My first fractional seat was a four-month run as chief operating officer of a three-practice cosmetic dermatology group in California, in 2015. Full schedules, good doctors, and money that never showed up. Everyone in the building, the owner included, called it a collections problem.
It was not. The practice was not paying for the right billing software, the software it did have was not set up correctly, the billing codes inside it were years out of date, and the office paperwork was a mess on top of that. Every claim built on a stale code was wrong before an insurer ever saw it, so no amount of chasing denials was ever going to recover that money.
The fix was not clever. A weekly check that every billing code in use was current, and a rebuilt paperwork system so the front office and the billing desk were working off the same file. Four months in, insurance billing was up 42 percent month over month.
The part I am proudest of is that the client kept both the code check and the paperwork system after I left. A fix that survives you is the only kind that counts. And the part that transfers: a shortfall that looks like an effort problem is very often a maintenance problem. Before you hire more people to chase the symptom, ask when the thing underneath it was last kept current.