Why ‘Just Bill It’ Doesn’t Work Anymore — For Any Specialty: Understanding A/R in Healthcare for 2025–2026 Practice Leaders
- revenuequestllc
- Nov 20
- 13 min read
Updated: Nov 21
Published: November 20, 2025
Last Updated: November 20, 2025
Author: Marketta Burrell, CRCP
Company: RevQuest LLC
Important Disclaimer: This content is provided for educational and informational purposes only and does not constitute legal, medical, or professional advice. Healthcare compliance requirements can vary by state, payer, and type of practice. Readers should consult with qualified healthcare attorneys, compliance professionals, and their professional advisors before implementing any compliance strategies discussed in this article. RevQuest LLC does not provide legal advice and recommends working with qualified legal counsel for specific compliance guidance.
Healthcare practices are accustomed to pressure, having navigated staffing shortages, new payer rules, and unexpected changes multiple times. You remain resilient even when challenges arise.
The problem is not that your team is not working hard enough. The problem is that the environment has changed faster than your internal workflows.
In 2025 and 2026, “just bill it” is not a safeguard. It rarely protects margins on its own, and for many practices it quietly hides deeper issues in A/R, staffing, and technology.
Billing still matters. It is simply no longer the full strategy.
The Myth of “Just Bill It” in Today’s Environment
For years, billing felt simple. You submitted a claim, waited, and expected payment. CMS's January 2026 prior authorization rule requires 72-hour decisions, and the No Surprises Act enforcement is ramping up throughout 2025. As a result, payer complexity is not easing; it is accelerating on a fixed timeline.
Now, every specialty is facing a different reality:
More payer rules and clinical policies to track.
More denials and quiet downcoding.
Heavier documentation expectations.
Higher patient responsibility and more follow-up.
Shifting reimbursement models.
Initial denial rates of 10% or more are now common, with several recent analyses showing 2024 denial rates around 11–12% for many providers. In some payer segments, especially Medicare Advantage and commercial plans, nearly 1 in 6 claims can be denied at least once before payment.
Workforce shortages and burnout make it harder to keep up. More than 60% of nurses report burnout, and a large share of healthcare employees cite staffing shortages and lack of resources as major problems.
Administrative overload pulls clinical staff and managers into screens instead of exam rooms. Rising healthcare costs and shrinking margins leave less room for preventable write-offs.
Even strong billing teams feel the strain. The habit of “just sending claims out the door” assumes that submission alone is enough. In most organizations today, it is not.
What Is Really Draining Revenue in 2025–2026?
When providers talk about revenue problems, they often describe the symptoms: slow payments, rising denials, or “not enough time to fix it all.”
Underneath that, several patterns keep showing up:
Workforce shortages and burnout. Fewer people are doing more work, with constant distractions and competing priorities.
Administrative overload. Staff spend more time chasing authorizations, correcting data, and untangling payer rules than working claims cleanly the first time.
Rising costs and margin pressure. Overhead climbs while reimbursement feels flat or unpredictable. Small leaks matter more.
Inefficient workflows. Manual steps, duplicate entry, and systems that do not connect cleanly. Every handoff is a chance for a delay or error.
Increased denials and policy changes. Payers update guidelines and use more automation. Practices are expected to keep up, often without extra support.
Uneven technology adoption. Some tools are in place, but they are not always integrated, fully used, or configured for your actual processes.
The Medicare Physician Fee Schedule's effective 0% update for 2025 means no revenue growth from rates. The January 2026 prior authorization transparency requirements mean faster denials if documentation is not airtight. Telehealth coverage rollbacks could invalidate claims that were fine six months ago.
Security and compliance risks. Cyberattacks on healthcare organizations have doubled in the past three years. A single ransomware incident can freeze billing operations for weeks, and outdated systems are the most vulnerable targets.
Each factor on its own is workable. Together, they quietly stretch your team, your timelines, and your cash flow.
The mindset of “we billed it, so it should pay” does not address any of these issues. It only moves charges into a system that is already strained.
Your A/R in Healthcare Is Sending You Messages
If you want to see how well your current approach is working, look at your aging report.
Common signs appear across solo practices, group practices, and larger organizations:
90+ day balances that never seem to shrink
a growing list of small-dollar claims no one has time to touch
denials that repeat for the same reasons
underpayments that are written off without review
claims bumping up against the timely filing limits
Industry benchmarks often recommend keeping A/R over 90 days at around or below 12–15%. Yet many practices now see 18–22% or more of their A/R sitting in the 90+ bucket, especially when staffing is tight or denials have spiked.
That gap represents real work and real revenue at risk.
These patterns are rarely about effort. Most teams are working at or beyond capacity.
They are indicators that:
The front end is overwhelmed.
Denial follow-up is reactive.
No one has time to study trends.
Payer changes are absorbed in pieces instead of through a clear plan.
If these patterns stay in place for another quarter or two, recovery often becomes harder and more expensive. It is still possible, but it will ask more of everyone involved.
Catching the signals now gives you options while the numbers are still manageable.
This is also where a focused, outside view matters. RevQuest LLC™ reads your A/R the way a CFO reads a forecast. We translate those aging numbers into a clear picture of where revenue is leaking, where your team is overloaded, and where a small shift could create a measurable win.
A Brief Example: What Changes When You Look Deeper
Imagine a midsize multispecialty clinic with about a dozen providers. On paper, they were “billing everything.” Charges went out daily.
But their aging report showed:
nearly 25% of A/R sitting in 90+ days.
denials clustering around a few payers and a handful of denial reasons.
Staff are working late to rework the same types of claims.
A focused review found three key issues:
Registration errors from one high-volume location.
A payer-specific policy change that never made it into internal workflows.
No structured process for underpayment review.
By tightening front-end checks, updating workflows for that payer, and assigning weekly worklists for denials and underpayments, the clinic reduced 90+ A/R by several percentage points in a few months and freed up staff time for higher-value work.
They did not work harder. They worked with better information.
That is what revenue intelligence does. A simple “we sent the claim” mindset could not have revealed those patterns on its own.
This is the kind of work RevQuest LLC does through the Revenue Recovery Path™ suite. Tools like the A/R Recovery Scorecard™ and A/R Recovery Cleanup™ are designed to surface these patterns quickly and give your team a practical, prioritized plan instead of another generic report.
CFOs Already Know “Just Bill It” Is Not a Plan
Hospital CFOs, practice owners, and finance leaders watch the numbers from a different angle.
They see:
more volatility in monthly revenue
gaps between projected and actual cash collections
limited visibility into denial drivers
rising labor costs to cover the same work
Higher patient balances and slower patient payments
growing pressure from payers and auditors
They are also responsible for:
proving the value of any innovative technology or vendor
balancing staffing budgets against overtime and burnout
preparing for audits and regulatory changes
building forecasts that lenders, boards, and partners can trust
From that vantage point, “we billed it” is the start of the conversation, not the end. Executives are looking for revenue intelligence.
They want to know:
What is driving denials and delays, by payer and denial reason?
Where automation can replace manual, repetitive work?
How much A/R is at risk in 60–90+ days if nothing changes?
How does outsourcing or co-managed support compare to adding more internal headcount?
Some organizations are already seeing denial reductions and lower labor costs per claim when they align RCM workflows with automation and analytics.
They are also seeing a fundamental shift in payer behavior. Insurers are deploying AI-powered claims review and automated denial systems at scale. If your revenue cycle is still running on manual processes and reactive workflows, you are bringing analog tools to a digital fight, and your cash flow shows it.
You do not reach that level of responsibility by ignoring problems. You reach it by facing them early and making smart adjustments. Seeing the old “just bill it” habit as incomplete is one of those adjustments.
RevQuest LLC was built for that executive view. Our advisory and consulting work does not add more tasks on your plate. It gives leadership a clean, digestible picture of risk and opportunity, and then backs your internal team with the hands-on support to act on it.
Why Outsourcing Is Not a Hindrance. It Is a Relief Valve.
Many practices hesitate to explore outsourcing because they worry about losing control or replacing their staff.
And this is exactly where the divide shows up inside your practice.
Yet with projected healthcare worker shortages approaching 100,000+ vacancies by 2028, including billing and coding specialists, the question is not whether to find external support, but how to find the right partner before the shortage worsens.
Done well, outsourcing should do the opposite of what you fear.
A specialized RCM partner like RevQuest LLC supports the team you already have by taking on specific, clearly defined work, such as:
Daily charge review and scrub before submission.
denial triage and follow-up by payer and denial type.
underpayment review and targeted appeals.
building and working A/R worklists by age and balance.
monitoring clean-claim rates and days in A/R.
preparing concise, actionable reports for leadership.
On the technological side, RevQuest LLC brings:
practical automation for eligibility and claim status checks.
rules to flag high-risk claims before they are sent.
simple, readable dashboards that show denial trends, payer patterns, and 90+ A/R at a glance.
secure processes that support remote or hybrid teams.
For remote or hybrid environments, this also means:
standardized workflows across locations
clear division of responsibilities between your internal staff and our team
protected access to data with appropriate controls
This kind of support does not diminish your staff. It protects them from burnout and constant firefighting.
You have already built an organization that rises under pressure. RevQuest LLC is designed as a co-managed partner, not a takeover. Outsourcing in this model gives your team the bandwidth and backup they need to keep rising without running on empty.
For many leaders, it is also a capital-light way to gain advanced workflows, automation, and reporting without hiring and training an entire internal RCM department.
What Providers Are Really Working Toward
When providers talk about “fixing billing,” they are rarely just talking about claims.
Most are aiming for a different day-to-day reality:
fewer administrative headaches
fewer late nights trying to catch up
more time focused on patient care and clinical decisions
technology that actually makes work easier, not harder
smoother patient payment experiences that do not strain relationships
a revenue cycle that they can explain to partners, lenders, and staff with confidence
User-friendly, integrated platforms.Automation for repeatable denials and routine tasks. Dashboards that show what is working and what is not. Targeted training and compliance support so staff can use new tools correctly.Payment options that better fit patients and improve collections.
These are not distant goals. They are attainable with the right mix of internal leadership, external support, and clear priorities.
The Revenue Recovery Path™ services at RevQuest LLC are built around that exact mix. We help you stabilize today’s billing, then layer in the level of revenue intelligence and support that matches where your practice is and where you want it to go.
For practices that want tools in-house, Revenue Reset™ digital products give your team ready-made templates, letters, and checklists to respond to payer behavior without starting from a blank page.
The Real Fix: Revenue Intelligence, Not More Billing
Submitting more claims will not solve systemic issues, no matter how hard your team pushes.
What changes outcomes is understanding:
Where revenue is leaking?
Which processes are causing delays?
How is payer behavior shifting?
How does your staffing and technology line up with your goals?
A focused revenue intelligence review can turn your A/R data into a simple, usable map. For example, a structured assessment might:
Calculate how much of your A/R sits in 60–90+ days compared with benchmarks.
Identify your top denial reasons and payers by volume and dollar amount.
Estimate the impact of improving clean-claim rates by a few percentage points.
Outline quick-win process changes that your team can implement without a full overhaul.
Even modest shifts matter. Improving clean-claim performance or reducing 90+ A/R by a few percentage points can translate into meaningful cash-flow improvement over a year.
You are not replacing your team. You are giving them clarity, support, and a path forward that does not rely on sending claims out and hoping the numbers improve.
At RevQuest LLC, that is the role of tools like the A/R Recovery Scorecard™, the A/R Recovery Cleanup™, and the R.O.O.T. Method™ Diagnostic. Each one is designed to meet you where you are, reveal what your data is already trying to tell you, and then support your team in fixing what matters most.
The Denial Decoder™ adds another layer by translating messy denial patterns into clean, simple findings and next steps your team can use right away.
Before Another Quarter Passes
If your aging report feels heavier than it did last year, or your staff keeps saying there is no more capacity left, you are not alone. These dates are not guesses.
They come directly from CMS’s Interoperability and Prior Authorization Final Rule (CMS-0057-F):
By January 1, 2026, impacted payers must comply with faster prior authorization decisions (72 hours for urgent, 7 calendar days for standard requests) and provide specific denial reasons.
By March 31, 2026, those payers must publicly report their prior auth metrics, including denials and turnaround times.
Once that starts, every gap in documentation, every preventable denial, and every weak point in your A/R process becomes more visible—and more expensive.
Practices of all sizes are feeling the same pressure:
more complexity
more administrative friction
more silent revenue loss
You do not have to overhaul everything to stabilize your revenue. But you do need a clearer picture of what your numbers are already showing you.
This is where RevQuest LLC™ gives you leverage.
If you are not sure where the leaks are:
Download the 5 EOB Red Flags Every Practice Misses Checklist. It is a quick, practical way to spot the most common revenue-draining issues hiding inside everyday EOBs—missed adjustments, incorrect reductions, silent downcoding patterns, and signals your team usually overlooks because of time pressure. It is designed to help you catch problems before they turn into repeat denials or write-offs.
If denials are already stacking up:
Use the Denial Decoder™. It breaks down a denial cluster by payer and denial type and gives you a clean, usable summary you can act on—not another spreadsheet your team has to interpret on their own.
It is designed for the 2025–2026 landscape: AI-driven payer edits, documentation shifts, and increased automation behind the scenes.
If A/R is drifting into 90+ days:
Leverage the Revenue Recovery Path™, RevQuest LLC’s structure for restoring control without overwhelming your staff.
Key tools include:
A/R Recovery Scorecard™ for a simple view of where your aging is trending.
A/R Recovery Cleanup™ for targeted recovery and real cash impact.
The R.O.O.T. Method™ Diagnostic for practices that need a deeper reset.
Even small improvements in 60–90+ day A/R create measurable cash-flow changes over the next quarter.
You already know your practice performs under pressure. You have proven that more than once.
What changes your next quarter is not pushing harder. It is acting on the signals your data is already giving you.
Start with the step that fits your current reality:
Download the 5 EOB Red Flags Checklist
Run your next denial pattern through the Denial Decoder™
Or, if your A/R is growing, take the first step in the Revenue Recovery Path™
RevQuest LLC turns complex billing patterns into clear, actionable next steps—before the 2026 compliance deadlines elevate the risk.
You have carried your practice this far under pressure. Now let your revenue systems rise with you.
Marketta Burrell, CRCP, is the founder and CEO of RevQuest LLC™ and creator of Revenue Reset™, Downcoding Defense™, and the Denial Decoder™.
With over 23 years of healthcare revenue cycle experience, she helps providers navigate payer policy changes, identify hidden underpayments, and strengthen revenue integrity across their practice.
You don’t have to face payer pressure alone.
RevQuest LLC™ and Revenue Reset™ are here to support you — from strategy to systems to survival.
📚 Sources & Further Reading
Payer Policy & Industry Trends
Centers for Medicare & Medicaid Services (CMS). Interoperability and Prior Authorization Final Rule (CMS-0057-F) Published January 17, 2024.
Confirms:
• 72-hour urgent PA decisions
• 7-day standard PA decisions
• Public reporting of PA and denial metrics by March 31, 2026
Centers for Medicare & Medicaid Services (CMS). No Surprises Act Implementation Updates.
https://www.cms.gov/nosurprises
Confirms: Increased payer enforcement + documentation and billing transparency.
National Patterns of Algorithmic Downcoding *Oncology News Central* https://oncologynewscentral.com/articles/downcoding-practices-by-payers
Confirms: Increasing payer complexity, rising administrative burden, and financial strain for practices.
Workforce Shortage, Burnout & Labor Trends
U.S. Bureau of Labor Statistics. Healthcare Workforce Projections.
https://www.bls.gov/emp/tables/industry-and-occupation.htm
Confirms: Rising healthcare vacancies through 2028.
National Council of State Boards of Nursing (NCSBN). 2024 Workforce Study.
Confirms: Over 60% of nurses report burnout.
Denials, Billing Pressure & Administrative Burden
American Medical Association (AMA). 2024 Prior Authorization Survey.
Confirms: High administrative time; increased denial-related burnout.
Medical Group Management Association (MGMA). 2024–2025 Practice Operations Report.
Confirms: Administrative overload• Rising denials• Shrinking margins for practices
KFF (Kaiser Family Foundation). Health System Pressures & Documentation Burden.
Confirms: Increasing payer-driven documentation requirements + financial pressure.
Downcoding & Payment Reductions
Davis Wright Tremaine LLP. Payer Downcoding Practices & E/M Reductions.
Confirms: Growth of payer-driven algorithmic downcoding and documentation thresholds.
Oncology News Central. National Patterns of Algorithmic Downcoding.
https://oncologynewscentral.com/articles/downcoding-practices-by-payers
Confirms: Widespread adoption of automated downcoding tools across payers.
Cybersecurity, Ransomware, & Billing Disruptions
Department of Health and Human Services (HHS). Ransomware & Healthcare Cybersecurity Reports.
Confirms: Cyber incidents freezing billing operations; increased risk for healthcare organizations.
Disclaimer: This content is for educational and strategic analysis purposes only and does not constitute legal, financial, medical, or business advice. Healthcare practices should consult with qualified legal, financial, and business advisors familiar with their specific circumstances, contracts, and local market conditions before making any strategic decisions regarding payer contracts or business operations.
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