How awareness becomes intention, and intention becomes measurable change.

I. The Question That Started All of This

A few weeks ago, Dr. B sent me a note that stopped me for a second.

He wrote:

“Our philosophy should be: the provider wants to get paid highly, accurately, and as immediately as possible. If my system can be like an instant income generator, we will have no problem attracting providers.”

It was a simple line, but it carried a real dream —

the kind of dream every small practice holds quietly in the background:

Can we actually pay providers quickly and predictably?

Is fast payment a fantasy… or just a discipline problem?

My instinctive answer was: Maybe it’s possible. But only if we study the data honestly.

New software doesn’t magically fix anything — not without understanding the people, process, and technology that created today’s reality. If you don’t repair the foundation, new tools just automate the chaos.

So I turned back to the ERAs.

If Part I (ERA Series - Part 1 - Awareness) of this series was about hearing the signals,

and Part II (ERA Series - Part 2 - Incentive Design) was about designing the incentives so humans can carry the change,

then this Part III asks the most important question:

Did any of those changes actually make a difference?

That is where AR days enter the story.

II. AR Days Are Not a Number — They Are a Shape

Most dashboards flatten AR into a single number.

“AR Days: 38.”

“AR Days: 52.”

But real AR tells its story in shape, not averages.

When I studied a few months of Dr. B’s ERA data, what emerged was a tale every practice should hear:

• A clean claim cycle of ~19 days

• A long tail stretching all the way to two years

• And everything in between — from preventable denials to missed eligibility checks to human habits repeating across NPIs and payers

The surprise was not the shape itself.

The surprise was how predictable it was.

Almost every small practice has this same AR curve hiding behind the scenes — a short cycle that proves speed is possible, and a long tail that proves process discipline isn’t.

This long tail is where revenue goes to die quietly.

III. Step 1 — Baseline the AR Range (Before You Touch Anything)

If you want to improve your AR, don’t start with dashboards.

Start with:

• Shortest payment cycle (your actual potential)

• Longest open claims (your structural failures)

• Median AR days (your baseline)

• Provider-level variation

• Payer-level variation

• Patient-responsibility aging

This is your “before picture.”

If you skip this step, everything downstream becomes guesswork.

IV. Step 2 — Study the Long Tail (It’s Not Noise — It’s Diagnosis)

The long tail teaches you everything you didn’t want to see:

• Eligibility wasn’t checked

• Prior auth wasn’t obtained

• Credentialing was incomplete

• Add-on CPTs were billed alone

• Modifiers were missing

• Demographics were wrong

• Patients weren’t asked for their copay

• Claims bounced in loops for months

These are not technical mysteries.

They are routine workflow fractures masquerading as payer problems.

And once you see them, you can’t unsee them.

V. Step 3 — Shrink the Tail by Fixing Preventable Denials

This is where Parts I and II merge:

• ERA tells you what broke

• Cupcake incentives tell you how to sustain the fix

• AR days tell you whether the fix stayed fixed

When the staff catches inactive eligibility before the visit, AR shortens.

When prior auth is obtained at scheduling, AR shortens.

When credentialing alignment is clean, AR shortens.

Nothing magical.

Just physics.

Fixing these predictable denial buckets collapses AR:

from 40–60 days → to 19–22 days.

Practices that do this consistently stabilize cashflow without increasing headcount, pressure, or burnout.

VI. Step 4 — Provider-Level AR Fingerprints

This part often surprises people.

Every provider has a distinct AR signature:

• Some never trigger preventable denials

• Some repeatedly make the same coding errors

• Some document in ways that lead to rework

• Some sail cleanly through the system
  
  

Same EHR.

Same payers.

Same clearinghouse.

Different habits.

A 1% improvement in the “worst offenders” does more for AR days than redesigning your entire billing workflow.

Peer coaching — not policing — is how you build a cleaner system.

VII. Step 5 — Measure AR Monthly, Not Daily

AR cycles have a natural latency:

• Day 0: Patient seen

• Day 1–2: Claim submitted

• Day 3–10: Claim enters adjudication

• Day 17–22: ERA + payment arrives

• Day 23+: Any preventable denial will prolong it

This is not a same-day metric.

So daily AR dashboards create noise;

monthly AR dashboards reveal signal.

Quarterly ERA audits prevent drift — the same way calibration prevents instruments from slowly losing accuracy.

Kaizen is small, continuous correction — not panic-driven reinvention.

VIII. Step 6 — The Silent Killer: Patient Collections

Eligibility tells you the patient’s responsibility.

Discipline decides whether you collect it.

Many practices don’t collect copays because staff feel uncomfortable asking.

This is how a $25 responsibility becomes a 60-day AR problem.

You cannot shorten the AR cycle without fixing:

• point-of-service collections

• financial transparency

• front-desk confidence

• scripts and training

• the culture of asking clearly and kindly

Small amount × large volume × no process = AR drift.

IX. What Success Looks Like — A 14–19 Day AR Cycle

A short AR cycle isn’t a myth.

It is simply what happens when:

• claims are clean

• eligibility is verified

• prior auth is obtained

• credentialing is aligned

• providers follow consistent patterns

• patient responsibility is collected

• ERA insights feed back into staff habits

This is what Dr. B actually asked for —

not rapid payment for its own sake, but a workflow that earns rapid payment because it removes friction before it begins.

When you build this discipline, your practice becomes:

• predictable

• stable

• trustworthy

• attractive to providers

• attractive to patients

• financially healthy

• operationally calm

In other words:

You create exactly the “instant income generator” Dr. B imagined — not through magic, but through math and habits.

X. Closing the Loop — Awareness → Incentives → Measurement

Part I taught us that ERAs already held the truth.

Part II taught us that humans carry the change.

Part III shows us whether the change stuck.

The full loop is this:

1. Listen to what ERAs show.

2. Make the work lighter and fair so people can act on it.

3. Measure AR days to know if the system is working.

4. Revisit quarterly to prevent drift.

That’s it.

No $100k software.

No dashboard revolution.

No twelve consultants.

Just discipline, clarity, and care.

What gets measured improves.

What improves becomes habit.

And habit is how a practice becomes a healthy practice.

Rumpa Giri is a healthcare technology leader who studies ERA data to detect systemic patterns — the small, fixable cracks that silently drain revenue and overwhelm staff. During her strategic sabbatical, she has been studying RCM deeply, helping small practices uncover the quiet signals hidden inside their ERAs.

She believes ERAs are one of the most underutilized operational tools in healthcare, and that with a little clarity and discipline, practices can build healthier, calmer revenue systems without more software or more burnout.

And that gives her hope — that not all fixes need to be expensive, loud, or complicated. 💜