# Family Medicine Case Study

> See how WeBill Health defended revenue for a family medicine practice through modifier 25 accuracy, preventive coding and steady A/R follow up.

Source: https://webillhealth.com/case-studies/family-medicine/  
Publisher: WeBill Health  
Last updated: October 27, 2026

Case study · Family Medicine

## $216K more in annualized collections for a 5 provider family medicine practice

Denials were running at 14% and $210K sat in A/R past 90 days. Patients were paying only 76% of what they owed. Ninety days after WeBill Health took over the revenue cycle, every one of those numbers had moved.

5 providers$1.5M annual collections beforeResults measured at day 90

**+$18K**Monthly collections, from $125K to $143K

**5%**Denial rate, down from 14%

**$100K**Cleared from A/R over 90 days

**90%**Patient balances collected, up from 76%

The practice

## Care was delivered. Payment was not keeping up.

A five provider practice seeing every age group, with preventive care, chronic conditions and same day problems all landing on the same schedule. Each visit type carried its own billing rules, and the gaps added up.

| Specialty | Family Medicine |
|---|---|
| Providers | 5 |
| Annual collections | $1.5M, about $125K a month |

What we found in the audit

### 14% of claims denied

Too many claims came back unpaid, with the same denials repeating month after month.

### $210K stuck past 90 days

Earned money was sitting in aging A/R with no one working it by payer or by filing deadline.

### 91% clean claim rate

Too many claims needed rework before a payer would even process them.

### 76% of patient balances collected

Copays and balances were left behind at checkout and never recovered.

What WeBill Health changed

## Seven fixes before the visit, in the coding and after submission

Every claim received human pre submission review by family medicine coding experts, checked against our payer rule libraries for each carrier this practice bills.

Before the visit

### Catch coverage problems early

* Eligibility verified before every appointment
* A patient balance workflow so copays and balances are collected at checkout

Coding

### Match every code to the chart

* E/M levels coded from medical decision making or total time, matched to the documentation
* Preventive visits and same day problem visits billed correctly with modifier 25 when both are documented
* Chronic care claims checked for the consent and monthly time the codes require

After submission

### Work every open dollar

* Payer follow up on every unpaid claim
* Aging A/R worked in priority order by payer and by age

90 day results

## Before and after WeBill Health

### Denial rate

Lower is better

Before**14%

After**5%

### Clean claim rate

Higher is better

Before**91%

After**98%

### A/R over 90 days

Lower is better

Before**$210K

After**$110K

### Patient balances collected

Higher is better

Before**76%

After**90%

### Monthly collections

Higher is better

Before**$125K

After**$143K

Every bar starts at zero. Figures come from the practice’s own billing reports, comparing the baseline month with month three.

Where the $216K comes from

## An extra $18K collected every month

Monthly collections rose from $125K to $143K by day 90. Held for a full year, that is $216K the practice collects on care it was already delivering.

The gain came from specialty specific coding and fewer days in A/R. Fewer claims were denied, and balances that had aged past 90 days were finally collected.

Monthly collections before$125,000

Monthly collections at day 90$143,000

Increase per month$18,000

Annualized increase$216,000

Net return on the WeBill Health fee152%

Net return is the annualized increase in collections, minus the annual WeBill Health fee, divided by that fee. It is calculated before any savings from the practice’s previous billing arrangement.

The math

## Where the $18,000 a month came from

Estimated breakdown, built from family medicine billing benchmarks and 2026 Medicare rates, tied to this practice’s measured before and after figures. Each line is a claim count multiplied by what those claims pay. A/R cleared from the old backlog is reported separately and is not part of this monthly gain.

| Change | Added a month |
|---|---|
| Denials stopped before they happenedAbout 1,087 claims a month at an average of $115 collected. Cutting the denial rate from 14% to 5% means 98 fewer denials a month. Before, about half of denials were never reworked, so 49 of those claims are now paid that were not. | $5,635 |
| Patient balances collectedPatients owe about $22,500 a month in copays, deductibles and coinsurance. Collection rose from 76% to 90%. | $3,150 |
| Problem visits paid beside preventive visitsSeparate problem visits billed with modifier 25 beside a preventive visit or wellness visit, 50 a month at about $90 each. | $4,500 |
| Underpaid claims recovered115 claims a month paid below the contracted rate, short by an average of $41, now appealed and recovered. | $4,715 |
| Added collections a month at day 90 | $18,000 |

Prior authorization moved to WeBill Health as well. The AMA 2025 survey puts that work at 13 hours a week per physician, or about 65 hours a week for 5 providers. At the national median wage for medical administrative staff ($45,930 a year, BLS May 2025) plus benefits, that workload is worth about $106,623 a year in staff time.

Codes and conditions

## The claims behind these numbers

| Visit type | Codes and rules | Typical conditions (ICD 10) |
|---|---|---|
| Preventive visit plus a problem | 99381 to 99397 with 99213 or 99214 and modifier 25 | Adult exam with abnormal findings Z00.01; essential hypertension I10 |
| Medicare wellness visit | G0439 with a problem E/M and modifier 25, plus G2211 where the visit is ongoing care | Generalized anxiety disorder F41.1 |
| Child checkup and vaccines | 99392 with 90460 and 90461 by component | Routine child exam Z00.129 |
| Imaging that needs approval | MRI and CT ordered with prior authorization before scheduling | Low back pain M54.50 |

What it costs

## The 5% fee against the cost of doing this in house

This practice’s WeBill Health rate is 5% of collections. At $143,000 a month that is $85,800 a year. Here is what the same work costs a 5 provider practice that staffs it in house, before software and clearinghouse fees.

| Item | Per year |
|---|---|
| In house billing staff2 billers for 5 providers (MGMA: about one per two to three providers) at $73,160 each, the BLS median of $51,140 plus benefits | $146,320 |
| Prior authorization staff time13 hours a week per physician (AMA 2025), 65 hours a week, at the BLS median for medical administrative staff plus benefits | $106,623 |
| In house cost | $252,943 |
| WeBill Health fee, 5% of collections | $85,800 |
| Saved against in house staffing | $167,143 |
| Added collections a year | $216,000 |
| Better off each year with WeBill Health | $383,143 |

What other family medicine practices can take from this

## Three family medicine billing gaps worth checking this week

### Code E/M by decision making or time

Since 2021, office visit levels are chosen by medical decision making or total time on the date of service. Notes that still follow the old history and exam format often support a lower level than the care delivered.

### Document both services when a checkup turns into a problem visit

A preventive visit and a separate problem oriented visit on the same day can both be paid when the note supports each one and modifier 25 is applied.

### Keep chronic care management claims audit ready

Chronic care management codes require documented patient consent and a minimum amount of clinical staff time each month. Missing either one turns the claim into a denial.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[See all specialties](https://webillhealth.com/specialties/)

Your practice next

## Find out what your family medicine practice is leaving uncollected

The Revenue Defense Audit reviews your denials, aging A/R and patient collections the same way we did here. You get a written report that ranks the fixes by dollars at stake. We reply within one business day.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[Check my Revenue Defense Score](https://webillhealth.com/revenue-defense-score/)

Questions

## About this case study

How fast did the results appear?

Every figure on this page was measured at day 90, comparing the practice's baseline month with its third month on WeBill Health.

Why is the practice not named?

We protect our clients' privacy. The figures come from the practice's own billing reports.

What drove the biggest change?

The denial rate. Cutting denials from 14% to 5% meant far more claims were paid the first time, which lifted monthly collections and stopped new balances from piling up in aging A/R.

Does WeBill Health work with other family medicine practices?

Yes. Family Medicine sits in our Office Visit and Consultation billing group. Every account is handled by coding experts who work family medicine claims every day.

WeBill Health is a specialty focused revenue cycle management partner for independent practices. Request a Revenue Defense Audit at https://webillhealth.com/form/