Welcome back to The ProfitRx, the podcast dedicated to relieving the financial pains of medical practices. In today’s episode, Josh Fertel, an expert in billing, revenue cycle management, and revenue optimization, dives deep into one of the biggest challenges facing healthcare practices: cash flow.
Josh shares his insights on what an ideal billing and reimbursement cycle looks like, where clinics commonly get tripped up, and the profound impact of delays on practice operations. The conversation explores the importance of communication within medical teams, the evolving landscape of cash-based versus insurance-based practices, and the benefits and challenges of hybrid models that mix both approaches.
You’ll also hear Josh’s candid thoughts about the math behind running a thriving practice, real-world examples from his own experience, and practical advice on streamlining operations, adding new revenue streams, and creating value for both providers and patients. Whether you’re a practice owner, administrator, or just interested in the business side of medicine, this episode is packed with actionable strategies to help keep your practice financially healthy and ahead of the curve.
Let’s jump in!
Timestamps:
00:00 Cash Flow and Collection Impact
04:42 Patient Billing Miscommunication Issue
07:14 "Cash-Only Practice Benefits and Growth"
11:27 Navigating Patient Loss and Revenue
13:22 Direct Physician Access Services
17:43 Networking and Learning via LinkedIn
22:21 "Hybrid Model in Family Practices"
24:01 Optimizing Insurance Coding Practices
29:34 "Marketing Conversations on Business Models"
33:16 Starting Out: Grow Patient Volume
35:15 "Embrace and Appreciate for Success"
40:29 Telehealth Startup or Money Grab?
41:16 Creative Ideas in Healthcare
Optimizing Cash Flow in Medical Practices: Hybrid Models, Billing Cycles, and Revenue Growth
Cash flow issues are a constant pain point for medical practices. In episode 4 of The ProfitRx, Medical billing and RCM (revenue cycle management) expert Josh Fertel to discusses the real-world challenges and solutions for optimizing cash flow, streamlining billing, and sustaining growth in today’s healthcare environment. Here are the top takeaways for medical practice owners and administrators.
Understanding the Ideal Billing Cycle
According to Josh, the ideal billing reimbursement cycle is streamlined and fast:
Claims submitted within 24–48 hours after the visit is signed off
Insurance payments received within 21 days for clean claims
Patient collections (deductibles, co-pays) within 30 days if not paid upfront
“Within 45 days,” Josh shares, “that claim should be cleared off the books.” Yet, the reality is rarely ideal-delays push claims into 60, 90 days or more, harming cash flow and collection rates.
Where Does the Billing Breakdown?
Josh reveals that the biggest bottleneck isn’t just coding errors or poor follow-up-it’s lack of communication. A missed message about an extra service, for example, can result in lost revenue and patient confusion. Solid communication between providers, front desk staff, and billing teams is critical for capturing every dollar and keeping the revenue cycle healthy. “The submitting part is the easy part,” Josh says, “it’s the follow-up and communication that really matter.”
Insurance vs. Cash-Based: The Hybrid Approach
A hotly debated topic is whether practices should stick with insurance or go cash-based. Josh’s advice is pragmatic:
If you’re starting out and want to grow volume, you need to take insurance.
If you want less administrative hassle and more predictable cash flow, consider a cash-based model.
But today, most practices can’t afford to do just one. “Every practice is hybrid,” Josh notes, since 25-30% of revenue comes from patient payments (co-pays, deductibles) even in an insurance-based clinic.
He recommends practices look for opportunities to incorporate both models. For instance:
Offer services not covered by insurance (e.g., IV therapy, cosmetic procedures, weight loss programs) as cash-pay add-ons.
Consider a concierge or membership model for direct revenue and enhanced services (longer visits, direct physician access).
Carefully analyze which insurance contracts are worth keeping as your practice grows.
Growth and Revenue Opportunities
For practices seeking new revenue streams, Josh encourages incremental innovation:
Start with services that don’t require significant upfront investment.
Pilot cash-based add-ons and memberships alongside insurance billing.
Weight loss programs and preventative health services are popular, often not covered by insurance, and can be integrated with little disruption if done thoughtfully. “Look in the mirror first,” Josh says. Make sure your current revenue cycle is tight, then build on that foundation.
Keys to Sustainable Cash Flow
Regularly review your receivables—if claims age past 45–90 days, it’s time to investigate.
Empower your front desk to communicate and collect payments effectively.
Leverage technology and payer portals for efficient follow-up.
Stay engaged—practices with hands-on leadership reap the biggest gains.
Final Words
Optimizing cash flow isn’t about abandoning insurance or going all-in on cash; it’s about finding the right blend for your patient base, improving communication, and capturing every revenue opportunity. As Josh Fertel concludes, “Everything in life is a math problem… and you can’t grow what you don’t measure.”
Interested in more actionable insights? Listen to the full episode of The ProfitRx for an in-depth look at revenue growth strategies in medical practices.
The ProfitRx - Podcast Website - https://theprofitrxshow.com/
Josh Fertel's LinkedIn - https://www.linkedin.com/in/josh-fertel-439815b4/
J3RCM Website - https://www.j3rcm.com/
TopHealth Media - https://tophealth.care/