What to Do When Your Cash Dips (and Where to Start Looking First)

Every practice has felt it: that slow-drip panic when the bank balance is lower than expected. Payroll is due. Bills are stacking up. You’re booked out for three weeks, but the cash isn’t flowing like it should.

Before you hit the big red panic button, know that cash flow dips happen, even in well-run clinics. The good news? The answers are usually in your numbers. And no, we’re not talking about crystal ball forecasts or “gut checks.” We’re talking about revenue cycle metrics. These are the day-to-day indicators that quietly tell the real story behind your cash flow.

Here’s where to start looking when things get tight.

1. Days in A/R: How long does it take for you to get paid?

This is the big one. If your days in accounts receivable are creeping up past 40 (and especially if they’re over 60), you’ve got a cash delay problem. It means money is sitting on the table, waiting to come in, possibly due to claim denials, delays in processing, or slow payer responses.

Break it down by payer. Is one insurance company consistently dragging their feet? Are you submitting clean claims on time? Are follow-ups happening, or are they falling through the cracks?

2. A/R Aging Buckets: Where’s your money stuck?
Don’t just look at the total A/R. Look at how old it is. If a big chunk is sitting in the 91–120+ day buckets, that’s a red flag. The older the claim, the harder it is to collect. Focus your team’s energy on working down the oldest claims first, but also investigate why they’re piling up.

3. First Pass Resolution Rate: Are claims getting paid the first time?
If claims are routinely getting denied or kicked back, you’re wasting time and losing money. Check your first pass resolution rate (the percentage of claims paid without resubmission). If it’s below 90–95%, there’s likely a documentation, coding, or eligibility issue upstream.

4. Net Collection Rate: Are you actually collecting what you’re owed?
Even if you’re billing correctly, if your net collection rate is low, it means you’re not recovering the full amount you should be. This might be due to untimely filing, lack of follow-up, write-offs, or uncollected patient balances. If you’re collecting less than 95% of what you’ve contracted to receive, it’s time to audit your RCM process.

5. Patient Collections: Are you leaving money on the table at check-in?
Patient balances are making up a larger percentage of revenue these days, but they’re also harder to collect after the visit. Do you have a clear policy on collecting copays and outstanding balances at the time of service? Are staff trained and empowered to have those conversations? Are you sending patient statements on a consistent schedule? It’s deductible season and those patient A/R balances have been piling up.

6. Charge Lag: Are you even billing everything you’re doing?
Sometimes the issue isn’t with collections, it’s with charges never being entered in the first place. Look at how much time passes between the date of service and when the charge is submitted. A long charge lag delays revenue and makes it harder to stay on top of the revenue cycle.

7. It’s revenue cycle, not revenue linear.

Real chat? If you’re a well-run practice and doing everything right, there will still be dips. It’s called revenue cycle, not revenue linear for a reason. The elephant in the room? It’s payers. They are businesses controlling their own cash flow and tax obligations. There are forces beyond your control. One of the best ways to prep for this aspect is to know your numbers. Look at your practice dollars year over year. If every single April for the last 4 years has had lower net collections than March, it may just be a normal dip.

Wrapping up

If your cash is dipping, don’t just cut costs. Find the leak.

It’s tempting to hit the brakes on expenses when cash gets tight. And yes, it’s smart to assess your overhead, your staffing model, and any unnecessary subscriptions or service contracts. But the more sustainable solution is to fix your pipeline.

Look at your RCM performance. Run the reports. Ask hard questions. And if you need help untangling the data or revamping your billing process, we do this every day.

A cash dip isn’t a failure. It’s a signal. And with the right response, it can be the push your practice needs to get stronger, smarter, and more financially resilient.

Need an extra set of eyes on your metrics? Let’s dig in.

Disclaimer: The content provided herein is intended for educational purposes only and does not constitute financial or legal advice. This content is not intended to create, and receipt of the launch guide does not constitute, an attorney-client relationship. While efforts have been made to ensure the accuracy of the information presented, it may not necessarily reflect the most current legal developments or regulations and does not provide a complete representation of all associated legal and compliance considerations for any given topic. Therefore, readers are encouraged to seek professional legal advice or consult with appropriate professionals regarding specific legal issues or concerns related to their individual circumstances.