Medical billing analytics: billers who think like analysts
Every comment in your weekly reports is a data point. After five months, we analyze all of them and show you what's really costing you money, and who can fix it: the front desk, the providers, credentialing or us.
What one weekly report already shows
- Where denials come from: front desk & eligibility 39% (member ID, referral, authorization), coding 30% (diagnosis, modifiers, bundling), credentialing 27% (taxonomy, payer enrollment), documentation & other 4%.
- The single biggest cause: provider taxonomy not on file or not enrolled with the payer, 27% of denials. Fixed once at the payer, it disappears from every future claim.
- What each code pays: e.g. 99204 averages $334, 99214 $209, 11721 $70 per paid claim.
- Where claims end up: 62% paid and posted, 13% written off on the office's instruction, 11% sent to secondary.
[Charts: denial-root-causes.png, denial-reasons-sample-report.png, payment-per-cpt-sample-report.png]
12 analyses we run on your data
| # | Analysis | What it leads to |
|---|---|---|
| 1 | Denial causes grouped by who can fix them | Front desk training, coding feedback or credentialing fixes |
| 2 | Denial rate by payer | Which insurers to watch, and where credentialing needs an amendment |
| 3 | What each payer pays for each CPT code | Highest- and lowest-paying payers per service; contract renegotiation |
| 4 | Payments vs. your fee schedule | Underpayments flagged and appealed |
| 5 | Denial rate by CPT code | Services that need better documentation or prior auth |
| 6 | Denial rate by provider | Targeted documentation feedback, without blame |
| 7 | Days to payment by payer | Cash flow forecasting and follow-up timing |
| 8 | Timely-filing risk list | Claims near their deadline worked first |
| 9 | Write-off review | Revenue written off that could have been collected |
| 10 | Secondary insurance capture | Intake fixes so balances don't fall to patients |
| 11 | Resubmission success rate | Proof that corrections work, and where they don't |
| 12 | Practice response time | Claims waiting on your input, and how long |
An example of what we'd tell you
“Almost 4 in 10 of your denials start at the front desk. A two-minute eligibility and referral check before each visit would prevent most of them. Another 27% come from one taxonomy problem that we can fix with the payer this week.”