What Most Surgeons Don’t Know About Their Billing Reports (And What It’s Costing Them)
Most surgeons don’t ignore billing reports because they don’t care.
They ignore them because they’re busy saving lives, running a practice, managing staff, and trying to squeeze in family time—while a stack of “financials” gets dropped on their desk that feels like a foreign language.
The problem is this:
✅ Billing reports are not just paperwork.
They’re a map showing exactly where your money is going… and where it’s leaking.
If you don’t know what to look for, it’s easy to assume things are fine because deposits are still coming in.
But in reality, many surgical groups are losing tens of thousands per month without realizing it—through avoidable denials, underpayments, poor follow-up, and reporting that looks “busy” but doesn’t show the truth.
Let’s break down what most surgeons don’t know about their billing reports—and how to fix it.
1) A “Good Deposit Month” Doesn’t Mean Your Billing Is Healthy
One of the biggest misconceptions is:
“Collections look good this month, so everything’s working.”
Not always.
Billing and payment cycles are delayed. What you collect today could reflect work done 30–120 days ago depending on the payer.
So when a billing company or in-house team says “Great month!” you have to ask:
Was it high because we billed well?
Or was it high because a big old balance finally paid?
Or was it high because of one payer release / backlog clean-up?
Or was it high because of patient balance collections that won’t repeat?
✅ What you really want isn’t just deposits.
You want predictable cash flow tied to current production.
Fix: Track collections and charges by date of service month (not just deposit month).2) Your Reports Might Show Activity… Without Showing Effectiveness
Many billing reports are filled with data like:
of claims submitted
of claims processed
of follow-ups completed
of calls made
That sounds productive, right?
But here’s the truth:
📌 High activity doesn’t mean high collections.
A practice can submit thousands of claims and still suffer from:
wrong payer sequencing
missing modifiers
incorrect authorization handling
poor documentation capture
no aggressive follow-up on underpayments
constant “rework”
✅ What you need is not more work.
You need better outcomes.
Fix: Ask for outcomes-based KPIs:
First-pass payment rate
Denial rate by payer
Days in A/R
Net collection rate
Underpayment recovery
3) A/R (Accounts Receivable) Can Be “High”… and That’s Not Always a Flex
Surgeons often hear: “You have a lot of A/R, that’s good.”
Not necessarily.
High A/R can mean:
claims are sitting too long
denials aren’t being appealed
documentation is missing
insurance is stalling and no one’s pushing
patient balances aren’t being collected
old claims are being “kept alive” but not resolved
If your A/R is growing faster than collections, you don’t have momentum—you have backlog.
✅ The goal is not to have big A/R.
The goal is to turn A/R into cash quickly and cleanly.
Fix: Demand an A/R aging breakdown that’s real and actionable:
0–30 days
31–60
61–90
91–120
120+ (the danger zone)
4) You Might Be Missing Underpayments Completely
Most practices assume insurance payments are “correct.”
But payers often underpay due to:
bundled codes applied incorrectly
missing modifiers (or ignored modifiers)
contract misloads
fee schedule misalignment
reductions on assistant surgeon or critical care
incorrect multiple procedure reductions (MPR)
wrong allowed amount
If your reports only show:
✅ billed charges
✅ paid amount
✅ adjustment
…you still may not know if the payment was right.
Because the real question is: Did they pay what your contract says they owe?
Fix: You need underpayment reporting that includes:
expected allowed amount
actual allowed amount
variance
trend by payer
5) “Adjustments” Aren’t Just Numbers—They’re Lost Revenue Categories
Adjustments fall into multiple buckets:
Contractual adjustments (expected/normal)
Non-covered (may still be appealable)
Timely filing (often preventable)
Medical necessity (appealable with documentation)
Denial write-offs (only acceptable if truly uncollectable)
Patient responsibility (collectible if you have a system)
Most billing reports lump them all together.
That hides the truth.
✅ A practice can look “stable” while quietly writing off large amounts from:
avoidable denials
missing documentation
unworked A/R
unresolved offsets
Fix: Require adjustment reporting broken down by:
payer
reason code category
appeal status
write-off reason authorization
6) Denials Are Often Being Counted Wrong (Or Not Counted at All)
Here’s a common reporting trick:
A claim denies → gets corrected → gets resubmitted → eventually pays.
A billing report might show:
✅ paid claim
and never highlight that it was denied first.
So you think you have a clean operation…
…but you’re actually running a constant denial-rework machine.
Denials cost money in:
staff time
delayed cash flow
missed timely filing windows
lost revenue when follow-up fails
Fix: Track:
denial rate (true denial rate)
denial root cause
denial recovery rate
denials by provider and payer
7) Surgeon Billing Is Unique—But Your Reports Might Be Too Generic
Surgical practices and trauma groups deal with:
critical care time rules
E/M level justification
modifiers like 24, 25, 57, 58, 59, 78, 79
same-day procedures
global period rules
consult vs inpatient admit complexities
multiple tax IDs / NPIs / place of service variations
facility vs professional billing coordination
Generic billing reports often do not capture the nuances that directly affect surgeons.
If your reports look like they’re designed for a pediatric clinic or a family practice, that’s a red flag.
✅ Surgeons need surgical intelligence, not generic billing stats.
Fix: Add specialty-specific reporting:
critical care frequency and approval rate
E/M distribution by provider
modifier utilization and denial rate
top CPTs by volume and revenue
global package conflicts
8) Your Collections Might Look Fine While Your “Net” Is Slipping
Surgeons often focus on gross collections, but what actually matters is:
How much you keep after losses and preventable write-offs
Two practices can collect the same amount… but one is losing far more due to:
excessive write-offs
higher denial volume
unworked aged A/R
weak patient collections
improper documentation capture
✅ The better metric is Net Collection Rate and Adjusted Net Collections.
Fix: Ask your billing company to provide:
Net collection rate (%)
Write-offs by category (not lumped)
Avoidable write-off totals (monthly)
What You Should Be Receiving Every Month (Minimum)
If you’re a surgeon and you want real clarity, your billing partner should provide a monthly packet that includes:
✅ Charges by Date of Service Month
✅ Collections by Payer
✅ Denial Summary (by reason + payer + provider)
✅ A/R Aging with action plan
✅ Top unpaid claims (high dollar)
✅ Underpayment tracking / variance report
✅ Patient balance performance report
✅ CPT + modifier analytics
✅ Trends: last 3–6 months
If you’re not getting this, your billing is being managed on “autopilot.”
The Bottom Line: Your Billing Reports Should Answer 3 Questions
Every month, your reports should clearly answer:
1) Are we getting paid correctly?
Not just paid—paid correctly.
2) Are we getting paid on time?
Cash flow is king, especially in surgery.
3) Where are we losing money?
Denials, underpayments, old A/R, patient balances—these should be visible.
If your reports don’t answer these questions, they’re not reports.
They’re paperwork.
Want a Cleaner, Surgeon-Friendly Version of Your Monthly Reporting?
At Access Billing Network, Inc., we specialize in helping surgical and trauma groups understand their numbers without drowning in spreadsheets.
We simplify reporting so you can spot:
underpayments
denials
documentation risk
missed revenue opportunities
before it becomes a problem.