Reimbursement Analysis for Medical Practices: Catch Revenue Leaks Fast
Reimbursement analysis is the hidden goldmine your practice might be ignoring. With Q1 behind us, now’s the time to dig into your numbers, catch underpayments, and fix slow claim cycles. I’ll walk you through how to make this quarter your most profitable yet.
Key Takeaways
- Q2 is the ideal time to audit reimbursements after the Q1 deductible crunch.
- Analyze AR aging reports to flag delayed claims.
- Track CPT code reimbursements and match them to contracted rates.
- Watch for denial trends and fix workflow issues early.
- Patient collections must be convenient and consistent.
- Create a simple dashboard for your team to boost accountability.
- Use reimbursement data to make strategic business decisions.
Q1: Holiday Hangover Meets Deductible Season
Let’s face it—January starts slow. Between the post-holiday haze and patients just beginning to use their benefits, revenue might feel sluggish. But now that we’re well into Q2, those deductibles are starting to get met. That means insurers should be covering a bigger portion of claims.
Still, this varies wildly by specialty, location, and patient volume. Which is why it’s smart to do a little deeper digging right now. Not just to see how much you’re being paid—but how fast you’re being paid.
Start With Your Accounts Receivable
Time to crack open your AR report. Focus on both insurance and patient balances. A healthy billing cycle means most of your outstanding claims should fall within the 0–30 day window. As time stretches out, balances should shrink.
| Age of Claim | What You Want to See |
|---|---|
| 0–30 Days | Majority of your AR |
| 31–60 Days | Moderate amount |
| 60+ Days | Should be decreasing steadily |
If you notice a large balance from one insurance company sitting in the 60+ day range, that’s a flashing neon sign to investigate. Is the payer delayed? Is something wrong with your claims?
Now’s the time to find out—before it becomes a bigger issue.
Related: Effective Strategies for Managing Patient Accounts Receivable in Healthcare
Claims Delays? Dig Into the Why
You already know that getting paid isn’t just about submitting a claim and crossing your fingers. There are layers—clean claim submission, correct coding, timely follow-up, and denial management.
If denials or delays are showing up in patterns, don’t ignore them. This is your chance to be proactive. It might mean tweaking a workflow, retraining staff, or even updating your billing software. But catching these trends now can save you serious money in the long run.
What About Your Patients? Are They Paying?
This is deductible season, after all. So ideally, your patients are paying more of their share right now. But if balances are stacking up and patients aren’t paying, it’s time to look closer.
Are front desk staff asking for balances upfront?
Are you sending statements consistently?
Do patients have multiple, convenient ways to pay—like text, online portals, or card readers at check-in?
If not, you’re probably leaving revenue on the table without realizing it. This is your moment to tighten up those front-end systems and make it easier for patients to settle their accounts.
Track Your Top CPT Codes Like a Pro
Once you’ve cleaned up your AR, the next move is this: get nerdy with your CPT codes. Seriously, this step is gold.
You want to run a breakdown of your top 10–20 most-used codes and check how much you’re actually being reimbursed for each one—by payer. Look at the allowed amount, not just the payment. Why? Because we’re still kinda in deductible season, so payments may be split between insurance and the patient.
What matters right now is:
Are those allowed amounts lining up with your contracted rates?
If you’ve negotiated a specific rate for a 99213 and the EOBs keep showing a few bucks short—you’ve got a problem. Maybe the payer is underpaying. Maybe your contract isn’t loaded correctly into the system. Either way, this step can save you thousands if something’s off.
Pro tip: Even if your contracts haven’t changed recently, check anyway.
Sometimes, payers mess up on their end and change how claims are processed—without telling you. So yeah, your billing team should be doing spot-checks regularly, not just assuming everything’s fine.
Verify Contracted Rates Against Medicare (if applicable)
If your contracts are tied to Medicare fee schedules—this part’s for you.
Here’s what to do:
Head over to the Medicare Physician Fee Schedule and look up your CPT codes.
Find the year that your contracts are based on.
Multiply by the percentage you’re contracted at (example: 125% of Medicare).
Compare that to what you’re seeing on your EOBs.
| CPT Code | Medicare Base | Contract % | Expected Allowed | Actual Allowed | Match? |
|---|---|---|---|---|---|
| 99213 | $93.00 | 125% | $116.25 | $116.25 | ✅ |
| 99214 | $137.00 | 125% | $171.25 | $165.00 | ❌ |
If the math doesn’t match, time to start asking questions.
Match Your Billing System to Your Bank Account
Look—we all love seeing a claim get paid in the billing system. But if that money never actually hits your account? Yikes.
Now’s a great time to do a quick financial audit:
Are EFT and ACH deposits from payers actually showing up in your bank account?
Are patient credit card payments being deposited fully by your merchant provider?
Does your billing system show payments that don’t exist in real life?
This kind of stuff can go unnoticed for months—especially if no one’s checking. So carve out a little time, match up payments line-by-line, and make sure no money’s gone MIA.
Use This Quarter-End to Your Advantage
Let’s be real: this might feel like a lot of data and numbers—but doing this now will save you from digging through six months of mess later. If something’s wrong, you’ll know exactly when it started and how to fix it.
Taking just one day at the end of each quarter to run through this checklist can literally pay for itself.
Turn Your Revenue Review Into a Workflow Audit
Once you’ve looked at reimbursements and bank deposits, it’s time to zoom out a little.
This isn’t just about numbers—it’s about systems. Because when your practice grows, the only way to stay profitable is to have repeatable, scalable workflows. That means everything from how claims are submitted to how staff handle denials needs to be dialed in.
Start by asking yourself:
Is your team consistently following up on unpaid claims within 30 days?
Are rejections being worked daily, or are they piling up in a dusty work queue?
Does everyone understand their role in the billing cycle, or is there finger-pointing when things fall apart?
If any of these answers make you cringe, good news—you’ve got room to grow. A strong workflow equals stronger reimbursement.
Spot Denial Trends Before They Become Expensive
Denials are part of the game, but letting them slide is a recipe for leaking revenue.
Run a denial report—yes, right now—and look for patterns.
Are certain CPT codes always denied for the same reason?
Is a particular payer constantly bouncing back claims for missing modifiers or documentation?
These are signals. Not just for billing to fix, but for your clinical and front desk teams to get involved too.
If your front desk is missing authorizations, or your providers aren’t documenting correctly, those denials will keep coming back. This is where communication between departments isn’t just helpful—it’s essential.
Set a meeting. Share your findings. Fix the root cause instead of reworking the same claim ten times.
Build a Scalable Revenue Process
Look, chasing down payments and putting out fires is exhausting. And it gets harder the more patients you see.
So your goal? Build a revenue system that runs smoother as you grow.
Here’s what that looks like:
- Claims go out clean the first time
- Denials are worked and resolved within a week
- Front desk collects balances at check-in
- Patient statements go out consistently
- Staff is trained and retrained on the workflow
Even better, document all of this into a playbook. Yes—a real SOP (standard operating procedure). That way when someone’s out sick or you hire a new biller, you’re not starting from scratch.
Automation tools can help too. Whether it’s reminder texts for patient payments or tools that flag claims missing key info, technology should work for you.
Quarterly Check-Ins Aren’t Optional Anymore
This is your business. Your paycheck. Your livelihood.
Doing a reimbursement check once a quarter is no longer a nice-to-have—it’s necessary. It helps you catch mistakes, tweak your systems, and make sure every dollar you earn actually shows up in your account.
Plus, once you get in the rhythm, it won’t feel overwhelming. Just block off a few hours every three months and knock it out. You’ll thank yourself when your cash flow stays strong and steady all year long.
Build a Simple Dashboard Your Whole Team Can Understand
Let’s be real—most people on your team don’t want to read a 12-page financial report. But if you give them the right data in the right format, you’ll be shocked at how much more engaged they become.
Start building a monthly dashboard. Something visual. Easy to digest. And relevant.
Here’s a sample layout:
| Metric | Goal | Current | Trend |
|---|---|---|---|
| Insurance AR < 30 Days | 70% | 63% | 📉 |
| Average Reimbursement per CPT 99213 | $116.25 | $115.90 | 📈 |
| Patient Collections Rate | 90% | 78% | ⚠️ |
| Denial Rate | <8% | 11% | 🔥 |
Keep it simple. You don’t need 40 metrics. Focus on the few that move the needle: reimbursement rates, AR aging, denial trends, and patient collections.
And remember, this isn’t just for the billing department—your front desk, clinical team, and admin staff all play a role in revenue. Sharing these numbers builds accountability.
Train Your Team With Data-Driven Feedback
You can’t expect your staff to improve if you don’t show them what’s broken.
Use your monthly dashboard to train smarter:
Is the front desk team failing to collect balances?
Show them the drop in patient AR collection rates.
Is your clinical team under-documenting procedures?
Walk them through the denial reasons and missed reimbursements.
This isn’t about shaming—it’s about empowering your team to be part of the solution. When they see the direct connection between their work and the practice’s income, things change. Fast.
Frequently Asked Questions About Reimbursement Analysis for Medical Practices
What is reimbursement analysis for medical practices, and why is it important?
Reimbursement analysis for medical practices is the process of reviewing insurance and patient payments to ensure claims are paid accurately and promptly. It helps identify underpayments, streamline billing workflows, and protect your cash flow—making it essential for any financially healthy medical practice.
How often should a reimbursement analysis for medical practices be done?
A proper reimbursement analysis for medical practices should be done quarterly at minimum. This allows you to catch payment issues early, identify trends, and stay on top of AR. Monthly mini-reviews can also help if your practice has high volume or a complicated billing setup.
What tools are best for conducting a reimbursement analysis for medical practices?
To perform a reimbursement analysis for medical practices, you can use tools within your EHR or billing software, custom dashboards in spreadsheets, or third-party revenue cycle management platforms. These help you track CPT reimbursements, AR aging, and denial rates with better clarity and accuracy.
What do I do if my reimbursement analysis shows underpayments?
If your reimbursement analysis for medical practices shows you’re being underpaid, compare EOBs with your contracted rates. Follow up with payers to dispute incorrect payments and make sure your billing system is correctly configured. Fixing underpayments now protects your future revenue.
Why is deductible season so critical for reimbursement analysis for medical practices?
Deductible season affects how much insurance pays vs. what the patient owes. That’s why it’s a key time for reimbursement analysis for medical practices. If patients aren’t paying or claims are being delayed, early detection in Q1 helps prevent major losses later in the year.
How can I reduce denials with better reimbursement analysis for medical practices?
Reimbursement analysis for medical practices helps pinpoint why claims are being denied—whether it’s missing info, incorrect coding, or payer issues. With this insight, you can fix workflows, retrain staff, and automate checks that prevent denials before they happen.
How can I verify if payers are honoring contracted rates during reimbursement analysis?
A smart reimbursement analysis for medical practices includes comparing your actual allowed amounts to your payer contracts or Medicare benchmarks. If the math doesn’t add up, it’s time to flag it, dispute it, or renegotiate. Spot-checking CPT codes monthly is a good habit.
Should the team be involved in the reimbursement analysis process?
Yes—bringing your team into the reimbursement analysis for medical practices creates more ownership and accountability. Whether it’s front desk staff collecting balances or clinicians improving documentation, sharing the data gives everyone a stake in the practice’s financial success.
What KPIs should I track during reimbursement analysis for medical practices?
When doing a reimbursement analysis for medical practices, focus on insurance AR aging, patient AR, denial rates, average reimbursement per CPT code, and percentage of clean claims submitted. These metrics help you find leaks and plug them before they impact revenue.
Use Your Metrics to Make Better Decisions
Here’s where it gets fun: once you’ve tracked and shared your data for a few months, it stops being just “data”—it becomes a decision-making engine.
Staffing decisions. Scheduling changes. Even whether you should drop a payer that keeps underpaying.
This is how you move from reactive to strategic.
- Seeing your denial rate climb? Maybe it’s time to invest in billing training or outsource your RCM.
- Noticing patients aren’t paying on time? You might need to roll out an easier online payment portal.
- Reimbursement dropping on a high-volume code? Time to re-negotiate your contract or shift your coding strategy.
You get the idea.
Final Thought: Stop Guessing, Start Leading
Running a practice is hard enough without flying blind. But when you understand your revenue, share it with your team, and use it to drive action—you stop reacting and start leading.
That’s how the most profitable, smooth-running practices operate. Not with more hustle. But with better systems, better data, and better conversations.