Keeping clients

Billing services lose clients in two ways: a surprise, or silence. Both are communications failures wearing a spreadsheet costume. This lesson is the operating rhythm that keeps a client for years.

The report card

Every month, each client gets a one-page report. Four numbers, a sentence each, no decoration:

• Charges submitted versus the prior month. Direction matters more than level.
• Net collection rate: payments divided by charges minus contractual write-offs. This is the number that shows whether the practice is actually capturing what it earns.
• Denial rate: denied claim dollars over total submitted. Industry benchmarking treats anything over about 10 percent as trouble and under 5 percent as excellent. Your value to the practice is this line trending down.
• Aged receivables: how much is sitting over 60 and over 90 days, measured against the published benchmark that days in A/R should stay below 50 at minimum, with 30 to 40 preferable (AAFP).

Then one short paragraph: what you fixed, what needs their decision, what is coming (a payer policy change, the January fee schedule update, a patient balance issue). The report takes you twenty minutes once your systems are set. It is the entire retention program, because a practice that reads four honest numbers every month never wonders what it is paying for.

The habits around it

Bad news early. A timely filing near-miss, an audit letter, a payer holding payments: the client hears it from you the day you know, with a plan attached. Bad news ages badly in this business, and the office manager's fear is not the error, it is looking foolish in front of the physician because the biller sat on it.

One scheduled touchpoint. A short monthly call after the report goes out. Agenda optional. The point is that the relationship has a pulse.

Annual review tied to January. Medicare's fee schedule and the year's code changes land every January. Schedule each client's contract and pricing review against that calendar, when the practice is already thinking about the new year's numbers.

Growth: what the ladder looks like

Client one ends the drought. Two stabilizes it. Three makes it a real income, per the unit economics in "The honest money." Around client four, you will hit your personal capacity ceiling, roughly where charge entry, follow-up calls, and reports consume a full week. The hire at that point is another biller, contracted first: pay per claim or per hour, exactly like the apprenticeship arrangement in "Getting good enough to be trusted," but with you standing in the middle. Your margin at that moment is the spread between what a client pays you in percentage terms and what you pay help per claim, and it is the beginning of the firm rather than the job.

Churn will still happen. Practices merge, physicians retire, hospitals absorb offices and bring billing in-house. A clean transition-out clause, the one you wrote in "Setting up shop," converts an ending into a reference and occasionally into a returning client. Conduct yourself at the exit as you did at the pitch.

The lesson this course was designed around comes later.