Silent Profit Killers

Most O&P practice owners know their biggest expenses. They know what components cost, which payers are the most frustrating, and where referral volume is strongest. But when profitability starts to feel lower than it should, the cause is rarely one dramatic event. More often, profit disappears quietly. It doesn’t happen through obvious catastrophes, but through operational blind spots, overlooked processes, and small financial leaks that become normalized over time. A practice recently contacted us because they assumed collections was the issue with their cash flow. While collections needed work, further examination revealed that was not the full picture—they had multiple silent killers affecting their cash flow. Here are five profit killers worth investigating in your practice. The Underpayments Nobody Notices One of the most expensive mistakes I see in practices is assuming that payment equals correct payment. It doesn’t. A claim gets paid, the team posts the remittance, and everyone moves on. But what if the reimbursement was incorrect? Are the correct fee schedules loaded into your software system to ensure that payment received is correct? Is your billing staff trained to review and ensure correct payment? Do you have a standard operating procedure for handling underpayments? Outdated payer contracts, incorrect fee schedules, silent reimbursement reductions, and payer repricing errors can quietly cost practices thousands of dollars without triggering any alarm bells. Many practices monitor denials but never audit underpayments. Denials That Quietly Die Claim denials are part of doing business in O&P. What matters is what happens next. Too often, denied claims are written off simply because no one has the time, ownership, or process to pursue them. Over time, this becomes accepted behavior—and a major profit leak. Even more concerning, many practices fail to track denial trends. Are repeated denials tied to a single payer? Is a specific L-Code denied frequently? Denial trends lead to a documentation issue? Denials contain valuable data—if you utilize it. Practices that analyze denial patterns often uncover preventable workflow failures that can be corrected upstream. Coding Leakage Not every revenue loss comes from denied claims. Sometimes it comes from claims that were paid but coded incorrectly. Coding leakage happens when: Incorrect L-Codes are selected Add-on components are missed Custom-fitted versus off-the-shelf distinctions are misunderstood Documentation does not support the code billed A single coding error may seem minor. But repeated across dozens or hundreds of claims, those small misses become significant lost revenue. Coding accuracy is not just a compliance issue—it is a profitability issue. Your practice should have a process such as an internal auditor or spot auditing that reviews claims to ensure coding is done correctly, documented correctly, and revenue is not leaking out your practice. Documentation That Creates Future Recoupments Some claims look profitable until the audit letter arrives. Incomplete physician documentation, weak medical necessity support, missing delivery documentation, inconsistent dates, or insufficient justification can all create future repayment risk. In today’s audit environment, getting paid does not mean you are protected. Practices often focus heavily on claim submission while giving less attention to documentation quality. That can become an expensive mistake. I can’t write about this enough: Documentation needs to be continuously reviewed, staff needs to be continuously educated, and internal audits need to take place. A proactive internal documentation review is far less painful than defending recoupment demands later. Workflow Delays That Stall Cash Flow Sometimes the problem is not billing at all. It starts much earlier with incomplete intake, delayed physician documentation, prior authorizations sitting untouched, claims parked in work queues, and no clear ownership of the next steps. Every operational delay slows patient care—and delays revenue. Busy practices often mistakenly assume that productivity equals efficiency. But if work is moving slowly between departments, revenue gets trapped long before a claim is ever submitted. Review your practice’s timelines. How long does it take for a patient appointment from casting to test socket? How long does it take from casting to prior authorization? How long does it take from casting to get those codes in so administrative staff can do what they need to do? Where to Start You do not need a full operational overhaul to identify financial leaks. Start with a simple assessment: Are you auditing underpayments? What are your top denial reasons? How old are your aged accounts receivable? Are claims assigned clear ownership? When was the last time coding accuracy was reviewed? Would your documentation survive an audit? Profit rarely disappears because of one mistake. More often, it leaks away through small process failures that become “the way we’ve always done it.” But once you identify the silent profit killers in your practice, they are often easy to fix. Erin Cammarata is president and owner of CBS Medical Billing and Consulting. She can be contacted at erin@cbsmedicalbilling.com. Image: Andrii Yalanskyi /stock.adobe.com

Silent Profit Killers

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