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Everyone called it collections. It was maintenance.

A dermatology group's missing revenue looked like weak collections. It was out-of-date billing codes and a broken paper trail.

In 2015 I took my first fractional seat: four months as chief operating officer of a cosmetic dermatology group with three practices in California. Calendars were full and the doctors were strong. The cash never arrived. Everyone inside, owner included, said the trouble was collections.

I looked and disagreed. The group was not paying for the proper billing software, the software it did own was configured wrong, its billing codes were years old, and the office paperwork was chaos besides. A claim carrying a stale code is wrong before any insurer opens it, so chasing denials could never bring that money back.

My fix was plain. A weekly check confirmed every billing code in use was current, and I rebuilt the paperwork system so the front office and billing desk drew on one file. By month four, insurance billing was up 42 percent, month over month.

I am proudest that the client kept the code check and the paperwork system once I left. A fix that outlasts you is the only kind worth counting. The lesson travels: a shortfall that looks like lack of effort is often lack of maintenance. Before hiring more people to chase the symptom, find out when the underlying system was last updated.

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