Delayed Billing from Incomplete Referral Cycles

$110,000-$190,000 annual per PCP (self-pay 5-8% of referral volume; 20-35% referrals abandoned due to cost; average self-pay specialty visit $3,000-$5,000; collection rate 40-50% vs. 85-90% for insured; write-off rate 25-35% on self-pay referrals) • $140,000-$220,000 annual per PCP (employer direct 8-12% of referral volume; 18-28% patients unaware of plan details; 12-18% referral abandonment; collection delays 10-15 days; write-off 3-5%) • $140,000-$230,000 annual per PCP (Tricare 10-15% of referral volume; 15-20% patients confused about coverage; 10-15% referral abandonment; collection delays 12-18 days; write-off 2-4%)

Compliance Officer audits referral sample quarterly; identifies missing ABNs/modifiers in 8-15% of cases; creates corrective action plan; manually re-files referrals • Compliance Officer maintains employer contract matrix; manually verifies referral meets contract terms; separate tracking for compliance exceptions; escalates to CFO quarterly • Compliance Officer maintains state-specific Medicaid referral checklists (50 states); manually reviews referral sample; tracks compliance in shared Excel; alerts referral team of patterns