The Loyalty Penalty: Why Your Best Employee Might Be Your Biggest Financial Leak
- Soendeep Kaur
- Nov 19
- 3 min read
The Story of "Betty"
Every independent practice has a "Betty."
Betty has been with you since you opened your doors. She knows your patients by name. She remembers their birthdays. She brings donuts on Fridays. She is the heart and soul of your front office. Because she is so capable, she wears many hats: she answers the phones, she checks patients in, and—crucially—she handles your billing.
You trust her implicitly. And you should. She is loyal, hardworking, and honest.
But here is the hard truth that no one wants to tell you: Betty is costing you thousands of dollars every single month.
This isn’t because she is incompetent. It isn’t because she is lazy. It is because you have sent a soldier into a digital war armed with nothing but a fax machine and a smile.
The "Unfair Fight": Generalists vs. Algorithms
Ten years ago, a smart, generalist administrator could effectively manage a practice’s revenue cycle. The rules were relatively static, and payers were slower to adjudicate.
Today, the landscape is radically different.
Insurance giants like UnitedHealthcare, Aetna, and Cigna have deployed sophisticated Artificial Intelligence (AI) models designed to flag claims for denial at lightning speed. These algorithms scan for minute discrepancies in coding—missing modifiers, lack of specificity in ICD-10 codes, or bundling issues—that the human eye easily misses.
When you ask a loyal employee to manage your billing while also running the front desk, you are asking them to fight a supercomputer with one hand tied behind their back.
The Data: The High Cost of Multitasking
In our audits of private practices, we consistently see a metric we call the "Loyalty Penalty."
This is the gap between what a generalist collects and what a specialized Revenue Cycle Management (RCM) team collects.
The math is unforgiving:
The Multitasker Standard: An in-house employee juggling phones and billing typically achieves a Clean Claim Rate (CCR) of 85% to 90%.
The Specialist Standard: A dedicated RCM team, using predictive denial software, targets a CCR of 98%+.
That 8% to 13% gap does not look like a disaster on a daily basis. It looks like a few denials here, a few write-offs there. But compounded over a year?
If your practice brings in $1,000,000 annually, a 10% "Loyalty Penalty" means you are effectively burning $100,000 a year.
That is the cost of a new ultrasound machine. It is the cost of a nurse practitioner’s salary. It is the cost of your own retirement contribution.
The Trap of "Defensive Billing"
The cost isn't just in denials. It is also in fear.
In-house staff often lack the ongoing training required to feel confident about high-level coding. To stay "safe" and avoid audits, they often default to downcoding—billing a Level 3 visit for a complex patient who actually qualified for a Level 4.
They do this to protect you. But in reality, they are devaluing your expertise. You are performing high-complexity medicine but getting paid for low-complexity care. A specialized partner knows the guidelines well enough to bill for the full value of your work, audit-proof and compliant.
The Pivot: You Don’t Have to Fire "Betty"
When physicians hear this data, their first reaction is often defensive. "I can't fire Betty; she's family."
Good news: You don't have to.
In fact, firing her would be a mistake. Your practice needs her warmth, her institutional knowledge, and her connection with your patients.
The solution is not replacement; it is repurposing.
Let Betty be the face of your practice. Let her focus on patient experience, care coordination, and filling your schedule. These are high-value tasks that require a human touch.
Let specialists handle the war. Move the revenue cycle—the coding, the submission, the denial management, and the A/R follow-up—to a partner equipped to fight the payer algorithms.
This is not a demotion for your staff. It is a relief. It removes the burden of "Pajama Time" and the stress of angry collections calls, allowing your team to return to why they entered healthcare in the first place: helping people.
Is It Time to Specialize?
You would not ask your cardiologist to perform your neurosurgery just because they are "loyal." You would want a specialist.
Your revenue—the financial oxygen of your practice—deserves the same level of respect.
If you suspect that the complexity of modern billing has outpaced your current workflow, you are probably right. But you don't have to guess.
Let’s Look at the Numbers Together.
I offer a free, 30-minute Revenue Cycle Analysis for independent practice owners. We will look at your Clean Claim Rate, your Days in A/R, and your denial trends to calculate exactly what the "Loyalty Penalty" might be costing you.
No sales pitch. No pressure to switch. Just a clear, data-driven look at your financial health.
