Tag: patient collections at time of service

5 Places Your Practice May Be Losing Revenue

Posted on by Reviora Healthcare LLC in Uncategorized

Reviora Healthcare LLC | Guaranteed Revenue Partner

Your P&L can look fine on the surface and your practice can still be bleeding five or six figures a year — quietly, in places nobody reviews on a Tuesday afternoon. Revenue leakage rarely shows up as one dramatic loss. It shows up as a dozen small ones: a denied claim nobody re-worked, a payer that took 45 days too long, a copay nobody asked for. By the time it’s visible on a financial statement, it’s already gone.

Here are five places specialty practices lose money most often — and what the data says about each one.

Are claims getting denied before they ever reach the payer?

Denials are the most visible leak, and they’re getting worse, not better. A March 2024 MGMA Stat poll found that 60% of medical group leaders reported an increase in their practices’ claim denial rates compared to the same period the year before. MGMA’s own DataDive Practice Operations data set put the single-specialty aggregate first-submission denial rate at 8% — a number that has barely moved since 2019.

Every denied claim means rework: a coder or biller has to stop, investigate, correct, and resubmit — work that costs staff time whether or not the claim ever gets paid. The practices bucking the trend aren’t working denials harder; they’re preventing them earlier, at intake and coding, before the claim ever leaves the building.

Is your money sitting in AR instead of your bank account?

Days in AR is the clearest signal of how fast your practice actually gets paid — and most practices don’t like what it tells them. HFMA’s MAP Keys, the industry-standard benchmark used across revenue cycle management, set the target range for net days in AR at 30 to 40 days, with accounts over 90 days ideally kept below 10% of total receivables.

Every extra week a claim sits unworked is a week that money isn’t funding payroll, supplies, or growth. AR that drifts past 60 or 90 days isn’t just slow — it’s a strong predictor that a percentage of it will never be collected at all.

Is prior authorization quietly consuming your staff’s week?

Prior auth isn’t just a clinical headache — it’s a direct revenue cycle cost. The AMA’s most recent Prior Authorization Physician Survey found that 95% of physicians report prior authorization delays access to necessary care, and 88% say it drives higher overall utilization and administrative waste. Separately, CAQH’s 2024 Index found that only 35% of medical prior authorizations are conducted fully electronically — meaning most of that burden still runs through phone calls, faxes, and payer portals.

That’s staff time spent chasing approvals instead of working denials, verifying eligibility, or following up on aged claims — and it’s one of the most under-measured drains on a specialty practice’s revenue cycle.

Is a credentialing delay keeping a provider from billing at all?

This one doesn’t show up as a denial — it shows up as revenue that was never billable in the first place. A November 2025 MGMA Stat poll found that 32% of medical groups reported some form of credentialing backlog: files stalled, CVO delays, or completions slipping into the following quarter.

A provider who isn’t credentialed and enrolled can’t bill in-network, no matter how many patients they see. For specialty practices bringing on new physicians or renewing existing panels, a stalled file is unbillable clinical time — every single day it sits open.

Are you leaving patient balances on the table at check-out?

Point-of-service collection has quietly gotten worse across the industry. MGMA’s single-specialty Practice Operations data showed the percentage of copayments collected at time of service fell to 56% in 2022, down from 89.9% in 2019 — a swing that reflects both rising patient financial responsibility and looser front-desk collection habits.

Every dollar not collected at check-out becomes a statement, then a follow-up call, then — often — a write-off. It’s the cheapest dollar your practice will ever collect, and it’s the one most often skipped.

What this adds up to

None of these five leaks are dramatic on their own. Together, they’re often the difference between a practice that’s merely surviving and one that’s actually growing. This is exactly why Reviora built the Managed Outcomes Agreement (MOA) — a written performance agreement covering the benchmarks that matter most across denials, AR, and collections — backed by the Benchmark Recovery Protocol, which activates automatically if performance slips for two consecutive months. It’s Expert-Led Technology: our specialists own the outcome, and the technology supports the work rather than replacing the judgment behind it.

If you want a clearer picture of where your own practice is leaking revenue, we’ll walk through it with you — no sales pitch, just a look at your numbers. Book a free 30-minute consultation.

FAQ

What is a good clean claim rate for a medical practice? Clean claim rate measures the percentage of claims that get paid on first submission with no correction needed. Industry benchmarking bodies like MGMA and HFMA treat rates in the mid-90s and above as strong performance; anything meaningfully lower usually points to front-end data or coding issues rather than payer behavior.

How many days should it take to get a medical claim paid? HFMA’s MAP Keys benchmark net days in AR at 30 to 40 days for a healthy revenue cycle, with fewer than 10% of receivables aged past 90 days. Claims routinely sitting past 60 days are a sign of a bottleneck somewhere in the process.

Why do healthcare claims get denied? Denials trace back to a mix of causes — eligibility and registration errors, coding mistakes, missing prior authorization, and timely-filing misses are among the most common. MGMA’s data shows denial rates have been rising industry-wide, which is why prevention at intake matters more than appeals after the fact.

How much revenue does a specialty practice lose to billing and collection gaps? It varies by practice size and specialty, but the leaks compound: denied claims requiring rework, AR aging past collectible windows, uncredentialed providers who can’t bill, and missed point-of-service collections. A revenue cycle assessment is the only reliable way to size the number for your specific practice.

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