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Case study · Internal Medicine
Denials were running at 15% and $205K sat in A/R past 90 days. Patients were paying only 72% of what they owed. Ninety days after WeBill Health took over the revenue cycle, every one of those numbers had moved.
The practice
A four provider internal medicine practice caring for a large Medicare population with multiple chronic conditions. Complex visits were being coded simply, and preventive services were billed under the wrong rules.
| Specialty | Internal Medicine |
|---|---|
| Providers | 4 |
| Annual collections | $1.35M, about $112.5K 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 internal 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 $186K comes from
Monthly collections rose from $112.5K to $128K by day 90. Held for a full year, that is $186K 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 internal 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 879 claims a month at an average of $128 collected. Cutting the denial rate from 15% to 5.2% means 86 fewer denials a month. Before, about half of denials were never reworked, so 43 of those claims are now paid that were not. | $5,504 |
| Patient balances collectedPatients owe about $16,900 a month in copays, deductibles and coinsurance. Collection rose from 72% to 90%. | $3,042 |
| Chronic care management months billedPatients with two or more chronic conditions enrolled in 99490 with consent and 20 minutes documented, 63 a month at about $60 each. | $3,780 |
| Underpaid claims recovered69 claims a month paid below the contracted rate, short by an average of $46, now appealed and recovered. | $3,174 |
| Added collections a month at day 90 | $15,500 |
Prior authorization moved to WeBill Health as well. The AMA 2025 survey puts that work at 13 hours a week per physician, or about 52 hours a week for 4 providers. At the national median wage for medical administrative staff ($45,930 a year, BLS May 2025) plus benefits, that workload is worth about $85,298 a year in staff time.
Codes and conditions
| Visit type | Codes and rules | Typical conditions (ICD 10) |
|---|---|---|
| Follow up for chronic conditions | 99213 or 99214 plus G2211 on Medicare | Essential hypertension I10; type 2 diabetes with hyperglycemia E11.65 |
| Annual wellness visit | G0438 once per lifetime, then G0439 every 12 months; problem visit with modifier 25 when separate | Hyperlipidemia E78.5 |
| Chronic care management | 99490 for the first 20 minutes a month, consent documented, not in a month with 99491 or 99487 | CKD stage 3 N18.30 with hypertension I10 |
| After a hospital stay | 99495 or 99496 transitional care, contact within two business days | Chronic diastolic heart failure I50.32 |
What it costs
This practice's WeBill Health rate is 5% of collections. At $128,000 a month that is $76,800 a year. Here is what the same work costs a 4 provider practice that staffs it in house, before software and clearinghouse fees.
| Item | Per year |
|---|---|
| In house billing staff1.5 billers for 4 providers (MGMA: about one per two to three providers) at $73,160 each, the BLS median of $51,140 plus benefits | $109,740 |
| Prior authorization staff time13 hours a week per physician (AMA 2025), 52 hours a week, at the BLS median for medical administrative staff plus benefits | $85,298 |
| In house cost | $195,038 |
| WeBill Health fee, 5% of collections | $76,800 |
| Saved against in house staffing | $118,238 |
| Added collections a year | $186,000 |
| Better off each year with WeBill Health | $304,238 |
What other internal medicine practices can take from this
Medicare pays for the Annual Wellness Visit, G0438 for the first and G0439 after that, but does not cover a routine physical. Billing the wrong one leaves the visit unpaid or billed to the patient.
Managing several chronic conditions often supports a higher level of medical decision making. Notes that document the problems addressed and the risk involved support the level billed.
Chronic care management codes require documented patient consent and a minimum amount of clinical staff time each month.
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 15% to 5.2% 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. Internal Medicine sits in our Office Visit and Consultation billing group. Every account is handled by coding experts who work internal medicine claims every day.
Our billers and coders work every day in the five EHR, EMR and practice management systems most used in internal 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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