Medical Billing Expert Reveals Revenue Cycle Mistakes Costing Healthcare Practices Thousands Monthly

About This Blog

In this episode of Fountain of Vitality with LaMont Leavitt, Brandy Brimhall represents 26 years of dedicated healthcare revenue cycle expertise focused on solving the administrative challenges that drain medical practices nationwide. As President of Rapid Credentialing and a dual-certified professional in both coding and compliance, Brimhall has built her career around what she describes as a "passionate obsession" with healthcare billing, collections, and credentialing systems. Her comprehensive certifications spanning coding, compliance, auditing, and credentialing position her as a multifaceted resource for practices struggling with claim denials, recoupment requests, and enrollment complications that silently erode profitability.

Brimhall's diagnostic approach to revenue cycle management mirrors the methodology healthcare providers use with patients. She identifies interferences in billing systems, determines root causes of collection failures, and implements targeted solutions that streamline operations while increasing cash flow. Her work addresses the entire spectrum from front desk insurance verification errors to aging accounts receivable management, helping practices understand that patient relationships suffer both directly and indirectly from billing complications visible on every explanation of benefits statement patients receive.

Documentation Foundations That Determine Practice Financial Health  

Medical documentation serves as the bedrock of every downstream revenue cycle activity, yet many healthcare providers underestimate its significance until facing audits or recoupment requests. Brimhall emphasizes that doctors consistently express one primary goal: getting paid properly for services rendered. However, she expands this objective to include combating denials effectively, conducting successful appeals, and keeping money already received from payers. Sound documentation makes all these outcomes possible, while inadequate records create what Brimhall describes as problems for healthcare providers.

The challenge stems from a disconnect between medical education and administrative realities. Most healthcare professionals enter practice wanting to focus exclusively on patient care, often surprised by documentation requirements that determine their financial viability. Medical schools rarely emphasize coding, billing, and documentation necessities, leaving practitioners unprepared for the administrative burden that significantly impacts their revenue. Technology improvements have streamlined some documentation processes, but the fundamental principle remains unchanged.

Brimhall uses a construction metaphor to illustrate documentation's role in practice success. Just as builders must pour solid foundations before erecting structures, healthcare providers must establish sound documentation practices before expecting stable revenue cycle systems. Every claim, appeal, and audit defense depends on documentation quality. Practices that treat documentation as an afterthought rather than a strategic priority inevitably face claim denials, failed appeals, and costly recoupment requests that could have been prevented through proactive attention to record-keeping standards and completeness.

The Credentialing Gap Sabotaging Insurance Reimbursement  

Provider credentialing and enrollment create the foundation for legitimate insurance billing, yet many practices operate with incomplete or outdated enrollment information that undermines their revenue potential. Brimhall identifies credentialing confusion as a pervasive problem where providers assume enrollment with one payer plan automatically grants access to all products under that payer's umbrella. This misconception leads to claim rejections, patient collection errors, and revenue losses that practices often cannot identify or correct without expert intervention.

The credentialing process involves two distinct phases that serve different purposes. First, payers conduct screening to verify provider legitimacy, confirming proper licensing, accurate location information, and absence of identity theft issues. This screening ensures facilities and providers meet basic legitimacy standards before payers consider enrollment. Second, enrollment establishes the provider's network status, determining whether they access out-of-network benefits, register as non-participating with Medicare, or contract as in-network participating providers. Each enrollment type carries different billing implications, reimbursement rates, and patient responsibility calculations.

Rapid Credentialing addresses these complications through discovery processes that reveal actual enrollment status across payer plans and products. Many practices discover they've been treating patients under plans where they lack proper enrollment, resulting in improper billing, incorrect patient collections, and flawed benefit verifications. The service completes end-to-end credentialing and enrollment, adds new lines of business as practices expand their payer relationships, and manages ongoing credentialing changes when providers join practices, locations change, or facility transitions occur.

Understanding Revenue Cycle Interference Points  

Revenue cycle success depends on identifying and eliminating interference points that disrupt cash flow and create administrative burdens. Brimhall evaluates practices using the same methodology doctors use with patients, looking for system disruptions that prevent optimal function. These interferences manifest as claim rejections, claim denials, records requests, recoupment demands, disrupted patient relationships, reduced collections, and increasing aging accounts receivable. Each interference point connects to others, creating cascading effects that compound problems throughout the billing cycle.

Front desk operations represent the first critical interference point. Improper insurance data entry and inadequate benefit verification create downstream problems that become exponentially harder to resolve. When staff members fail to input payer information correctly or verify benefits thoroughly, practices submit claims destined for rejection or denial. This initial error wastes staff time, delays payment, and creates patient confusion about financial responsibility.

Credentialing status creates another major interference point that many practices overlook until claims start rejecting. Enrollment with a primary payer network doesn't automatically include enrollment across all plans and products under that network umbrella. Practices treating Medicare Advantage patients without proper Medicare Advantage enrollment face systematic claim rejections that no amount of resubmission will resolve.

Clean Claims Require Complete Code Descriptions  

Medical coding translates clinical documentation into standardized language that payers understand and process. Brimhall describes this as "same story, different language," emphasizing that accurate translation determines whether practices receive proper reimbursement. However, many practices rely exclusively on practice management software for coding guidance, unaware that these systems rarely provide complete code descriptions necessary for confident, accurate coding decisions.

Procedure codes communicate services performed, diagnosis codes explain medical necessity, and modifiers provide additional context that standalone codes cannot convey. Modifiers function like descriptive language in storytelling, adding detail that helps payers visualize circumstances surrounding services. Just as descriptive terms in novels help readers understand characters and settings more vividly, modifiers provide payers with information about procedures performed.

Brimhall previously used printed coding manuals but has transitioned to findacode.com, an online resource providing current, complete code descriptions accessible via computer or phone. This tool enables demonstration during seminars and webinars while ensuring work with the most current coding information available. Complete code descriptions help practices understand not just what codes represent, but also the specific documentation elements required to support each code selection defensibly.

The Eagle Mindset for Navigating Revenue Cycle Storms  

Brimhall introduces a mindset shift that transforms how healthcare practices approach inevitable billing challenges and audit requests. Drawing inspiration from eagle behavior during storms, she contrasts two approaches to revenue cycle difficulties. Most practices react like smaller birds, hunkering down when storms hit, waiting passively for challenges to pass, and dealing with damage afterward. This reactive approach extends problem resolution timelines, increases financial impact, and creates unnecessary stress for administrative teams.

Eagles demonstrate a superior strategy by rising above storms rather than hiding from them. This elevated perspective allows eagles to see dangers ahead, navigate through challenges more efficiently, and minimize storm impact through strategic maneuvering. Brimhall encourages practices to adopt this proactive stance toward revenue cycle management.

This eagle perspective requires understanding all revenue cycle components and their interconnections. Practices gain stamina and strength by familiarizing themselves with payer policies, maintaining current coding resources, conducting regular internal audits, and ensuring proper credentialing across all relevant plans. When challenges inevitably arise, prepared practices navigate them faster and more successfully than those caught unprepared.

Audit Preparedness Strategies That Protect Practice Revenue  

Healthcare providers face compliance obligations requiring annual documentation audits, whether conducted internally or outsourced to external experts. This requirement exists to ensure practices identify and correct their own oversights before payers discover them through external audits. Proactive audit approaches dramatically improve outcomes when payers initiate reviews, request records, or issue recoupment demands.

Brimhall identifies specific areas where audit problems commonly emerge, particularly around timed therapy units and examination level coding. Timed therapy coding follows specific guidelines that many practices misunderstand, resulting in overbilling that invites payer scrutiny and recoupment requests. Similarly, examination and re-examination procedure codes require specific documentation elements to justify the level billed.

Success stories emerge from practices taking proactive approaches to payer policy familiarization and complete code description review. These prepared practices can demonstrate due diligence when audits occur, showing they've documented thoroughly and translated records properly into code. Their familiarity with specific payer policy guidelines enables them to reference supporting documentation during appeals, often minimizing recoupment amounts or eliminating them entirely.

Managing Team Anxiety During Revenue Cycle Challenges  

Audit notifications trigger immediate anxiety in practice teams unfamiliar with the process or unprepared for scrutiny. Front desk staff and billing specialists often react with fear about potential costs, provider anger, and job security when audit requests arrive. Brimhall addresses these emotional responses with practical guidance that reframes audits as learning opportunities rather than punishments.

Her approach involves diagnostic thinking applied to the audit situation itself. Rather than catastrophizing about worst-case scenarios, she encourages teams to investigate why audits occurred, what billing patterns might have triggered payer interest, and which upstream processes may need adjustment. This analytical stance transforms audit anxiety into productive problem-solving that benefits practices long-term.

Brimhall reminds anxious staff that losing sleep over audits provides no value, while learning from them creates lasting improvements. The goal involves understanding audit triggers and developing response strategies that teams can implement confidently during future challenges. This preparation mindset helps practices see around corners, anticipating problems before they escalate rather than reacting after damage occurs.

Emerging Technology Solutions for Revenue Cycle Efficiency  

Artificial intelligence is being implemented across multiple healthcare revenue cycle touchpoints, creating opportunities for increased efficiency and accuracy. AI applications currently support provider documentation, code selection assistance, claims processing optimization, and appeals strategy development. These technologies help providers document more efficiently while maintaining coding confidence through better translation from clinical notes to billable codes.

Claims processing represents another area where AI creates value by helping clinics understand appropriate next steps when claims process incorrectly or face denials. Rather than leaving billing staff to decipher complex denial codes and payer-specific requirements, AI systems can analyze denial patterns and recommend specific actions to resolve issues quickly.

Benefit verification and prior authorization processes currently consume significant staff time while creating frustration for both practices and patients. AI development in these areas promises to streamline these time-consuming tasks, making them more efficient for clinics overall.

Practical Steps for Revenue Cycle Optimization  

1. Verify Front Desk Processes - Ensure insurance information entry accuracy and thorough benefit verification

2. Confirm Credentialing Status - Document enrollment across all relevant payer plans and products

3. Access Complete Code Descriptions - Use current resources beyond practice management software

4. Review Payer Policy Guidelines - Understand specific expectations for each contracted payer

5. Conduct Regular Internal Audits - Identify and correct coding issues before payers discover them

6. Develop EOB Review Protocols - Establish systematic processes for rejection and denial management

7. Monitor Accounts Receivable Aging - Track and address outstanding balances from insurances and patients

Taking Action on Revenue Cycle Health  

Brandy Brimhall's revenue cycle expertise offers healthcare practices a roadmap for transforming billing challenges into operational strengths. Her emphasis on documentation quality, proper credentialing, complete code descriptions, and proactive audit preparedness creates systems that withstand payer scrutiny while maximizing legitimate reimbursement. The eagle mindset she promotes helps practices rise above revenue cycle storms, navigating challenges with confidence rather than fear.

The insights shared on Fountain of Vitality demonstrate that revenue cycle success requires ongoing education, current resources, and strategic thinking about how administrative processes impact both collections and patient experience. Connect with Brandy Brimhall at Rapid Credentialing to assess your practice's revenue cycle health, address credentialing gaps, and develop the systems that ensure you receive proper payment for services rendered while maintaining compliance with payer requirements and industry standards.

Visit Fountain of Vitality for more exclusive stories and insights into healthcare practice management and financial optimization.

Follow the Fountain of Vitality podcast:

Website: http://www.fountainofvitality.com
Tiktok: https://www.tiktok.com/@fountainofvitalitypod 
YouTube: https://www.youtube.com/@FountainofVitalityshow 
Facebook: https://www.facebook.com/profile.php?id=61578729509030# 
Rumble: https://rumble.com/user/Fountain_of_Vitality 
Instagram: https://instagram.com/fountainofvitalitypodcast 
Email: info@fountainofvitality.com

Follow LaMont Leavitt:

LinkedIn: https://www.linkedin.com/in/LaMontJLeavitt/
Twitter/X: https://x.com/ljleavitt1 
InnoviHealth Website: https://www.innoviHealth.com

Follow Brandy Brimhall: