"I Think It’s Fine" is the Most Expensive Sentence in Mental Health Billing.
- Lorraine Seibold
- Mar 2
- 4 min read
Social media is currently a loop of the same three billing tips. Every company is posting that same “Revenue isn’t lost because...” template, maybe throwing in a sparkle emoji for flair, and calling it a day.
The worst part? They aren’t lying. They’re just staying on the surface.
When I look at a practice, I’m not seeing therapists who “forgot” to check their reports. I’m seeing therapists who open a report and feel like they’re staring at a foreign language. There’s a massive gulf between having data and actually knowing what it's telling you.
The Silence in the Data
If I ask a practice owner for their 60-day A/R, they can click a button and give me a number. But the second I ask, “How much of that is actually collectible and how much is just dead weight?” the room goes quiet.
That’s not an insult. You’re a clinician. You were trained to hold space for people, not to reconcile insurance remits. But private practice has this sneaky way of forcing you to be a compliance officer, a collections manager, and a contract analyst. These are all roles you never signed up for.
The Blind Leading the Blind
So, you go to social media groups. You crowdsource answers from other practice owners who are just as overwhelmed as you are. You’re all looking at the same broken system from different angles, hoping someone has the magic key. But when everyone is crowdsourcing, nobody is actually accountable for the result.
And then there’s the ultimate irony: calling the insurance companies themselves. You spend forty-five minutes on hold to ask the very people who created the confusing rules (and who benefit when you don't get paid) how to get your money.
You’re asking the person who owes you a check to give you a masterclass on how to collect it. Most of the time, the rep on the other end is just reading a script from a screen that doesn’t even match what’s actually happening with your claim. It’s a cycle of misinformation. You wouldn't ask a pharmaceutical rep how to diagnose a patient, so why ask an insurance rep how to run your business?
Death by a Thousand Cuts
I’m tired of watching preventable revenue loss. It’s rarely one giant disaster that sinks a practice. Instead, it’s the quiet stuff.
And honestly? I’m discouraged by how much inaccurate advice is circulating right now. I see it every day. You have volume-based billing "factories" that treat your revenue like a data entry task instead of a financial system. Then you have individuals positioning themselves as experts because they once worked at a front desk.
Working at the front desk is fine, but it’s not the same thing as understanding payer contracts, claim lifecycle patterns, or how insurance companies actually behave when they don't want to pay you. There is a massive difference between touching the process and actually understanding the system.
Revenue cycle management isn’t just clerical work. It’s analytical. It requires pattern recognition, deep compliance awareness, and a working knowledge of how payers move over time. When that depth is missing, you don't just see it in your reports. You feel it in your cash flow.
This work isn't just about clicking "submit." It's about knowing what happens when the system says "no." When you combine bad advice with the slow leaks of a messy backend, you get a crisis. It looks like this:
The “Ghost” Rejections: Claims that were rejected at the clearinghouse level but never actually made it into the payer's system. They just vanished.
The Linked EFT Loop: You “set up” the electronic funds transfer, but it never fully linked to the ERA. Now you’re hunting for paper checks that may or may not exist.
The $12 Underpayment: One payer is paying $12 less than your contracted rate. It’s only $12, so you ignore it. Multiply that by 40 sessions a month and you just bought the insurance company a nice dinner every single week.
The Secondary Payer Limbo: Claims that have been sitting for 90 days because a COB (Coordination of Benefits) wasn’t updated. Now the clock is ticking on timely filing and you're the one losing out.
It Doesn’t Feel Like a Crisis
This is the crisis. It doesn't feel urgent. It just feels like a constant, low-level tightening of your cash flow. It feels like “unpredictability.” You start thinking, “Maybe next month will be better,” or “Insurance is just slow right now.”
That is usually a lie we tell ourselves to avoid looking at the backend.
There are people who do this all day. Not in a spammy, “knowledge nugget” way, but in a granular, unsexy, pattern-recognition way. They see the $12 discrepancy because they know what the contract says. They see the “dead” A/R and have the courage to tell you it's dead so you can actually see your true net worth.
“I think it’s fine” and “I know exactly what’s happening” are two very different things.
If you’re confident in your numbers, that’s fantastic. Truly. We need more of that in this industry.
But if you’re operating on “I think it’s fine,” you’re leaving money on the table. You’re working too hard to let your revenue leak out of holes that should have been plugged months ago.
Know, Don't Guess
Revenue doesn't care about your best guesses. It only cares about the systems you have in place to capture it.
