You Own the Practice. Do You Own the Access?
Physician-owned practices don’t operate in silos, but too many are run as if they do.
Today I onboarded a small practice and found the same quiet vulnerability I see again and again. The in-house biller had admin access to everything: the clearinghouse, the payer portals, the practice management system, the merchant accounts. Every system that touched the practice’s money ran through one person’s login.
Then that person left. And the physician, the one who owns the practice, signed every contract and pays every monthly invoice, was locked out. When she contacted the vendor to regain access, she was refused. The reason? Her name wasn’t listed as an administrator.
Sit with that. The owner of the practice could not access the systems collecting the money she had already earned, because a departed employee had been set up as the gatekeeper and no one had ever corrected it.
This is not a rare horror story. It is a structural risk hiding inside a large share of independent practices, and it usually stays invisible until the day it suddenly isn’t.
Why this happens
It rarely happens through bad intent. A biller gets hired, sets up the accounts under their own name to get things moving, and the practice grows around that setup. The physician is busy seeing patients. The systems work, the money comes in, and no one stops to ask whose name is actually on the account. Convenience hardens into dependency, and dependency becomes exposure.
The trouble is that revenue cycle work sits at the intersection of your money, your patients’ protected information, and your payer relationships. Concentrating control of all three in a single login, with no owner-level oversight, is a risk to your finances, your compliance posture, and your continuity of operations all at once.
The principle: stewardship, not surrender
When you hand your billing to a third party or an in-house biller, you are not giving away your money. You are asking someone to steward it: to collect what you are owed, completely and compliantly, on your behalf. Stewardship means the steward answers to the owner. It does not mean the owner asks permission.
That distinction should show up in how your billing operation treats you every single day.
Want a report? It should be produced quickly, without a sigh and without pushback. Want to know what was billed and collected this week? You should get an accurate answer, not a deflection. Want to log in and look for yourself? You should already have the keys.
If you ever feel like you are being managed away from your own data, that is the warning sign. Transparency that comes with friction is not transparency. Defensiveness when you ask reasonable questions is not protection. It is a flag.
What to verify this week
You do not need to be a billing expert to close this gap. You need to confirm a few things and refuse to let them slide.
First, confirm that you, the owner, are listed as an administrator on every system tied to your revenue: clearinghouse, payer portals, practice management and EHR, and any merchant or banking platform. Not your biller alone. You.
Second, make sure access does not live with one person. If a single departure can lock you out, your setup is fragile by design. Owner-level access should be permanent and independent of any employee or vendor.
Third, document who has access to what, and review it whenever someone is hired or leaves. Offboarding should always include revoking access, just as onboarding granted it.
Fourth, test it. Actually, log in. An account you have never opened is a question mark, not a safeguard.
And finally, set the expectation out loud with whoever handles your billing: full, transparent access on request, no pushback, no defensiveness. A good partner will welcome that conversation. Anyone who resists it is telling you something you need to hear.
The bottom line
This is your money. You already worked for it. Allowing someone to steward your revenue is a normal, healthy part of running a practice, but stewardship without ownership of access is just exposure waiting for a bad day.
Make sure your billing operation gives you full, transparent access, willingly. Because the day you finally need to get in should never be the day you find out you can’t.
