Run through this quarterly. Most practices fail at least three of these — and those are the three that hurt the most.
Industry benchmark is 5–8%. Anything above 10% means a systemic problem — not random bad luck.
Denials that sit go stale. Most payers have 90–180 day appeal windows — don't burn them.
The older a claim gets, the less likely it pays. Track this number monthly, not quarterly.
Primary care averages 28–35 days. Specialties run 35–50. Know your benchmark — and beat it.
If 80% of your visits are 99213, that's probably right for a primary care practice. If you can't explain your distribution, a payer can challenge it.
Modifier 25, 59, and 51 are the ones auditors scrutinize most. Use them only when documentation supports it.
One gap here can mean months of claims paid at out-of-network rates — or rejected entirely.
Payers update fee schedules. If you haven't re-checked, you might be accepting rates that were set years ago.
Pull 10–15 random charts per provider. Compare what was billed against what was documented. Surprises here are better found internally than by a payer.
Incident-to billing at 100% requires the supervising physician to be on-site. If that's not happening, don't bill it that way.
We'll do a full RCM review — denials, AR, coding, contracts — and tell you exactly where revenue is leaking.
Get Your Free Revenue Assessment