Here’s the “reality check” so many now-successful doctors have thanked me for delivering to them:

If you’re a physician/practice owner struggling to maintain cash flow

(or even hoping to bring in the Big Bucks), please know this:

Your lack of success is NOT because you haven’t found the right

super-secret device or magic advertising bullet…

Nope.  The success you crave is being held up because of something much simpler… and much easier to solve.

So here is the Big Question: Do you want to waste more time chasing fads… and second-guessing yourself…

… Or are you finally ready to learn and implement the first simple step to creating lasting financial success in your practice?

Okay, then. Let’s get started on changing your life forever…


Dear Doctor:

My name is Dr. David Zahaluk and I’m on a mission to change how medicine is practiced in the US.  I want to reconnect doctors with their patients in a more humane way – knowing that you can have adequate time for your patients and a personal life too.  I want to reconnect doctors with their ideals – the values that drew you to your profession – of being someone who helps people in a profound way… to live longer, healthier lives.

In order to accomplish this, I need you to improve your business infrastructure first.  I need to provide you with better management, more organized workflows for your staff, better marketing and better billing/collection processes.

Only when you’re surrounded by best in class people and processes, will you become the best physician you are capable of being.  The biggest beneficiary of this process improvement will be your patients.  That is real healthcare reform: better organization and management of your business practices so the doctor-patient dynamic can evolve.

You simply can’t excel (or in some cases survive) until first you “clean house”.  We have become so fragmented and overworked as doctors that we have lost our way.  And heaven help us if we rely on government, insurance companies or some other party to give us our direction.  We have to be responsible if we want our practices and our lives to improve.

Even though I’ve been a physician for almost 2 decades, as well as a practice development consultant, I’ve never heard this much panic in the profession.  I get emails and calls all the time from doctors who are scared they will have to leave the profession because they can’t keep their practice cash flow up.  (And then do what… get a job at Home Depot?)  Most of the struggle comes from the high-wire balancing act we doctors have to perform to get payment from the insurance companies.

Their fears are justified.  Look at some of the pertinent statistics:

  • Gross charges denied by payers have grown over the last decade to 18% of all charges. … which equates to $118,800 of lost revenue for the typical primary care physician.
  • 25% – 40% of all claims are either delayed via editing or are denied.
  • 20 – 50% of denied claims are never re-filed.
  • 90% of denials are preventable.
  • 67% of denied claims are recoverable.
  • Most practices lack clear documentation and protocols to address accurate data capture, clerical errors, and follow up procedures.
  • Turnover in a medical office averages 30% per year; eventually your in-house billing personnel will leave – it’s just a matter of when
  • The cost of hiring an average billing clerk – not a top level person – has increased by nearly 40% to a national average of $31,421.  When you add in the cost of FICA/FUTA/SUTA, Worker’s comp and other benefits, the real cost of that employee increases to $40,847

I have worked with practices and practitioners from California to Florida and from Wisconsin to Texas.  I typically see net practice revenue increases of $100,000 annually and more by working on the billing and coding processes of a practice.  It’s not magic; it’s just a simple fact:

“Doctors are so busy seeing patients and supervising their staff they don’t have time to be good at managing the billing process.  Yet, from a business perspective, that is the #1 most vital process in your practice.”

I make this point repeatedly throughout my book, The Ultimate Practice Building Book, Traffford Press 2007.  Most medical practices are not run like a large company is.  There is no uniform adherence to business standards, whether it is standards for hiring staff, marketing or billing.  As a profession we are vulnerable here, unless we start to make our practices run like a real business does.  The real enemy of our financial success is us, because we try to manage too many processes we are not good at, rather than teaming up with the right professionals who can carry us forward.

Okay, What’s the Problem?

If we’re going to make your office more financially successful and a happier place to practice, we should begin by diagnosing the problem.  Let’s begin with that…

Problem #1: Management.      It’s not the biller you hire or even the billing software – it’s the urgency with which you go after the money.  We make it our business to go after every dime as though our existence depended on it – because in reality, your success is our success.

The typical in-house biller keeps a stack of denials on his/her desk that sit there seemingly forever.  With no one to report to, there’s no real urgency to get started.  These denials are revenue to you; they may be just more busy work to your biller.

What gets measured gets managed – that’s a key principle of management. That is why we put processes in place to measure the timeliness of claims submission, the accuracy of claims data and duration of the claim cycle.  We created standards that clean claims go out no later than 2 days after the date of service, that we receive receipt of claims within 2 days of submission and we have a definitive response on all claims within 3 weeks of submission.

In order to make that work you need at least 3 levels of employee.  You need someone to enter the claims, someone to work the denials and someone to measure the outputs of the first two and supervise their progress.  One in-house biller just cannot compete with our team of highly trained specialists.

Problem #2: Too Little Skin in the Game

OK, if you’re the in-house biller or outsource billing company for a small practice, here’s the drill.  You work really hard at first to make a good impression and earn accolades… for a while.  Then you coast.

It’s hard to fire someone, and most doctors are loathe to let someone go.  Especially because it turns out there is isn’t a lot of really good help out there in the medical billing world.  Most billers are average to below average.  And you may replace one biller with an even more mediocre one.

But when the biller’s life gets complicated, processing your claims might become less important.  Days of delay become weeks – because once they have your business, you’re no longer the top priority.  They don’t have “skin in the game”.  They’ll never go after the claims with the same intensity as if it were their own.

I have a client with an in-house biller who just mentally “flaked out” after 11 years on the job.  When the manager (his wife) finally looked at the billings they found there was $16,000 worth of bills in the current month that had not been submitted for no good reason, except for her “stress”.  There were tens of thousands more not submitted and about a third of it could no longer be recovered because it was past the 180 day posting deadline.

His billing person’s stress literally cost my client over $15,000 just because she couldn’t stay on task.  Could you imagine taking $15,000 out of the bank and just lighting it on fire?  The scary thing is, when we look at most practices we see the same huge waste of money, often larger than this clients’.

Problem #3: Not Working With the Top People.

Do you know that a person can become a medical biller by taking a short correspondence course?  Literally they learn their profession by trial and error with your billings.  You become their free college course.  And if a charge get missed, or incorrectly entered incorrectly, you are paying for their mistakes… big time!

Granted you may not meet this person.  You may meet a salesperson who is fronting for this business.   Beware the inexperienced in the field of billing.  At Performance Billing Services we have over 50 years of collective experience in solving all billing challenges.

Problem #4: Most Doctors Under-Code.

Doctors have been trained from residency to avoid overcoding.  The threatened reprisals from Medicare, including sanctions, revocation of your license, huge fines and even jail time, have been permanently etched in our frontal lobes.  Let’s face it, we’re afraid – and we routinely undercode.

Did you know that, according to Medicare, undercoding is as much fraud as overcoding?  The answer of course is to code correctly.  That means for most of us, we have to be retrained.  Because we work in partnership with Ultimate Practice Builder, we can offer their best-in-class “Success Tracks” coding coaching program absolutely free to our billing clients.  That is a $2,250 value to you… but even more when you consider it will add tens (and in some cases hundreds) of thousands of dollars to your practice revenue.

You can read more about this below…

Problem #5: As Your Practice Grows, Billing Efficiency Decreases.

Did you know that as your practice grows, the efficiency of the billing processes decreases?  One person can only process so many claims in a day.  Once you reach threshold, your process loses efficiency (and your collections go down) until you can afford to hire and train and manage more help.  Many practices are stuck because their billing infrastructure simply will not allow them to grow past this glass ceiling (point of constraint).  When you use Performance Billing Solutions, your growth is not constrained.

Problem #6: The High Cost of Personnel.

Even in today’s tight job market turnover is high in a doctor’s office.  That national average is 30% per year – meaning your staff may turn over completely every 3.3 years.

Let’s face it, the new generation of employees isn’t as concerned about doing their job well.  They are more concerned about their benefit package, their next raise and more time off.  With more hospital systems coming into the market and gobbling up small independent practices it will be harder and harder to keep your best employees.

If you lose your biller – even if he/she was mediocre – it’s going to be a pretty bad day.  Your whole cash flow hangs in the balance.

Not to mention that staff costs are deceptively high.  According to the average medical billing clerk (that is an entry level position) earns a base salary of $31,421.  Now add to that 30% for FICA/FUTA/SUTA, worker’s comp, benefits (which you have to offer to keep this person), etc.  Now we’re up to $40,847… just for someone who probably isn’t a top person.

And yes, savvy physicians pay more for the best billing personnel – sometimes even into the six-figure range – because they know it is an investment that will return them a multiple of what they are paying.  But if an illness should arise, a spouse’s job transfer, a divorce… your cash flow could be temporarily wiped out leaving you stranded.

Problem #7: Not Having Top of the Line Software (It Changes Regularly).

The best software is likewise a key investment in securing your cash flow, especially with the changing insurance codes, pre-certification rules and other mumbo-jumbo.

Why do you want to invest in all that hardware, software and updates only to own something that is outdated in a few years?  Doesn’t it make more sense for us to carry that cost for you?  Leverage our state of the art technology so you don’t invest a lot of your hard earned money in software that will soon be obsolete.

Problem #8: (This is the most important problem.) The Real Key to Practice Growth Can Only Be Found In Your Billing Data.

If you haven’t been paying close attention so far, now is the time to wake up and read very carefully…

Most billers don’t understand the significance of the data they are processing and they can’t help you to profit from it.  There, I said it.

They don’t have advanced degrees in marketing, they don’t have medical degrees and they don’t have experience in building a medical practice.  They’re not bad people – just limited in the scope of what they can do for you.

I got started in medical practice consulting because I was very successful in building my own practices.  In fact, I took a small 2-physician urgent care from a gross revenue of just over $500,000 to over $1,800,000 in 3.5 years.  Suddenly other doctors wanted to know what I was doing to be so successful.

How did I do it?  By improving the marketing, process flow, staff training, coding and billing.  But I always studied the results of what I was doing very closely.  In a medical practice, your financial scorecard is best represented by your billing and collections.  You show me your billing and collection data and I can pretty much tell you what is working in your practice and what isn’t.

In fact, I routinely take solo practices up in revenue by six figures or more and I always start by analyzing their billing and collections data.  (I also look at their P+L, mainly to look a their costs.)

We have several proprietary marketing products that work like gangbusters that can significantly grow your practice… but they work much better if we have access to your data.  In fact we offer these products (through Ultimate Practice Builder) at deep discounts to all current clients of Performance Billing Solutions.  But getting the billing done right and having access to the data is like building the foundation to your dream house.  Don’t start building your castle until you have a solid foundation.

What Are the Possible Solutions?

You basically have 4 choices…

A.     Hire, train and supervise your own In-house medical biller

B.     Outsource your billing to one of the run-of-the-mill billing companies

C.     Turn your practice over to a management company

D.     Outsource your billing to Performance Billing Solutions

Choose #1 if you want…

  • To manage a technical process that you don’t have time to keep on top of
  • To have the lowest level of collections possible
  • To risk seeing one person quit and grind your cash flow to a screeching halt
  • To lose about $118,000 worth of revenue

Choose #2 if you want…

  • To have your billings managed by someone with no skin in the game
  • To be subject to the expertise level of someone that is very hard to vet (really, how can you ‘test them out’?)
  • To risk your cash flow being halted if they go out of business
  • A lack of strategic direction for your practice (they don’t help you build your practice)

Choose #3 if you want…

  • To lose control of your practice (I call this management by abdication.)
  • To give away up to 25% of your collections
  • To lose the ability to sell your practice or borrow against it
  • To lose the ability to expand your practice as it becomes more successful and earn passive revenue through associates and mid-levels
  • To risk dealing with people who may end up treating you unfairly ( Some of the stories I could tell would shock you.)

Choose #4 if you want…

  • More revenue… guaranteed
  • The lowest amount of risk… guaranteed
  • Consistently high collection ratios and short revenue cycles – often under 30 days
  • A free coding coaching program worth $2,250 that will raise your coding acumen and expertise
  • Access to the brightest minds in practice building and management at no added costs
  • Deep discounts on highly effective proven medical marketing campaigns

.Why Did I Create This Billing Company in the First Place?

The truth is I had no intention of getting in to the medical billing field.  It’s just not sexy.

But when I saw how many rogues and rapscallions were out there providing mediocre service or worse… and fleecing their physician clients… and what happened when their businesses got interrupted… I was appalled.

Both for my own practice and for our clients, I felt it necessary to step in and take care of this process once and for all.  It’s a basic necessity of practice that is so poorly managed.  No wonder doctors get more ulcers, grey hairs and family problems more than the average civilian.  We’re subject to processes that are dysfunctional and yet we’re still expected to make everything work out.


How is Performance Billing Solutions Different?

Performance Billing Solutions is not just another medical billing firm.  In fact there is no one else in the market that I know of that offers what we do at all… much less one that guarantees your results!  Here is how we’re different:

  1. We are 100% physician owned and managed.  I have walked in your shoes and I feel your pain.  And I’d like to help you feel a lot less pain and really start to enjoy being a doctor again.
  2. Free Coding Coaching program.  ($2,250 value) What can I say?  I developed this course in working with my most successful doctors and I’m very proud of it.  It is the best way I know of to download all of that technical expertise –and financial success – into your stubborn resistant brain.  It flat out works.
  3. Our Guarantee.  We’re so sure of our processes and our people that we guarantee your revenues will increase or you don’t pay for our services.
  4. Fifty years of combined relevant experience.
  5. Top of the line software.  Our claims scrubber is arguably the best in the business.  It is based on a huge database of all the rules and conditions imposed by the insurance companies.  You can not play ball with the insurance companies unless you know the rules… and our software evens the playing field.
  6. Staff training.  We study your denial trends and train your staff to stop making the same costly mistakes that lead to the denials in the first place.
  7. We’re a little bit obsessive-compulsive.  We review each claim twice (electronically and manually) to check for errors before claims go to the clearinghouses – by rigorously checking to make sure claims go out clean we can get you paid faster – sometimes within a week of the date of service
  8. We track your claims like hawks.  Our standard is to verify receipt of each claim within 2 days of submission and all denials within 3 weeks of claim submission.  If any claim is not tracking to get you paid on time, we flag it and provide the extra elbow grease needed to get claims through.

Success Tracks Interactive Group Coaching

Imagine being in a mini-residency where you learn the accurate details and advanced implementation of the AMA’s coding and documentation guidelines.  Only there is no call, no late nights and no scut work.  In fact you can do this residency from the privacy of your home or office.

We will drill down to look at all the relevant codes, modifiers and scheduling strategies to ensure you get paid for 100% of the services you perform.  This is not a course on how to rip off the insurance companies or milk the system.  This is for serious physicians that expect to work hard for their patients and get paid fairly for the services they perform.

Coaching takes place in either a small group or (occasionally) individual setting via webinar.  Physician-participants will provide their own clinical notes and charge slips as material to analyze and learn optimal coding and documentation guidelines.

The course lasts for 3 months, with new material added each week to strengthen your database of relevant knowledge.

What Are Doctors Saying About Performance Billing Solutions?

“My collections increased by 39.5% within the first year of working with Performance Billing Solutions.  That’s a six-figure increase in real income into my practice.”

– Sharon Kirven, MD

“Your program has raised my income by over $100,000 a year and my office has become significantly more efficient.  I am grateful for all your help.”

– Steve Wolfington, DPM

“Performance Billing Solutions is designed to help physicians realize their original vision of business ownership, wealth and the joy of medicine in today’s crazy healthcare economy.”

– Blair Singer, Author of “The ABC’s of Building a Business Team That Wins”

Important Note: Only Available to our full service clients!

Unfortunately, we only provide these services to practices we work with intensely. Why? Because billing performance is affected by every member of your office team. A lot of moeny is lost by not training and sometimes retraining your front office on the basics. If we can’t help that process along, we are not helping you. However, if you are ready to have a more lucrative practice, with less stress and more enjoyment then you are ready for the next step.  Simply send an email to me at  My assistant will get you scheduled for a free 20-minute consultation to ensure you are right for our program.  You will:

  • Meet your account executive – a knowledgeable, friendly expert –  who will be your liaison to our team of billing specialists should we choose to work together and who will call on you at regular intervals to ensure your practice needs are being met to 100%
  • Learn about our seamless transition management
  • Get all your questions answered about our billing service without being pressured to sign up

There you have it.  Now you know the pertinent facts.  Choose your options wisely… and remember, often the choice to do nothing is riskiest of all options.

I look forward to speaking with you.


David Zahaluk, MD


Founder and CEO, Performance Billing Solutions

PS#1 – After we fix your billing and collections, you’ll love what we can do with your marketing and staff training.

PS#2 – Coding Coaching is free for our billing clients and if you sign up before the end of the month you may be able to start Success Tracks right away. (No pressure, but you may not want to wait.)