The Staffing Squeeze is the Hidden RCM Threat

Hi and happy Tuesday,

Last Thursday, a small practice in Ohio lost its only seasoned biller. 

By Monday, eligibility checks were backed up, two high-value claims had missing narratives, and accounts receivable were over 30 days past due.

Technology was fine. Coverage at the desk was thin.

For 2025, staffing is the top operational risk. 62.2% of practices cite staffing shortages; capacity is down by ~11%, resulting in verification delays and slower cash flow.

But here's what most practices miss: the damage starts long before someone walks out the door.

The real cost nobody's talking about

When your front desk coordinator gives two weeks' notice, the calculator in your head probably shows something like this: 

Two weeks of recruiting, $3,000 in hiring costs, and another month of training.

The actual number? Between 90% and 200% of that employee's annual salary, and that's before you count the revenue you'll lose while the new hire gets up to speed.

For a dental practice billing coordinator making $45,000 annually, you're looking at $40,500 to $90,000 in total replacement costs. That's not a line item. It is a significant portion of practice profit.

The hidden cascade

Here's where it gets worse. Staff shortages don't just create obvious problems, such as delayed claim submissions. They trigger a domino effect that's harder to trace but devastating to revenue:

The 48-Hour Window: Claims not submitted within 48 hours of service see a 23% higher denial rate. When you're short-staffed, that window closes before you even realize it.

Every surveyed RC executive agreed that staffing shortages impact reimbursement workflows. 

Not "might impact." 

Not "occasionally affect." 

But, significantly impact. Every single one.

Why traditional solutions fail

Most practices respond to staffing gaps with one of three moves: 

1. Hire temps

2. Overwork the remaining staff, or

3. Throw money at recruiting 

All three fail for the same reason. They assume you can solve a structural problem with a personnel fix.

Temps don't know your systems, and overworked staff are prone to making mistakes. 

And even when you successfully recruit, over 60% of hybrid healthcare workers are at high risk of leaving, creating a cycle that never ends.

The low-lift fixes that actually work

1. Automate the predictable, not the complex

Not every workflow benefits from automation. Focus on the predictable tasks that drain time and attention, freeing your staff to handle the complex, revenue-critical work only humans can do.

Implementation: Start with one thing this month. If you're doing any eligibility checks manually, that's your target. Modern verification tools integrate directly with practice management systems and run checks automatically overnight.

Time to value: 2-3 weeks to full implementation. Most practices see ROI within 60 days.

2. Build a knowledge system, not a knowledge dependency

When your insurance coordinator knows exactly which appeals work for Delta Dental, but that knowledge lives only in their head, you don't have a system, you have a single point of failure.

Low-lift version: Create a shared Google Doc titled "RCM Solutions that worked." Make it a requirement that each team member adds one entry per week. Within 90 days, you'll have a knowledge base that protects you from turnover.

3. Cross-train in 15-minute blocks

You don't need everyone to know everything. You need everyone to know enough to prevent catastrophic failures.

Why this works: When your insurance coordinator quits, you don't need a replacement who can do everything they did. You need three people who can each handle 30% of the workload while you recruit new team members.

4. Rethink your hiring pipeline

Don't wait until someone quits to start recruiting. Practices with continuous hiring pipelines reduce time-to-fill by 40%.

The one thing to do this week

If you only have bandwidth for one change, make it this: identify your single point of failure and document their process.

Who's the one person in your practice who, if they quit tomorrow, would cause immediate revenue disruption? 

• Sit with them for two hours this week. 

• Record their screen. 

• Ask them to explain their daily workflow. 

• Capture the payer quirks, the workarounds, the stuff that "just makes sense" to them.

Those two hours might be the best revenue protection investment you make all year.

The bottom line: 

Staffing shortages will persist. Outpatient healthcare, like for dental care, experiences a 17-25% turnover rate, with 60% of the remaining staff at high-risk of turnover. 

You cannot hire your way out; make tomorrow’s work visible, standardize pre-visit checks, require minimal documentation, and cross-train for coverage.

Next week, I’ll show you how to measure your true cash velocity and shorten it by weeks without adding staff.

See you next Tuesday,
Dino Gane-Palmer