

Line-Item Posting is King: Avoid "bucket posting" (lump sums). Matching payments to specific dates of service and CPT codes ensures clean data and prevents missed appeal opportunities. 

Zero Dollars is Still a Transaction: When a payer sends a $0.00 remittance, it’s not an invitation to move on. It’s a signal to document the specific CARC (Claim Adjustment Reason Code) to prevent the "tangled ball of yarn" that is unresolved A/R. 

Watch Your KPIs: Aim for a Net Collection Rate of 95% or higher and a First Pass Denial Rate of less than 5%. If your days-to-post exceeds two weeks, your financial reports are essentially a lie.

CHAPTERS

00:00 Introduction: Setting the Stage for Payment Posting

05:17 Payment Posting Defined: The Scoreboard of Billing

07:38 The Four Moves That Make Payment Posting Work

11:32 The Payment Posting Workflow: Intake to Line Items

15:47 The Payment Posting Workflow: Denial Documentation

19:38 The Payment Posting Workflow: KPIs

22:10 Case Study: Recovering $78,000 in Lost Receivables

24:24 Conclusion: Mastering the Payment Posting Game

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this domain-specific deep dive, Jeremy explains why tracking metrics for eligibility and benefits (E&B) is the secret weapon of a proactive practice. Many providers view E&B as a "time suck," but without clear KPIs, you’re flying blind. Jeremy breaks down three essential metrics—Time to Completion, Accuracy Rate, and Call Time Logs—to help you identify which payers are dragging their feet and which staff members might need a little extra support. The goal is simple: ensure your patients never walk through the door without knowing exactly what they owe, preserving both your trust and your bottom line. 

KEYWORDS

​​Revenue Cycle Management, Private Practice, Medical Billing, Insurance Eligibility, Practice Management, KPIs, Patient Trust, Healthcare Finance

TAKEAWAYS

The Cost of Lost Trust: When a patient receives an unexpected bill, trust leaves your practice, and revenue usually follows right behind it. 

Move from Reactive to Proactive: Tracking metrics helps you catch "carve-outs" (where a payer subcontracts benefits) before they turn into denials downstream. 

Efficiency vs. Accuracy: It’s not just about how fast you do it; it’s about getting the right information the first time so your billing team isn't ripping their hair out later. 

Identify Payers of Concern: Use data to decide if a specific insurance company’s low reimbursement rate is worth the administrative headache of their "Byzantine" phone systems. 

The Power of Time Studies: Tracking call times for just two weeks can reveal which payers offer efficient portals and which ones are wasting your staff’s time. 

CHAPTERS

00:00 Introduction: Protecting Patient Trust Through Better Eligibility Metrics

03:42 Managing Time and Cost Through Eligibility Metrics

06:36 Key Performance Indicators for Eligibility and Benefits

13:50 The Trust Metric: Measuring Eligibility & Benefits Accuracy

17:24 The Final KPI: Eligibility & Benefits Call Time

19:36 The Eligibility & Benefit KPI Dashboard

20:53 Conclusion: Building a Stronger Revenue Cycle Through Metrics

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Eligibility & Benefit KPI Dashboard

EPISODE SUMMARY

Ever felt like you were crushing a game of Monopoly or Catan, only to have one bad card flip the entire board? In the world of private practice, Eligibility and Benefits (E&B) often feels exactly like that. You think your revenue is secure, and then—BAM—a missed rule or a shift in patient benefits leaves you disoriented and losing ground. 

In this episode of The Claim Game, Jeremy Zug dives deep into two "hidden" steps that often trip up even the best practices: updating accumulations and preventative patient communication. We’re moving beyond the one-time snapshot and looking at how to track the moving target of deductibles and out-of-pocket maximums. Whether you’re a solo provider or managing a large agency, mastering these domains is the only way to turn your billing system into a revenue engine rather than a drain on your mission. 

KEYWORDS

Revenue Cycle Management, Eligibility and Benefits, Private Practice, Patient Communication, Medical Billing, Deductibles, Cash Flow

TAKEAWAYS

E&B is a Snapshot, Not a Guarantee: An eligibility check is only accurate for the 15-minute window in which you looked; it is a quote, not a promise of payment. 

The Power of Accumulations: Patients rack up healthcare costs across multiple specialties throughout the year. If you aren't regularly updating their "accumulation" (how close they are to meeting their deductible), you risk overcharging them—which leads to messy refunds—or undercharging them, which makes collections nearly impossible once they leave the office. 

To Be Clear is to Be Kind: Preventative communication is the bedrock of patient trust. Surprising a patient with a $4,000 bill on the day of their appointment is a "trust-degrader" that can lead to abandoned care and a damaged reputation. 

Use the Right Tools: Don't reinvent the wheel. Using standardized E&B templates and benefit summary emails ensures your front office, clinicians, and patients are on the same page every single time. 

Process Over Magic Bullets: As shown in our Pennsylvania agency case study, injecting repeatable SOPs and clear communication into a fragmented system reduces aging AR and increases both patient and clinician satisfaction.

CHAPTERS

00:00 Introduction: Zooming In on Eligibility

02:12 Why Eligibility Isn’t a One-Time Check

04:59 Understanding and Managing Patient Accumulations

08:45 Communicating Financial Responsibility to Patients

12:42 The Consequences of Not Communicating Costs Upfront

14:02 Using Templates to Fix Accumulations and Communication Gaps

16:05 Case Study: How One Practice Recovered from Eligibility Breakdown

17:43 Conclusion: How to Protect Trust and Revenue with Better Eligibility

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Benefit Stages, Benefit Summary Email Template, Eligibility & Benefit Check Template

EPISODE SUMMARY

Prior authorization (PA) is the boss level of the Eligibility & Benefits domain, the giant locked door that stands between you and getting paid. This week, Jeremy is diving deep into the controversial world of prior authorizations, debunking the persistent myth of the "retro auth" and breaking down exactly how to conquer this gatekeeper of revenue.

We walk you through the three crucial hurdles: Identification, ensuring you know the requirements before the patient walks in; Request, mastering the art of over-communicating medical necessity to avoid the "delay loop" ; and the Outcome—including how to sidestep the exhausting peer-to-peer review trap.

We also zoom out to the massive national conversation happening right now—patient access vs. cost containment—and discuss the "gold carding" trend that could revolutionize how good providers play the game. Learn the two essential tools you need to turn PA chaos into efficiency and ensure your hard work translates into deposits, not denials.

It's time to build a bulletproof process and win The Claim Game as it's played today.

KEYWORDS

Prior Authorization, Revenue Cycle Management, RCM, Insurance Billing, Claim Denials, Medical Necessity, Retro Authorization, Gold Carding, Private Practice, Practice Management,  The Claim Game

TAKEAWAYS

Anticipatory Anxiety is Real: Prior authorization is often the most anxiety-inducing step in RCM, and for good reason—missing this step means you get paid $0 for the work.

Identify Early: Prior authorization is a permission slip that must be secured before the service is rendered. Use the intake call and your E&B check to identify if an auth is required for the specific CPT code or service.

Over-Communicate Medical Necessity: Avoid the time-sucking peer-to-peer review trap by making your initial submission bulletproof. Use the payer’s language: detail specific symptoms, measurable goals, and evidence-based treatment.

Retro-Auth is a Myth: Do not build your practice on the "hail Mary pass" of hoping for a retroactive authorization. The best strategy is pre-authorization. If the denial is due to your administrative error, you will usually have to eat the cost.

Track the Count, Don't Blow the Meter: Authorization numbers are not a one-stop gate; they are a meter. Use a countdown mechanism (like one in your EHR) to flag when you hit session eight out of ten. This prevents revenue loss and, most importantly, avoids disrupting your client's necessary care.

Essential Tools for Success: You need two pieces of equipment: a dedicated Prior Authorization Checklist(tracking dates, reference number, stipulations, and expiration) and an updated Insurance Contact Reference List with a tab specifically for authorization requirements.

CHAPTERS

00:00 Introduction: Entering the Prior Authorization Gate

04:03 The Three Hurdles of Prior Authorization

11:15 Access vs. Cost: The Prior Authorization Battle

16:01 The Myth of Retro Authorization

18:11 The Tools You Need to Master Prior Authorization

20:46 Case Study: The Importance of Tracking Authorizations

22:53 Conclusion: Winning the Prior Authorization Game

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Prior Authorization Checklist, Insurance Contact Reference List

EPISODE SUMMARY

Is your practice tired of wrestling with insurance denials? In this episode, Jeremy Zug flies solo to dive into the crucial third stage of the Revenue Cycle Management (RCM) Game Board: Eligibility and Benefits (E&B). Jeremy breaks down a two-step, methodical strategy designed to drastically cut down your denial rate and eliminate costly billing surprises. Learn why checking E&B is like reading a rule book before a major journey , and discover the key information to collect to ensure you get paid for the incredible value you add. It’s time to stop walking blind into more denials and start winning The Claim Game

KEYWORDS

​​Revenue Cycle Management (RCM), Eligibility and Benefits (E&B), Claim Denials, Prior Authorization, Payer Contacts, CPT Codes, Credentialing, Cash Flow, Practice Management, Practice Solutions, The Claim Game, Billing Surprises, Availity, Clean Claims, Documentation

TAKEAWAYS

​​We’re covering the two foundational steps to master the E&B territory: building your game manual and executing a consistent check.

1. Build Your Game Manual (The Centralized Cheat Sheet): Create a central, living database of essential payer-specific information.

Contact Information: Secure the direct, current phone numbers for provider relations—not the general patient line. Note the most efficient route for E&B details, whether a provider portal (like Availity) or a direct call.

Service List: Maintain a list of CPT codes for all services your practice provides to verify coverage for each patient’s specific plan.

Process Ownership: Assign a designated person to keep this "game manual" updated, ensuring the knowledge is tied to a repeatable process, not a single person's memory.

2. Make the E&B Check Mandatory (The Execution): This is the real-time verification that happens before the patient walks in. Every check must be identical and thorough, consolidated onto a standardized template.

Core Data: Collect and confirm the patient’s full name, date of birth, and subscriber ID—using objective sources like a copy of the insurance card (front and back) and driver’s license.

Required Checks: It's not just a yes/no active status. You need to confirm active coverage, provider match (NPI coverage) , CPT code coverage , telehealth coverage , and any prior authorization or referral requirements.

Document Everything: To have "fighting power" against incorrect denials, always secure a date, the payer rep name (if you called), and a reference number for every verification call. This paper trail is your best defense.

CHAPTERS

00:00 Introduction: Your Two-Step Strategy to Cut Denials

02:55 Creating Your Payer Playbook: Contacts, Codes & Clear Ownership

07:36 The Payoff: How E&B Checks Keep Your Claims Alive

09:01 The E&B Checklist: Verifying Coverage Before the First Session

12:02 The E&B Defense Strategy: What Happens When You Don’t Get It Right

15:37 Case Study: When Missing Steps Cost Thousands

18:09 Conclusion: The Foundations for a Strong, Repeatable E&B Process

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Eligibility & Benefit Check Template, Insurance Contact Reference List

EPISODE SUMMARY

Host Jeremy Zug welcomes Practice Solutions' Billing Director, Kelley Sonnenberg, to dive deep into a core RCM challenge: Insurance Eligibility and Benefits (E&B) verification. This episode cuts through the confusion, addressing the controversial question of who is ultimately responsible for E&B checks (patient or practice?) and the reliability (or lack thereof) of these checks (they're only about 70% accurate!).

Kelley, with her extensive experience leading a team of over 20 billers, provides actionable, expert advice on:

Handling the 30% Inaccuracy Rate: What to do when an E&B check fails.

Common Errors: The biggest mistake providers make (it's confusing different plan types!).

Carve Outs: The confusing reality of having a health plan (e.g., Blue Cross Blue Shield) that subcontracts mental health benefits to another company (e.g., Magellan).

The Power of Process: The critical need for Standard Operating Procedures (SOPs) and using E&B templates to stop building jobs around people.

Advanced Topics: How to handle the Authorization Game Over moment and the key to understanding Coordination of Benefits (COB), including the "Birthday Rule".

Simplified Patient Communication: Kelley’s brilliant, three-level "game" analogy for explaining complex terms like deductible, copay, and out-of-pocket maximum to your patients.

Ultimately, this episode empowers you to build the solid systems and foundation needed for scalability, making your practice function around process, not just people.

KEYWORDS

Insurance Billing, Revenue Cycle Management (RCM),  Eligibility and Benefits, EB Verification, Practice Management, Clean Claims, Prior Authorization, Claim Denials, Coordination of Benefits (COB), Carve Outs, Standard Operating Procedures (SOP)

TAKEAWAYS

E&B is a Practice Safeguard: While the patient is ultimately responsible for knowing their benefits, running an eligibility check is best practice and acts as a crucial safeguard for your practice to ensure clean claim reimbursement and prevent lost revenue from inactive plans.

Don't Trust the EHR Tool (Go to the Source): E&B tools built into EHRs are often confusing, can be inaccurate (not real-time), and pull pages of information that are hard to interpret. 

Always utilize the payer-specific portal (like Availity or Cigna's portal) for the most accurate and easy-to-read, specialty-specific information.

The Single Most Impactful Action: Implement a benefit template to standardize your process. This ensures that every check is thorough, covering the effective date, termination date, cost-sharing amounts, session limits, and the most critical item: Authorization requirements.

The Game Over Move: Authorization: If a patient requires prior authorization (especially for testing) and you don't get it, it will likely lead to a claim denial that cannot typically be overturned or retroactively authorized, meaning you lose the payment. A PCP referral is not the same as an authorization.

Collect the Back of the Card: Always obtain the front and back of the patient’s insurance card. The back of the card has the direct provider phone number for mental health/benefits, which is the quickest way to verify information and uncover carve outs.

COB and the Birthday Rule: Coordination of Benefits (COB) denials are common, especially in Q1. The general rule for dependent children is the Birthday Rule: the parent whose birth month comes first in the year has the primary insurance.

CHAPTERS

00:00 Introduction: Kelley’s Journey to Practice Solutions

04:19 Who Should Check Benefits—Practice or Patient?

06:59 Eligibility Checks Aren’t a Guarantee

08:54 The Most Common Eligibility Mistake

12:47 EHR vs. Payer Portals: Where to Trust Your Data

15:17 How to Talk Insurance With Patients

18:10 Eligibility Overhaul: Templates, SOPs & Intake

20:52 Open Enrollment Chaos: Preparing for January

22:19 Coordination of Benefits 101

25:09 Multi-Site Credentialing & Eligibility

26:13 How Payer Volume Impacts Eligibility Work

28:28 The One Detail You Can’t Miss: Authorization

30:30 Eligibility Mastery: Templates, Portals, Patterns

31:58 Conclusion: Foundations for Sustainable Expansion

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this essential episode (with Jeremy flying solo as Kathryn welcomes their third child!), we tackle the critical third territory on the RCM Game Board: Eligibility and Benefits Verification. Think of E&B as your practice's scouting phase. We break down exactly what E&B means, why it’s a non-negotiable step before any claim is mentioned , and how mastering this repeatable five-step workflow is the key to preventing those costly, frustrating surprises for both you and your patients. We’ll dive deep into:

The two crucial parts of E&B: checking eligibility (is the policy active with me?) and benefits (what does the patient owe?).

The nightmare of Prior Authorization (PA) and why correctly checking for this requirement is the punchline to avoiding guaranteed denials.

The non-negotiable conversation with your patient about their financial responsibility—the game-changer that builds trust and prevents billing surprises.

A real-world case study of a group practice that lost over $20,000 in two months because they missed this crucial step (and how they recovered).

This is all part of a sound practice management strategy, ultimately letting you claim victory for your bottom line. It's time to stop the claim denials and turn them into deposits.

KEYWORDS

Revenue Cycle Management, RCM, Insurance Billing, Private Practice, Practice Management, Eligibility and Benefits, Prior Authorization,  Claim Denials, Patient Care, Cash Flow

TAKEAWAYS

E&B is the Cornerstone: Eligibility and Benefits verification is the third step and a cornerstone of the entire front-end RCM process. It must happen before there is even mention of a claim.

The Two Checks: Eligibility is scouting to confirm the policy is active and you are In-Network. 

Benefits is determining the cost-sharing responsibilities (deductible, copay, coinsurance, out-of-pocket maximum).

PA is the Payment Key: A required Prior Authorization that is not handled correctly guarantees a denied claim. Getting that pre-approval is like getting a special key that unlocks payment.

Non-Negotiable Communication: You must clearly explain the patient's financial responsibility before the appointment. This transparency shifts the dynamic from "Why am I getting this bill?" to "Thank you for letting me know what to expect".

Repeat the Process: Benefits change all the time! This is not a one-and-done process. Continuously update benefits and benefit verification for accuracy and patient satisfaction.

CHAPTERS

00:00 Introduction to Revenue Cycle Management

01:59 Understanding Eligibility and Benefits Verification

05:15 The Workflow of Eligibility and Benefits

09:58 Prior Authorization: A Critical Step

11:24 Communicating with Patients Effectively

13:45 Tools for Managing Eligibility and Benefits

16:02 Case Study: The Importance of Verification

18:28 Conclusion: Turning Process into Practice

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Eligibility & Benefits, Insurance Contact Reference List, E&B Template, Benefit Summary Email Template, KPI Dashboard

EPISODE SUMMARY

You’ve mastered the day-to-day tasks of patient registration, but how do you know if your processes are actually winning? In this episode, Jeremy and Kathryn Zug zoom in on the Key Performance Indicators (KPIs) space within the Patient Registration territory of The RCM Game Board. They break down how practice owners can stop being reactive and start being proactive by moving beyond the day-to-day desk tasks and tracking essential data.

This deep dive into measuring your practice's success reveals the vital metrics that transform patient frustrations into a smooth, positive first impression and ensure your practice's financial health is aligned with your goals. Learn why the patient intake process, if not optimized, can create costly bottlenecks, delay cash flow, and put your practice at risk. It's time to put your data to work and turn those claim denials into deposits.

In this episode, we cover the critical KPIs for Patient Registration:

Provider Utilization: This goal-setting metric measures the percentage of a provider's desired available time filled with appointments and tells you how effectively your scheduling and flow processes are working. A low rate is a huge red flag for untapped revenue.

Missed or Canceled Appointments: Learn how to measure this rate and what a high number indicates about poor patient communication, unclear expectations, or an inconvenient scheduling process.

Form Handling Audit Pass Rate: This crucial HIPAA compliance metric directly impacts your revenue cycle! Learn why intake errors are a leading cause of rejections and denials and how to track the accuracy of your patient data and forms.

Patient Satisfaction Survey Analysis: Turn subjective patient feedback into actionable data to identify friction points that cause patients to drop out of care and ensure your first impression is a powerful one.

KEYWORDS

Revenue Cycle Management, RCM, Patient Registration, KPIs, Provider Utilization, Practice Management, Medical Billing, Insurance Billing, Healthcare Business, Form Handling Audit, HIPAA Compliance, Practice Growth

TAKEAWAYS

Move Beyond the Day-to-Day: Get a clear picture of your practice's health by conducting a monthly data pull on key metrics to identify bottlenecks, improve patient retention, and increase revenue.

Utilization is Goal-Driven: Provider Utilization is a goal-setting activity that measures your scheduling's effectiveness against the provider's desired hours, not just their physical availability. Low utilization can be a sign of a bad patient intake process, a provider with overly specific preferences, or ineffective scheduling.

Cancellations Are a Red Flag: A high rate of missed or canceled appointments is a big red flag that you must look at weekly. To correct this, run a test of your patient registration process (a "ghost shopper" test) and implement a solid wait list.

HIPAA & Claim Accuracy Are Linked: The Form Handling Audit Pass Rate is vital because intake errors and incomplete forms are a leading cause of rejections and denials—which delays cash flow and puts your practice at risk of HIPAA violations.

Ask Actionable Questions: When designing patient satisfaction surveys, the more granular the questions, the better. Ask questions directly linked to changes you are willing to make to find patterns and focus your improvements.

KPIs Create a Predictive System: A comprehensive KPI dashboard aggregates your metrics for a bird's eye view, helping you move from a chaotic, reactive process into a predictable, proactive system that ensures your practice is running the thing, not the other way around.

CHAPTERS

00:00 Introduction: Mastering the Patient Registration Metrics

02:09 From Tasks to Insights: Evaluating Patient Registration

04:28 Provider Utilization and Practice Health

06:42 Pulling and Analyzing Utilization Metrics

08:43 When Utilization Drops: Finding the Root Cause

14:09 Tracking Missed and Canceled Appointments

20:08 Form Handling Audit: Protecting Compliance and Cash Flow

25:05 Turning Feedback into Action: Patient Satisfaction Surveys

30:03 Dashboard Overview: Turning Metrics into Insight

32:09 Case Study: Using KPIs to Improve Patient Registration

33:59 Conclusion: Moving Forward with Data-Driven Decisions

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Patient Registration KPI Dashboard

EPISODE SUMMARY

This week on The Claim Game, Jeremy and Kathryn Zug make the final move in the Patient Registration territory of the RCM Game Board: 

Checkout. It’s easy to think the work is done when a session is over, but this final step is absolutely critical for a practice’s revenue cycle and reputation.

We break down the key elements of a solid checkout process—from physically guiding the patient to the checkout person and ensuring payment authorization works, to the essential practice of scheduling the next appointment on the spot. We discuss the tactical process for handling outstanding patient balances, including setting up payment plans for past due debt before the patient leaves the desk. Most importantly, we cover how to talk about money without damaging your relationship with the client, proving that clear, well-trained communication is the ultimate tool for diffusing emotion.

Plus, hear a fascinating case study about a practice that revolutionized its efficiency by measuring a single, unexpected KPI at checkout.

KEYWORDS

Private Practice, Revenue Cycle Management, Medical Billing, Insurance Billing, Mental Health Billing, Patient Checkout, Cash Flow, Patient Collections, Practice Growth, RCM Best Practices

TAKEAWAYS

Checkout Closes the Loop: A patient’s registration isn't complete until the first checkout has successfully happened, and this process is a major reputation-building activity.

The Three Key Actions at Checkout: A solid checkout process focuses on three tactical elements: 1) Collecting payment (and verifying the payment authorization works); 2) Scheduling the next appointment ; and 3) Offering to answer any questions.

Resolve Past Due Balances Now: Do not allow patients to leave the desk if they have past due balances without setting up a clear payment plan. Practice Solutions’ policy is to collect the current balance in full and set up a plan for the historical debt; you don't want to add to the debt.

Communication is the Key to Customer Service: Make sure your checkout person is extremely well-trained and good with people. Information is so good at diffusing emotion. They need to be able to clearly read an ERA or claims notes to explain why a balance exists in layman's terms—turning a potential confrontation into a transparent discussion.

Pitfalls to Avoid: The biggest pitfalls are failing to collect payment at the time of service, which leads to patient aging, and surprising patients with unexpected bills months or years later. Your patient aging shouldn't exist.

Essential Tools: Two key tools are the Payment Authorization Form (a legally binding document giving permission to charge a card) and the Checkout Checklist (a procedural guide for staff). These ensure consistent and correct application of your financial policies and empower your staff to have clear conversations about money.

CHAPTERS

00:00 Introduction: Completing the Registration Journey

03:48 Turning Checkouts into Cash Flow

08:14 Money Conversations that Build Trust

13:05 Avoiding Checkout Pitfalls

16:30 Power Tools for the Front Desk

20:26 Case Study: When Checkout Data Changes Everything

24:46 Conclusion: Checkouts that Build Reputation

26:21 Resources and Educational Opportunities

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Checkout Checklist, Payment Authorization Form