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Case study · Family Medicine
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
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
Too many claims came back unpaid, with the same denials repeating month after month.
Earned money was sitting in aging A/R with no one working it by payer or by filing deadline.
Too many claims needed rework before a payer would even process them.
Copays and balances were left behind at checkout and never recovered.
What WeBill Health changed
Every claim received human pre submission review by family medicine coding experts, checked against our payer rule libraries for each carrier this practice bills.
90 day results
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
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.
The math
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
| 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
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
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.
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.
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
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.
Questions
Every figure on this page was measured at day 90, comparing the practice's baseline month with its third month on WeBill Health.
We protect our clients' privacy. The figures come from the practice's own billing reports.
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.
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.
Our billers and coders work every day in the five EHR, EMR and practice management systems most used in family medicine. You keep your software, and we take over the billing inside it.
Using a system that is not listed here? Tell us on the audit call. Product names are trademarks of their owners and appear here only to show the systems we work in. No partnership or endorsement is implied.
Update, November 6, 2026: CMS finalized a smaller version of this cut. Under the CY 2027 final rule released November 4, Medicare
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