It’s Monday morning. You check your billing software. Still nothing. That signature you requested two weeks ago is missing. It feels like your revenue is held hostage by a fax machine.
Sound familiar?
I talk to practice owners every day who are doing incredible work with kids. But their cash flow? It’s stuck in a “pending” folder in some doctor’s office across town. I’ve been there, well, on the billing side of things. I’ve felt that pit in my stomach when I realized a practice couldn’t bill out $20k worth of claims because of a missing John Hancock.
In this 2026 landscape, documentation requirements have only gotten tighter. Payors are looking for any reason to deny, and an unsigned Plan of Care (POC) is an easy target.
I want to share five tips that I’ve seen work wonders for the clinics we partner with here in Florida.
1. The “Follow-Up” Cadence (Don’t Just Fax and Pray)
I used to think that sending a fax was enough. I assumed the doctor’s office was as organized as we are. (Wait! What? Yep, I was wrong.)
The “fax and pray” method is a recipe for delayed payments. You need a cadence. At Extra Mile Billing, we see the best results when practices follow a 3-5-7 rule.
Send the POC. If it’s not back in 3 days, call. If it’s not back in 5 days, call again. By day 7, it might be time for a “pop-in” if they are local. It sounds aggressive, but it’s about your livelihood.
2. Portals vs. Faxes: The Great Debate
I don’t know about you, but I find fax machines to be a “necessary evil” that should have died in the 90s. However, many Florida physicians still live by them.
If the physician’s office has a portal, use it. If they don’t, see if they will accept a secure email link. Moving away from the physical fax pile reduces the chance of your POC ending up under someone’s half-eaten cuban sandwich.
I’ve noticed that when clinics transition to digital-first communication, their turnaround time drops by nearly 40%. It’s a game-changer.
3. Build Relationships with the Gatekeepers
Here’s a secret I’ve learned from years in healthcare billing: the doctor isn’t your hurdle. It’s the front desk.
I’ve often seen practice owners get frustrated with physicians, but the physician never even saw the paperwork. Take the time to educate the front desk staff at your top referring offices.
Maybe send them some coffee or a treat? (I recommend a local bakery, it goes a long way!) When they know your name and know that you are waiting on those signatures to keep helping their patients, you move to the top of the pile.
We actually talked about the importance of these relationships and marketing your practice effectively in Episode 2 of our SPOT Growth podcast.
4. Digital Signature Compliance
In 2026, there is no excuse for not using digital signature tools. But, and this is a big “but”, they must be HIPAA compliant.
I’ve seen practices try to use standard, non-secure apps because they are “easier.” Please, don’t do that. It’s scary how quickly a compliance audit can go south when your signatures aren’t tracked correctly.
Ensure your platform provides an audit trail. This shows exactly when the doctor opened the document and when they signed it. It’s your best defense if a payor ever questions the validity of your POC.
5. Clear Tracking (The Death of the ‘Pending’ Pile)
If your tracking system is “I think Sally sent that out last week,” you’re in trouble.
You need a centralized tracker. Whether it’s in your EMR or a simple spreadsheet, you need to see at a glance:
- Date sent
- Method (Fax/Portal/Email)
- Last follow-up date
- Days outstanding
Don’t let it sit in the ‘pending’ pile. If it’s over 14 days old, it’s a fire. Treat it like one. At Extra Mile, we prioritize these “bottleneck” areas because we know that if the POC isn’t signed, the billing can’t happen.
If you’re feeling overwhelmed by the administrative side of your clinic, you aren’t alone. I’ve seen so many owners struggle to balance patient care with the “boring” (but vital) paperwork. Sometimes, the best move is to outsource the rest so you can focus on what you love.
Managing signatures isn’t the most glamorous part of running a PT, OT, or ST practice. But it is the heartbeat of your cash flow.
If you can cut your turnaround time in half, imagine what that does for your stress levels. (Phew! Just thinking about it feels great, right?)
You’ve got this!
Aaron and the Extra Mile Team