Sep 29, 2026
Written By Elizabeth Cifers
Billing is often blamed for a lot in a medical practice. A claim cannot be submitted. A drug is not paid. A denial comes back. A balance sits in accounts receivable longer than it should. The natural conclusion is that billing did something wrong. Sometimes it did. But in many retina practices, billing is simply where a mistake made elsewhere finally becomes visible.
That distinction matters because you cannot fix a problem if you start in the wrong place.
Practices may be organized into departments, but they do not operate as independent businesses. The front desk, technicians, scribes, physicians, pre-authorization team, coders, billers, research staff, and administration all contribute to the same operational and financial outcomes. Each person's actions, whether entering, documenting, ordering, verifying, or overlooking, impact what the next individual can do. If the front desk selects the wrong insurance plan, the error cascades downstream. If eligibility is not verified, the problem may not be discovered until the claim fails at the clearinghouse or the payer denies it. If an authorization does not match the drug administered, billing cannot create a valid authorization after the fact. If the documentation does not support the code, the fact that the claim was submitted correctly does not make the service defensible.
By the time these issues reach billing, days, weeks, or even months may have passed. If the error isn’t caught internally, the first feedback may be a payer denial weeks later. The employee involved in the original mistake may not remember the encounter or even know that there was a problem. Billing did not necessarily create the problem. Billing just happens to be where the problem first appeared.
The revenue cycle does not begin when a claim is created. It begins when the patient enters the practice’s system. The front desk is responsible for information that affects nearly everything that follows: demographics, insurance selection, eligibility, referrals, and sometimes the first indication that authorization may be required. That makes the front desk a gateway to the revenue cycle, not a separate administrative function disconnected from reimbursement.
Garbage in, garbage out still applies.
But an error does not automatically mean the employee is careless or incapable. The employee may have received inadequate training. The process may be unclear. The written instructions may bear little resemblance to what actually happens in a busy clinic. The practice may be so short-staffed that a new employee was placed at the desk before anyone had time to train them. Of course, you can also face an employee-performance problem. Sometimes you do. The complication is that performance, training, staffing, and broken processes often overlap. If every failure is labeled an employee problem, the practice may discipline or replace the person while leaving the root cause untouched. Then the next employee makes the same mistake, and everyone acts surprised.
This is not limited to the front desk. Technicians influence the information available to the physician. Scribes influence how the physician’s work appears in the record. Physicians determine the patient’s treatment, documentation, and ultimately the claim. The pre-authorization team determines whether the planned treatment meets the payer’s requirements. Coders and billers depend on all of that information being accurate, complete, and consistent. Physicians play a critical role, but they cannot run the place by themselves. Neither can anyone else.
It takes the entire practice.
The business of retina is patient care, but it is also the business of operating a medical practice. The work performed across the practice funds the payroll, benefits, retirement plans, equipment, drugs, and the ability to continue treating patients. That is why “this is our turf” and “that is not our responsibility” are not harmless attitudes. Everyone is responsible for the business, not because everyone has the same job, but because every job affects the outcome.
Clear roles matter. Accountability matters. Reporting structures matter. But a chain of command is not a silo. Employees can have defined responsibilities while still understanding how their work connects to the rest of the practice. In fact, that understanding is necessary for the practice to improve revenue, reduce denials, and move patients through the clinic without making everyone work harder than they should. When a problem occurs, accountability should not begin and end with assigning blame.
Instead of asking only “Who did this?” ask:
Keep asking until you reach the real answer.
Repeated errors may point back to poor training. Chronic shortcuts may point to inadequate staffing. A department filled with new employees may point to turnover. And ongoing turnover should prompt a harder question: What is happening within the culture of the practice? Breaking down silos does not mean eliminating accountability. It means tracing the failure through the entire process rather than blaming the department where it finally became visible. Look at where information is lost, where departments depend on one another, where bottlenecks develop, and where the same mistakes recur. Then fix the process, not just the latest symptom.
If your practice keeps correcting the same denials, reworking the same claims, or blaming the department where the problem finally became visible, it may be time to look further upstream. Elizabeth Cifers Consulting evaluates the entire operational and revenue-cycle process to identify where problems actually begin—and what needs to change to keep them from happening again.
Click Book a Free Consultation, and let’s talk.
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