MEDICAL BILLING AND RCM FIRMS
Running a Medical Billing Firm: Claims per Biller, Denials, Cash
The month closes and your largest client's collections look fine, but two of your billers spent most of the last fortnight reworking the same claims that came back. The invoice you send for the month is still based on percentage of collections, and the cash arrives after the salaries have gone out.
We look at the firm as a business. That covers claims worked per biller, how many come back for rework, how long each client takes to pay you, and how much revenue sits with one or two clients. Coding rules, payer rules and compliance are outside our work.
Book a first callCOMMON CHALLENGES
What goes wrong in
medical billing and rcm firms.
- 01Productivity is judged by claims touched per day, so a biller who sends a hundred claims that all come back looks better than one who sends sixty that clear.
- 02Denials and reworks are handled in each biller's own sheet, and the firm cannot say how much of the month went into repeat work.
- 03Clients pay your fee late, and the invoice is raised on collections that the client reports, so nobody on your side knows the exact amount until it is argued.
- 04One or two clients provide most of the revenue, and the owner learns of a contract ending only when the volume drops.
- 05New clients are taken on with a quoted price, but the real effort per claim is learned months later, once the team is already stretched.
NUMBERS TO TRACK
Count these
every week.
Claims cleared per biller
Claims one biller sent that were paid or closed without return in the month, listed per biller, with the split by client as a second view.
Rework and denial counts
Claims returned and worked again divided by claims worked, by client and by biller. Keep claims the payer denied as a separate count beside it.
Fee per hour by client
Fee received from the client divided by hours your team logged on its claims.
Top-three client share
Fees from your three largest clients divided by all fees for the month.
WORKED SAMPLE (ILLUSTRATIVE, NOT CLIENT DATA)
Claims and rework by biller for one month (illustrative, not client data)
| Biller | Claims worked | Returned for rework | Rework rate |
|---|---|---|---|
| Biller A | 400 | 40 | 10% |
| Biller B | 500 | 50 | 10% |
| Biller C | 300 | 60 | 20% |
| Team | 1,200 | 150 | 12.5% |
Biller C's rate is double the others. Of 150 reworked claims, 60 sit with one biller, which is 40 percent of all rework from a quarter of the volume.
COMMON MISTAKES
What owners often
get wrong first.
- 01Rewarding claims touched per day, when the rework rate shows many of them return.
- 02Pricing a new client without knowing fee per hour on the existing ones.
- 03Watching total revenue grow while the top-three client share creeps up and one contract holds the firm.
OUR FOCUS AREAS
Where the work
usually starts.
- 01Claims worked, claims cleared and claims returned, by biller and by client
- 02A rework log with the reason a claim came back, in the firm's own categories
- 03Hours spent per client against the fee received from that client
- 04Client concentration: the share of monthly fees from the top three clients
- 05Invoice-to-payment gaps by client, with a named person who follows up
- 06Team capacity: claims per biller per day against the load each client brings
- 07An onboarding check for new clients covering volume, claim mix and effort per claim
- 08A Friday sheet covering rework and fees by client, read by the owner and operations lead
START THIS WEEK
Things you can do
before you call anyone.
- For last month, list claims worked, claims returned and claims reworked for each biller. Divide the returns by the worked count.
- Hypothetical example: if the team worked 1,200 claims and 150 came back for rework, the rework rate is 12.5 percent. Split the same figures by client to find the one that returns the most.
- Write the fee received from each client and the hours your team spent on it. The fee divided by the hours is the number that tells you which clients are worth the effort.
WHAT YOU GET
Start with the priorities
that matter most.
Your first sheet: a biller sheet showing claims worked, claims returned and the rework rate for each biller and each client for the month
- A biller productivity sheet counting cleared claims, not touched claims
- A rework and denial log by client, with the share of each biller's month it took
- A client profitability sheet comparing fees received with hours spent
- A receivables list by client with an invoice follow-up routine
Not the right fit when: We do not advise on coding, payer rules or compliance; those need your coders, your clients and the relevant authority. If your trouble is a clinic's own collections inside its building, see /industries/healthcare/doctors-and-general-clinics.
HOW THE WORK RUNS
What happens after
you book.
- First call: you describe the business and the numbers you already track.
- Your first sheet: the one described under What you get, built from your own books.
- The rhythm: a regular review of claims cleared per biller, rework and denial counts, fee per hour by client, top-three client share.
- What you hold at the end: a written sheet and a named owner for each number.
WHICH SERVICE FITS
Where we usually start
for this trade.
Operations & Process Audit
We walk through how work really flows in your business, from order to delivery, and identify the delays, rework, errors and handoffs costing you money.
Business Audit
Operations & Process Audit is part of Business Audit. See the full service if the problem is wider than one piece.
PROBLEMS THIS SHOWS UP AS
How owners in this trade
describe it.
Our revenue is growing, but our profit is not
Sales are up but the money left over is not. Find where margin leaks in pricing, discounts, rework and overheads, and what to check this week.
My team is busy, but nobody takes accountability
Everyone looks occupied, yet deadlines slip and results lag. See how unclear roles, targets and reviews cause it, and how to build real ownership.
COMMON QUESTIONS
Before you
get in touch.
HOW THIS DIFFERS
Close trades,
different work.
How this differs from Doctors and general clinics
A clinic bills its own patients at the desk and collects at the visit; a billing firm bills for many providers and is paid by a share of what they collect.
How this differs from IT services and networking companies
An IT services firm sells project hours and delivery; a billing firm sells claims work to healthcare clients and its margin depends on rework.
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