Patient First: 18% to 61% Collections
Six providers. $220,000 in monthly charges. 75% of claims denied.
Patient First Primary Care has three physicians and three nurse practitioners.
The practice bills $220,000 a month. It was collecting $40,000. The gross collection rate was 18.2%.
Three out of every four claims were denied. The practice submitted roughly 250 claims a month across six providers. Most of those claims failed.
Why 75% of Claims Were Denied
Why 75% of Claims Were Denied
The practice ran fee-for-service and capitation through the same billing system. There was no separation between the two tracks.
Fee-for-service claims went unworked after denial.
Nobody tracked denial reasons. The same errors repeated month after month.
Capitation payments were not reconciled.
The practice could not confirm which payments had arrived. Revenue from this track was invisible.
The result: 250 claims a month across six providers. That volume was well below what the patient panel should have generated.
How We Lifted Collections to $134,200
How We Lifted Collections to $134,200
Fee-for-service track.
Claims were rebuilt from documentation forward. E/M coding was corrected before submission. Modifier use was reviewed against payer-specific requirements. Denial follow-up was assigned by root cause through accounts receivable management. Monthly claim volume went from 250 to 700. Previously unsubmitted encounters started going out.
Capitation track.
Payments were reconciled against the enrolled patient roster. Missing payments were identified and pursued. Revenue was separated from fee-for-service. Each track could now be measured independently.
Unified reporting.
Both tracks now feed into a single collections dashboard. Denial rates, AR aging, and collection trends update continuously.
Results
Results
| Metric | Before | After | Change |
|---|---|---|---|
| Monthly charges | $220,000 | $0 | No change |
| Monthly collections | $40,000 | $0 | +$94,200 |
| Collection rate | 18.2% | 0% | +42.8 pts |
| Denial rate | 75% | Reduced | Improved |
| Monthly claims | ~250 | 0 | +180% |
| Claims processed (6 mo.) | -- | 0 | 2,454 |
| Yearly collection gain | -- | $0 | +$1.13M |
| Monthly billing cost | Higher | Lower | Reduced |
Why Collections Grew Without Adding a Single Patient
Why Collections Grew Without Adding a Single Patient
The charges stayed at $220,000 a month. No new patients were added. No schedule changes were made. No providers were added.
Claims started going out correctly. They went out in higher volume. Denials got worked.
Separating the two billing tracks meant each one could be measured and fixed independently.
A 75% denial rate is a revenue emergency, not a billing nuisance.
Is Your Collection Rate Below 50%?
Is Your Collection Rate Below 50%?
If the gap between what you bill and what you collect keeps widening, a revenue assessment identifies exactly where the money is going.