3 Ways to Plug $10k in Monthly Revenue Leaks, with Matt Slimming of PT Pilot Billing

3 Ways to Plug $10k in Monthly Revenue Leaks, with Matt Slimming of PT Pilot Billing

Quick heads-up for all the private practice owners who are tuning in. If you have been tuning in to the show for a while, you know that it took me at least ten years of grinding in my own clinics before I finally figured out how to scale and sell my four practices for seven figures and about three times the national average. The biggest shift was not some secret marketing hack. It was how I thought about profit systems and, actually, my role as the owner.

That is exactly what we are going to be working on together with you at the High Performance Practice Conference this fall in San Antonio, Texas. From October 15th through 17th, 2026, Adam, Robin, and I are hosting a three-day hands-on event for PT, OT, speech, mental health, PEDs, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all, do not depend on them 24/7.

We will dig into simple profit and KPI frameworks, real leadership and culture work, and practical systems you can take home and plug in with your team. If you are doing roughly 6 to 7 low figures a year and you want your clinic to feel more like a real business and less like a job/cage, I would love to see you there. Frankly, I would love to see you bring your leadership teams as well because we will have breakout sessions for them too. You can get all the details and grab your seat. Let us get into our episode.

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Welcome to the show. I have a returning guest, Matt Slimming, the CEO of PT Pilot Billing and RCM out of New Orleans. Good to have you back, Matt. It has been a few years.

Thanks, Nathan. Yes, it is great to be back. It is great seeing your cool new studio and all the tech that you have got going on. What a great environment, but yeah, great to be back. You and I have both been busy just hustling and working our tails off for the last few years. It is great to make time to catch up again.

That is right, for sure. It is good to have you back in this regard, because in the past, I think I connected with you because you might have posted in the PT magazine, the PPS magazine. This time, you are coming back because you are a sponsor/speaker at our 2026 Private Purchase Owners Club Conference. In your presentation, you are talking about five leaks where owners are losing money losing revenue. We do not want to share all your secrets, but maybe we can talk about a few of those.

If people want to learn about all five, they can reach out to you and either get the presentation, or they cannot even talk to you directly. Whatever it is, I am sure there are some very important key things that owners need to know when it comes to plugging the leaks in the organization. You are coming at it from a billing collections perspective. You are seeing exactly where some pitfalls are in collections. This is something that you have seen a pattern of over the years.

It is getting worse. Look, it is funny. I want to just touch on something about sharing secrets. I have chatted with a lot of CEOs of different PT groups. One thing that comes up from time to time with CEOs who are from a different industry than PT and they come into PT, they are always amazed at how transparent everyone is. We are all just, “We do not want to keep secrets as PTs generally do, as people in the PT industry.” When you mentioned the secrets, I do not have secrets too much. If someone wants to know, “I will happily share everything I know.”

There you go. That is awesome. We just might not have time to get into it.

It is not the time for all this.

That would take a lot of time, but we can get into a few of them at least. I will let you take it from here. If you want to talk a little bit about how you got into the billing sphere, because last time we spoke, you were not doing billing, but as it pertains to how you found some of these leaks that are across clinics. Not just individual anecdotes, but these common issues, common themes that you are seeing regarding leakage. How did you find them, and how did you get to that point?

Thanks, Nathan. We owned seven clinics in the greater New Orleans area, and we started doing our own billing because it was tough to find a billing company at the time that we trusted. This was back in 2016, or 2017, I guess. It took us a few years, but we got good at it. About 2020, we started doing it with other friend groups, other friend clinics, and then it is just, it has grown from there. Now that is pretty much all I do. Over time, we analyze a lot of stuff for our clients, billing clients.

We know that there is the ability for almost every clinic to make a strong profit, but there are leaks in every organization from when that first referral comes in or that first patient calls in all the way through to reactivation of patients. We know there are leaks. Everyone has them. It is a matter of identifying which are the bigger ones and tackling those first. Since what I do is medical billing, essentially, we are looking at all that relates to leaks that relate to revenue lost through the billing and the revenue cycle process.

Stopping The Front Desk Cash Drain 

I feel it is getting worse, and we will probably only have time to touch on one or two leaks. The biggest ones occur at the front. These are the most massive ones. The reason that this is becoming more apparent than it was when we started to do this for clients in 2020 is that the rules are changing from the insurance companies. They are getting tougher. They are just really tricky to keep up with. On top of that, of course, we have got inflation on the staff side. We are not always paying. We cannot afford to pay amazing money for our front desk people. I cannot pay them the wage for a professional, usually.

We are asking these middle-wage earners to be sweet and friendly, and they are happy with the patients that are coming in and get them scheduled, get them rescheduled, and get a co-pay. Also, by the way, get insurance verification done, check eligibility, and make sure you have got every payer you can. Make sure you get the authorizations on top of that. It is a lot. The task of getting insurance verified, getting the benefits, and getting authorization at the front desk.

That was very doable ten years ago. With the complications that the insurance companies put before us, with the challenges of keeping staff and what you have to pay a great staff member, it is really not very easy to do. It can still be done at the front desk, but it is harder than it was. What we are seeing is more and more errors there.

I am sure if we consider the insurance verification process to be that which you identify, “Who are the payers for this patient?” Oftentimes there is more than one, and what are their rules? What is the co-pay? What is the co-insurance? What is the prior authorization requirement? What is the maximum benefit amount? All these different things. Of course, then we have to communicate that with the patients in a correct fashion so that they know their responsibility.

I can definitely see that. Verifications and authorizations can then become a distraction from their primary responsibility, which is to schedule those patients, reschedule those patients, collect every dollar at the time of service, or make sure patients get to the appointment ready to pay. Those are their main three priorities, and verifications and authorizations honestly do not quite help those main three priorities. Thus, we have usually recommended finding some way to offload. Those verifications and authorizations to some virtual assistant or someone outside of the person managing that one-on-one interaction with patients so they can focus on that.

Collecting Every Dollar At The Door 

It is still quite difficult to stay on top of things, or do they have the authorization that we need for that visit. Did that get communicated by the person who is supposed to get the authorization? Did they get it in a timely manner, or did we get the facts in time? Did we get all that information? It can be so hard, and there is so much going on at the front desk. I totally agree. If you can really shore up the collections at the front desk, that is the easiest way to start making a lot more money in your organization. You and I both know if they miss that payment at the time of service, then the likelihood of collecting the full dollar goes down dramatically.

You are collecting, on average, about $0.50 on the dollar for every copay or co-insurance that does not get collected at the time of service. It is imperative that they collect it at the time of service. To the point where I highly recommend keeping credit cards on file. You can capture all that on the same day, but I am totally on board with you. If there was one thing people could do to increase their revenue their cash flow, it is fixing things at the front desk, making sure it is as organized and systematized. That front desk person is given the bandwidth and the capacity to collect everything that they can.

I asked about going into this presentation at the PPO club conference. I asked one of my billing managers what it is. We have clients that really want to do this themselves. They want to get their front desk systems down, and we help them. We provide training for the front desk to help them. There are quite a few clients that, after doing that, allow us to do it. We have a whole remote front desk suite on site here in Louisiana. We do the remote front desk for a bunch of our clients. It is a nice service because it is so hard to get it straight. As you mentioned, it is hard to keep up with that. They have it for a bit.

Maybe that front desk person gets sick. I cannot come in, or their child gets sick, or you name it. Their car breaks down, weather gets in the way, and having some remote services like that can be a huge support.

Even just as a fill-in, not as a permanent, but yes, it is very useful because, as I said, the rules change. The worst-case scenario, of course, with this is the in-house front desk or whoever it is. Frankly, we do not see these areas just at the front desk, but even when they have a defined area at their office, the person doing this always keeps up with it. The nightmare scenario is, of course, maybe a poorly done insurance verification that maybe does not get all the information, or maybe it is the wrong payer. Maybe the patient has two insurances, and they go with a secondary. Who knows when they determine that no authorization is required.

Dodging The Prior Authorization Trap 

That is the worst, because if that is not the case, if authorization is required and maybe they called the wrong insurance, or they did not listen to the whole thing, or they did not, or they trusted the website for the payer, and you cannot trust those usually. You end up with PT treating this patient three times a week, and it could be a month before you hear back denial, no authorization. You have got $1200 that you, for many payers, cannot get retro authorization for. You just lost that money, and that is tough. That is a tough pill to swallow.

As I mentioned, one of my billing managers has said, “What is the average amount that you find that the clients that you have under you lose every month to those clients that are having this issue?” He said, “It is close to $10,000 a month on average.” Those clients that are having the issue, not everybody, but those folks who have an issue, do not want to outsource it. Do not want to really get involved and fix it. It adds up pretty quickly.

Man, that is another provider salary right there. That is a lot of money. If it is not another provider, it is a lot of money going out of your back pocket. You just got a hole in your pocket, and it is just falling out. That is crazy.

Thankfully, easy to fix. It is not rocket science. It just needs to be done correctly. Owners do not usually have the time to train their front desk on that. It is a lot. We get that. We understand. That is why we do that training. Yes, it is when you compound the effect of that month after month. Really, that is probably mainly profit. If they want to get that, that is profit that goes straight into the bank and into investments or whatever.

For sure. In line with you there, whatever you can do to free up stuff at the front desk so that everything can get collected. Authorizations are properly done. Verification is properly done. That is all systematized work. If the provider is not focused on that, if the owner is not focused on that, then that is a leaky hole in a bucket for sure. Where do you go from there? Say someone is short. Get that pretty short up. They have got someone pretty strong and stable. They dog it in their collections, and maybe they figured out the verification authorization game. Once that is all figured out, think collecting is significantly easier, but it sounds like you are still seeing leaks.

Look, when someone has that down, it is a joy. We love all our clients, but for those folks who take that seriously, it is a win-win. Of course, they are doing better. It is less stressful for us to get them paid. Yes, the next big leak for folks who are doing their own billing that we usually see is poor claim follow-up. When we generally take over an account or client, we are seeing just massive AR sitting there.

AR aging is going up into the light, down into the right.

Fighting Deliberate Claim Denials And Adjustments 

There are some good stats. The reason for this is because it is a lot, the insurance companies, they make their money, part of them massive amounts of money by denying claims, by not paying. Honestly, they bank on most owners not fighting those denials, not fighting those payments, those poor payments, but just some interesting stats. Healthcare nationwide, between 10% to 15% of all claims are denied. Between 2% and 5% of all claims have an incorrect adjustment code. Insurance companies will use an adjustment code rather than a denial. They will just put it. You would just assume, “It is just an adjustment, but it is an incorrect adjustment.”

When you say adjustment code, it is adjusting down from say $20 for that code down to $17 or $18 or something.

They may adjust the visit off completely and use an adjustment code as opposed to a denial.

They are just changing the semantics.

They are getting very creative. If you have AI looking for adjustment codes, it is not going to. That is right. Looking for denials and not out.

It might miss the adjustment codes. Think about what you are talking about. Interesting.

You have got between denials and incorrect adjustment codes. You are between 12% and 20% of all claims. There are claims that they say were never received. That is at least three percent. A funny story, years ago, I worked for a good-sized PT group. This is back in the late nineties, mid-90s. They brought in a guy to oversee their billing. He had worked previously for a large insurer that I will not name. He said that once a week, one of the managers would come downstairs. This was before EMR.

This is when everything was mailed, and he would empty an entire bucket of incoming mail into the trash. That day's claims were never received to be paid. Assuming that a huge percentage of providers at that time would not bother calling to say, “Wes, you never paid me on this claim.” That does not happen anymore. I am hoping, but there are things that they do. There are things that you hear about that they do that are in the same vein, where they try to say, “I never received it.” We know that many insurance adjusters are incentivized by the number of denials that they process. Everyone is motivated on the insurance side to lose claims, adjust down, deny.

I am cynical enough to believe that they just program their AI bots to deny at a certain rate, to adjust at a certain rate, and to mysteriously erase claims that had been. It is all tied just like a casino's slots. I think they are all just programmed at certain percentages.

Produce you a different, no, you are a hundred percent right. One of the players got in trouble last year because their denial rate was so very high. Upon investigation, these were denied by bots. The insurance company owned the bar. They programmed these bots to deny a certain amount of claims. 70% or 80% of the claims that the bots denied were later overturned by humans when they actually looked at the claim. Yes, Nathan, you are 100% correct in programming them to deny, and hopefully the law catches up with them, but not always.

You just cannot trust them in the meantime.

There is no trust in your insurance company. All of those reasons for under or no payments end up being maybe twenty percent of claims when you add all that up 1 in 5. When we look at these great PT groups and clinics that are doing their own billing, it is hard for their biller to keep up and to call on one-fifth of their claims that didn't get paid correctly. That is the second big leak is just no one on staff having the time to sit there and wait on hold to get through to the insurance company to fight it, to write the appeals, to deal.

Workers' Comp, for example, is a great example. In most states, there are some pretty stout provisions for providers to get after Workers' Comp, who pays after 30 or 60 days, to the point where in some states they can add, you can add $2,000 to the bill for a claim, up to $2,000 to the bill for a claim, $50 a day for every day they are late. There are some teeth for workers' comp more than there are for other payers, but yes. That would be the big second league made is folks just not having the time to work the AR every month and address all those nonpayments or underpayments.

How does your team become proficient in catching some of those adjustments or denials? Do you have software that supports all of this to make sure you are catching it, or how do you go about that?

It is interesting. There are some billing platforms out there. I will not mention names that tout their AI ability to do this. The challenge is that insurance companies have way better AI. It is not in their interest for our AI to be able to detect what their AI is doing. I do not think that every software, every billing platform, and we work in all the billing platforms, all the EMR billing platforms, as well as some other billing platforms that are separate from EMR. They all have some ability.

If you use the right filters, if you know what you are doing, you can set things up so that you can catch a lot of these things. A lot of it, Nathan, still comes down to a manual look. In some ways, there is job security for us, I guess, in that we are not about to be taken over by a robot this year. On the other side, it is a grind. It requires looking at these denial reasons, these adjustment codes, these payment amounts, then doing our own internal auditing for our clients. We can look at that stuff afterwards and make sure that the other things were not missed.

There was a time when I owned my own clinics that if you go back to the initial year or two in which I had the show back in 2018, 2019, maybe even into the 2020 that I recommended many people just do their own billing in-house because I simply was not impressed with the outsourced options that were out there. Now I have seen so many companies like yours that do such a better job than what we used to deal with. I tried outsourcing a few times, and just finding the right person to do it in-house ended up working out best for us.

Now that I have seen you or Will Humphreys, and other programs that provide billing support, you do so much better than having to train someone, have them on staff, and hope that they do great and hope that nothing ever happens to them, because if they did, then your collections all of a sudden go up in the air. You do not know where to start because you are so dependent on one person. It has been so good to see more people that we can outsource our billing and collections to.

Leveraging Economies Of Scale In Billing 

It is a specialized job, like anything. There are things to know that the average biller who is working in a PT clinic just is not going to learn. They are not going to be part of the conversation at the high level, probably, to really learn all the changes that are occurring. That is part of it. The specialization that is required these days is huge. The time that is involved is massive. When you have a team of about 30 here in the office, and there is a lot of collaboration, you can have someone on hold for half an hour waiting to speak to Blue Cross, and someone else can be doing whatever is needed in the account to keep things rolling. Just the economy of scale makes it a bit more realistic as well.

Not necessarily a billing-related question, but I am assuming it is another leak, and I am certain this was part of your presentation, but I find there are plenty of opportunities there for owners that are unaware there may be plenty of opportunity for increased revenue, just looking at the way that they are charging for services. I do not want to steal your thunder, but is that also another common leak that you are seeing?

It is a huge leak. Nathan of Cronhagen.

You and me, back in the old days, there were always three Therax, one manual, which is probably the worst way to bill nowadays. I am pretty certain it is, or heaven forbid, two Therax, two manuals nowadays would be even worse. Is that part of it as well?

Capturing Unbilled Clinical Value 

It is. It is such an important part, not just billing the right codes, but billing the right number of codes in a given time period. You walk into most physician offices, and they are being paid for an eight-minute consultation too. They are not seeing you for twenty minutes, probably, unless they are billing for all that time and adding stuff to it. We, as PTs, think, I have got to treat this patient for an hour or 45 minutes and only bill them for 30. We need, I think, to be looking at our treatment and just making sure that it is viable given the reimbursement environment, and then be making sure that we are billing all the codes that we are seeing. For example, a couple of years ago, self-care came out.

97535. Hardly everyone I talk to people all the time. They hardly know about it. I am like, this is going back twelve years when I was billing it, but every time I instructed on a home exercise program, especially at the initial eval, it was 97535. I do not know. Some States are easier to bill than others, but at least be aware of it.

That is right. It has changed a little bit for what you can bill it for, but look, the classic thing is, “Let us say it is a neck patient and they are having trouble sleeping and talking about positioning, pillow selection.” Things like that. It is all very doable. As a PT, you are having those conversations with your patient, probably almost every visit. You are saying, “How is it going?” Unless they are saying, “I am awesome.” They are talking about something outside of the clinic. That is a problem. When you can talk about that activity, that position, that whatever it is, help them and guide them. You better be getting paid for that. That is important work.

If it is not hands-on, even if it is not an exercise, that kind of consultation for ergonomics or pain-relieving positions or activities, lift with your legs, not with your back, and all that instruction is billable time. Got to take advantage of it.

That is right. For most of the providers, it is their third highest-paying code, not including the evaluation codes. That is a big one. Yes, I think billing the right codes, not being afraid to utilize group therapy when it is appropriate, and billing the right number of codes. Time and time again, we see clinicians who are underbilling or billing old-school, Nathan, as you described.

Billing via Medicare guidelines when they could be billing via AMA guidelines for the appropriate payers.

That is so true. It is a tough conversation for the owner to go to the staff PTs and say, “Listen, I would like you to start billing like this,” because it sounds like self-preservation, and it sounds like, “I want more money. Feed me.” It is just not so that we, actually, come in charge of this at all, but we do Google Meet, and we train the staff on how to optimize that. It is not. We are not going one-on-one with every staff member, but we do. The point is, this is not just your boss wanting to buy a boat. This is industry standard. This is how you treat yourself excellently. When you treat excellently, it just so happens that if you are billing what you are treating, it is optimal billing.

This is also, if you, I also like to lean on maybe a question around, “Do you think we are getting paid what we are worth as therapists?” If they say no, “Can I teach you how we can maximize what we think we are worth within the given guidelines, within today's guidelines? This is how we can do that.” To your point, I totally agree that it should not be coming from the owner, if at all possible. It should either be coming from their peers or from a third party like yourself, which is huge.

Having someone else besides the owner do that kind of training and show them what industry standard is, what best practices are, what is ethically justifiable, and how to document appropriately to justify higher-paying codes. Huge. Whatever investment you have to put into that is super important that it comes from someone besides the owner. Very good. I know we cannot get into everything else. I know you have a few more things that you found to be historical leaks for clinic owners. If they wanted to find out those other leaks, how can they either get your presentation or get in touch with you?

Happy to share that with Nathan and anybody. As I said, we just want PT groups to do well. If we are all doing well, we are all healthier. We are all probably better as an industry and showing our worth to the payers and all that good stuff. Anyone can email me, Matt@PTPilotBilling.com, and I’m happy just to share what we find best practices and even some disciplines, at your conference or shared, the weekly and monthly disciplines.

Tracking Billing Key Performance Indicators 

If they are doing their own billing, let me share. Is what you want to be doing every week and every month. You had your own biller, and that is great. Now, those owners with their own billers, they really need to be analyzing stuff. Looking at the billing there, just as for treatment, there are KPIs for billing there are KPIs as well. I can show folks how to measure that stuff, how to track it, how often to do it. They can feel confident that their billing is going well.

That is huge that you would offer that because I think billing and collections management across the industry by clinic owners is a really weak spot. We just do not know what is going on behind that curtain. We are just hoping that the money is coming in and that our bank account is going up. Once owners know how to manage billing collections, as you said, the billing collections KPIs that they should be aware of, what reports they need to be looking at, and what is good and what is bad within those reports, what is the industry standard, what is the expectation.

You can be very comfortable knowing the health and status of your billing collections team and that they are collecting every dollar that you should receive for the services you provide, because that is a weak spot. Again, that is another area, just like the front desk, that if you can clean that up, it can be very quick. When I say quick, 60 to 90-day increase in revenues.

It can happen quickly. It takes time when we take over a client to get all their AR back to the right KPIs because you might have to work a claim four times before it gets paid. The revenue increase starts right away because things are being done correctly on the front end. The payments start coming in better.

That effort that you put in on the front end, should you continue to manage appropriately, pays off forever. It is not just a one-time payoff. Now you are going to see an increase in standards and collections across the board going forward.

Absolutely.

Before we sign off, number one, to appreciate your time. Number two, is there anything else you want to share before we do so?

Man, I would just say we come across a lot of owners who are dejected, who feel that the glory days are behind them, and it is just too hard, and the money is not there. We see that there is still great potential for significant profit in PT practice. If you are listening to this and you are just having a tough day, and you just feel like the profits are not enough, there still is a significant opportunity, but it does require closing those leaks. Some of those leaks are new in the last five years. Some of those leaks have been around for 30 years. If we close all the leaks, then PT is great. Even if we close 75% of the leaks, a clinic can still be very profitable.

Very cool. Thank you for sharing and providing a little bit of optimism. There is a way to do it. It used to be a lot easier to make greater profit margins twenty years ago, but it takes this kind of effort. It is staying on top of your internal systems, procedures, and your KPIs. As we talked about today, it is still there to make a profit.

That is right. We are just going to be business owners.

We act like business owners who actually own a business and not physical therapists who just happened to own the clinic. Different mindset. Thanks for your time, man. Again, thanks for presenting at the conference. It was great to have you there.

Great. Thank you so much, Nathan. Appreciate all that you guys do.

Important Links

• Matt Slimming on LinkedIn
• Matt@PTPilotBilling.com
• PT Pilot Billing and RCM out of New Orleans
• 2026 Private Purchase Owners Club Conference

About Matt Slimming