A Guide to Grading Your Practice’s Billing Health
Running a small or mid-size medical practice means juggling clinical care, patient satisfaction, and the financial engine that keeps it all running: billing. One way to keep that engine humming is by giving your practice a billing wellness check — think of it like grading yourself with a report card. By asking the right questions, you can identify where you’re excelling and where you could use some improvement before small issues turn into bigger ones.
Here’s your step-by-step guide to “grading” your billing health.
Front-End Processes: The Foundation of Clean Claims
Before a claim is ever submitted, your billing success depends on what happens at the front desk. Inaccurate or incomplete information collected here can lead to denials and delays later.
Ask yourself:
Are staff consistently collecting accurate patient demographics and insurance information
Is insurance verified before each visit, with eligibility and benefits checked and documented?
Are appointments being confirmed and cancellations filled to maximize provider time?
Grade yourself: If you answered “yes” consistently, give yourself an A. If not, this may be an area where additional training, standardized processes, or outside support could help. A strong front end saves time, prevents rework, and ensures a smoother billing cycle from the start.
Capturing Every Dollar: Documentation and Coding Accuracy
Charge capture and coding are the backbone of getting reimbursed fairly. If services aren’t documented and coded properly, you risk leaving money on the table—or running into compliance issues.
Ask yourself:
Are all services provided being entered into the billing system?
Does documentation fully support the codes being billed?
Are modifiers applied correctly and consistently?
Are ancillary services (like injections or tests) being captured every time?
Grade yourself: Practices that regularly audit charts and spot-check coding accuracy will score higher. Even small gaps matter. For instance, missing charges for routine ancillary services repeated across dozens of patients can mean thousands of dollars lost. High marks here reflect consistent, accurate documentation and proactive chart review.
Measure What Matters: Tracking Key KPIs
You can’t improve what you don’t measure. Billing performance comes down to tracking the right metrics — your key performance indicators (KPIs).
Ask yourself:
What are your current days in A/R (accounts receivable)?
How does your net collection rate compare to industry benchmarks?
Is your clean claim rate consistently high?
What’s your first-pass resolution rate (claims paid without resubmission)?
Which payers account for the most denials—and why?
Grade yourself: Practices that monitor KPIs monthly or quarterly and compare them against specialty benchmarks often get higher marks. If you don’t know these numbers—or only look at them annually—your grade here may be lower. Think of KPIs as your progress report: they help you spot trends early and make corrections before problems escalate.
Payer Contract Reviews: Are You Getting Paid Fairly?
Payer contracts directly affect your bottom line, but many practices sign them and never revisit them. Over time, rates may become outdated compared to peers or no longer reflect the value of your most common services.
Ask yourself:
When was the last time we reviewed reimbursement rates?
Are we being reimbursed fairly for high-volume services?
Do we know which contracts are the most and least profitable?
Grade yourself: If you haven’t reviewed your contracts in the last year, you may be earning a C or lower in this category. High grades go to practices that schedule regular reviews, compare rates against peers, and negotiate updates when appropriate.
Staff Training, Compliance & Risk Review
Even the best processes fall short without well-trained staff and strong compliance practices. Regular training reduces errors, ensures staff are up to date on payer rules, and minimizes risk of audits or penalties.
Ask yourself:
Do staff receive ongoing training in coding, compliance, and payer policy changes?
Is there a process for monitoring regulatory updates and implementing changes?
Are internal audits performed to identify potential compliance risks?
Do staff know how to handle sensitive patient data securely?
Grade yourself: If training is consistent, compliance is monitored, and risks are reviewed regularly, you’re likely earning top marks. If training is only “one and done” or compliance is reactive, this is an area where your grade could improve. Think of this as the “ethics and safety” portion of your billing report card—it protects both your practice and your patients.
Other Areas to Review
Beyond the core categories, your billing wellness check should also look at:
Timely filing: Are claims being submitted within payer deadlines?
Denial management: Do you track, appeal and learn from denials?
Patient collections: Are payment options clear and convenient, from online portals to payment plans?
Each of these categories may not be a standalone subject on the “report card,” but they still count toward your overall GPA.
How Outsourcing Can Boost Your Grades
For many small and mid-size practices, maintaining an A+ billing report card is challenging. Limited staff, competing priorities and ever-changing payer requirements can all impact performance. That’s where outsourcing can make a difference.
A trusted billing partner can:
Standardize and strengthen your front-end processes.
Audit documentation and coding for accuracy.
Track KPIs and provide regular reporting with benchmarking.
Manage payer negotiations and contract reviews.
Deliver compliance expertise and staff training resources.
Stay on top of deadlines, denials, and regulatory changes.
By outsourcing, you gain access to expertise, technology, and processes that may be difficult to maintain in-house. The result? Better grades across the board—and more time to focus on what matters most: patient care.
Your Billing Report Card
Take a moment to grade your practice in each of these categories. Are you getting straight As? Or are there a few Cs you’d like to turn into Bs or better? A billing wellness check isn’t about perfection — it’s about progress. The more proactive you are, the stronger your financial foundation will be.
And if you need help raising your scores, outsourcing could be the extra credit that gets you there.