Most practices manage their revenue cycle reactively — putting out fires instead of preventing them. In this episode, Kem Tolliver, FACMPE, CPC, CMOM, CEO of Medical Revenue Cycle Specialists, joins Physicians Practice Managing Editor Keith A. Reynolds to explain what a truly strategic revenue cycle work plan looks like and how to build one that aligns with your overall business goals.

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Music Credits:
Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:24 | Sponsor message Copic medical liability insurance.

0:24 – 0:42 | Cold open Tolliver previews the episode's central warning: revenue leakage is a serious threat to financial stability — and it becomes more dangerous the more common it gets.

0:42 – 1:59 | Introduction Austin Littrell introduces the episode, plugs the April 29 AI webinar sponsored by Heidi Health and previews the conversation with Tolliver.

1:59 – 4:42 | What a strategic revenue cycle work plan actually looks like Tolliver explains how a strategic work plan aligns revenue cycle priorities with the overall business plan — broken down by quarter — and why most practices are still running off a business plan that hasn't been updated in years.

4:42 – 7:32 | Three moves to make in 30 days when payer friction is out of control Tolliver's framework: understand your denial drivers by volume, dollars and complexity; find where your cash is getting stuck in the AR aging buckets; and build real payer escalation relationships before you need them.

7:32 – 9:36 | The biggest mistake practices make when engaging payers Tolliver says it's showing up frustrated instead of prepared. Data, examples, trends and documented reference numbers beat complaints every time — because payers respond to evidence, not emotion.

9:36 – 12:08 | How to find the root cause when denials are spiking Tolliver's four-quadrant revenue cycle framework — front end, mid-cycle, payer communications and data — and how to use denial reason codes to trace a spike back to its source before it becomes a pattern.

12:08 – 14:02 | The denial type practices keep getting that a workflow fix could prevent Tolliver points to CPT coding as the most persistent offender — specifically the gap between correct coding initiatives and individual payer reimbursement guidelines — and explains why a payer-specific workflow is the fix.

14:02 – 18:00 | What a strong payer-specific action plan looks like — and who owns it Tolliver argues the billing team isn't the only one responsible. Providers, front desk staff and medical assistants all have a role — from closing notes on time to verifying benefits the EHR can't fully capture for certain specialties.

18:00 – 19:10 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

19:10 – 23:14 | Which metrics predict cash flow — and which create a false sense of security Tolliver's real cash flow predictors: aging AR, time-of-service collections, clean claims rate and denial rates by dollar amount. Her false sense of security warnings: gross collection rate and total charges, both of which can mask serious AR problems.

23:14 – 26:46 | When to automate, when to outsource and when to hire Tolliver's rule of thumb: automate anything repetitive, high-volume or rule-based; outsource when you need expertise you don't have in-house — like working down old AR during an EHR transition; and don't add staff until you've done a staffing ratio analysis.

26:46 – 28:42 | One tip to implement next week Tolliver's closing advice: look for revenue leakage. Under-coding, writing off collectible balances, accepting virtual credit card payments without negotiating rates and not pushing back on fee schedules are all quiet drains that practices normalize — and shouldn't.

28:42 – 30:40 | Outro Littrell thanks listeners, reminds the audience about the April 29 AI webinar and wraps the episode.

S1 Ep145: The revenue cycle mistakes quietly draining your practice, with Kem Tolliver of Medical Revenue Cycle Specialists

Off the Chart: A Business of Medicine Podcast

S1 Ep145: The revenue cycle mistakes quietly draining your practice, with Kem Tolliver of Medical Revenue Cycle Specialists