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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.
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.
Catch coverage problems early
- Eligibility verified before every appointment
- A patient balance workflow so copays and balances are collected at checkout
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
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 betterClean claim rate
Higher is betterA/R over 90 days
Lower is betterPatient balances collected
Higher is betterMonthly collections
Higher is betterEvery 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.
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.
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.
Your practice next
Find out what your family medicine practice is leaving uncollected
The Revenue Health 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.
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.