Billing Services for Physicians: Why Most Private Practices Are Collecting Less Than They Should

By Medtransic | February 23, 2026 | 12 min read | Updated: February 23, 2026

Quick Summary: The average physician practice loses 5 to 11 percent of collectible revenue every year — not from low reimbursement rates, but from billing failures that never show up as denied claims. Wrong E/M levels, missed add-on codes, unworked denials, and fee schedules set years ago. This guide breaks down exactly where physician revenue leaks happen and what MD billing services do differently.

Most physicians assume their billing problems show up as denials. They do not. The biggest revenue losses in physician billing are invisible — they come from claims that get paid, just at the wrong amount. Wrong E/M level. Missing add-on code. Fee schedule that has not been updated in three years. These are not denials. They are underpayments, and they accumulate quietly into five- and six-figure annual losses.

The second category of loss is claims that do get denied — but never get appealed. The average physician practice writes off 50 to 65 percent of denied claims rather than work them. That is revenue that was earned, billed, and then abandoned. Medtransic's physician billing team was built specifically to find and recover both categories of loss.

• 5–11% Revenue Lost Annually - Average physician practice billing gap
• $125K Lost Per Physician/Year - From E/M leveling errors alone
• 65% Denials Written Off - Practices without denial management
• $10K+ Lost Per Payer/Month - For each unenrolled provider

Why Most Physician Billing Falls Short

Physician billing fails in predictable ways. It is almost never dramatic — no mass denials, no system failures. It is the quiet accumulation of small, repeating errors across hundreds of claims per month. Each one is small enough to miss. Together, they add up to a revenue gap that most practices never measure because they are not looking for it.

Billing Services for Physicians

Billing services for physicians are specialized revenue cycle management services designed for physician practices — solo practitioners, group practices, and independent clinics. Unlike general medical billing, physician-focused billing services include specialty-specific E/M coding optimization, add-on code capture, payer contract analysis, credentialing and enrollment management, and denial management workflows built around physician-specific denial patterns. The goal is not just claim submission — it is maximizing the revenue a practice collects from every service it provides.

The common thread is that all of these losses are preventable. They are not the result of payers behaving badly or coverage gaps in patient populations. They are operational failures — things a competent billing service catches and corrects.

E/M Leveling: The Biggest Single Revenue Leak in Physician Billing

Evaluation and Management codes — the 99202 through 99215 series — are the core of physician revenue for most practices. And they are the single most commonly miscoded category in all of physician billing. The problem is not upcoding. It is undercoding. Physicians and their billing teams routinely code encounters at lower levels than the documentation supports.

The 2021 AMA E/M guidelines restructured leveling around medical decision making and total time. Most physician practices have not fully adapted their documentation or coding workflows to capture the higher levels their encounters now support.

Medtransic performs an E/M coding audit on every new physician practice we onboard. We pull a sample of 30 charts, apply the 2021 MDM criteria, and show the physician exactly how many encounters were coded below their documented level. In most cases, the audit reveals a consistent pattern — the same levels undercoded on the same visit types, week after week, month after month.

Missed Add-On Codes: The Revenue Nobody Notices Is Gone

Add-on codes are secondary CPT codes billed alongside a primary code to capture additional work performed during the same encounter. They are legitimate, expected, and specifically designed to reflect the full scope of what a physician does. They are also the most commonly missed category of billable charges in physician practices.

The reason they get missed is structural. Add-on codes require a specific primary code to be billed first — they cannot stand alone. Many billing teams are not trained to look for them, and many physicians do not include them on superbills because they assume the billing team will catch them. Neither assumption holds in general billing environments.

A physician billing company that actively tracks add-on code capture rates will show you exactly what you are missing. Medtransic includes add-on code analysis in every practice audit and builds specialty-specific add-on checklists into the billing workflow so nothing billable leaves the encounter without being captured.

Denial Management: Where Most Physician Practices Hemorrhage Revenue

The average physician practice has a 5 to 7 percent denial rate. That sounds manageable until you put real dollars on it. For a practice billing $1.5 million annually, a 6% denial rate is $90,000 in denied claims. If 60% of those go unworked — which is the industry average — that is $54,000 written off every year on revenue that was earned.

Most in-house billing teams and general billing companies do not have a structured denial management workflow for physician claims. Denials come in, get reviewed by one person, and if the fix is not obvious, they age out. Payer appeal deadlines — typically 60 to 180 days depending on the payer — pass unnoticed. The claim gets written off and the revenue is gone.

Medtransic works every denial. Every one gets a root cause assigned, a corrective action taken, and a resubmission or formal appeal filed within payer deadlines. We track denial rates by reason code, by payer, and by provider — so we can identify systemic issues and fix them upstream before they generate more denials.

Outdated Fee Schedules: The Silent Drain on Physician Revenue

Every commercial payer has a contracted fee schedule — the rates they agreed to pay your practice for specific CPT codes. These schedules update annually, vary by payer and region, and erode over time if you do not actively manage them. Most physician practices have not reviewed their contracted rates in years.

Here is what that costs in practice. A payer contract signed in 2020 at 110% of Medicare may now be below what competitors negotiated at 120–130% two years later. On a practice billing $1.5 million annually, that 10% rate gap is $150,000 a year — paid correctly on every EOB, generating no denials, showing no red flags. Just a lower number than you should be getting.

Medtransic performs a payer contract analysis for every physician practice client. We compare current contracted rates against regional benchmarks, identify which payers are underpaying, and provide the data you need to negotiate better rates. We also monitor for underpayments on every EOB — catching instances where a payer pays less than their own contracted rate and initiating recovery.

Credentialing Gaps: How Slow Enrollment Costs $10,000 Per Month

Every physician must be individually enrolled with each payer before that payer will reimburse claims. The enrollment process takes 90 to 180 days per payer. During that window, if a new physician is seeing patients, every claim submitted to that payer is either denied or held pending enrollment. That is $10,000 or more per payer per month in delayed or lost revenue.

A practice onboarding a new physician needs enrollment with 8 commercial payers plus Medicare and Medicaid — that is 10 simultaneous applications. Each has its own forms, timelines, and follow-up requirements. A single error on one application restarts the clock on that payer.

Medtransic's credentialing and payer enrollment team manages the entire process — applications, follow-up, error correction, and re-enrollment — with dedicated specialists who know each payer's requirements. We track every application and push for the fastest possible approval on every payer simultaneously.

What MD Billing Services Should Actually Include

A complete physician billing service is not just claim submission. Here is the full scope Medtransic delivers for every physician practice client.

How to Evaluate a Physician Billing Company

The physician billing market is crowded with general billing companies that handle every specialty without deep expertise in any. These questions cut through the marketing to identify whether a billing company will actually perform for your practice.

• Ask how they handle E/M coding. Do they audit charts against MDM criteria, or just code whatever is on the superbill? Ask to see the E/M level distribution for their current physician clients. A billing company leaving E/M leveling entirely to you is leaving money on the table.
• Ask for their denial rate and appeal success rate by specialty. Overall denial rate is meaningless — you need physician-specific data. The industry average for appeal success is 30–40%. A strong billing company hits 60–75%. If they cannot give you this number, they are not tracking it.
• Ask specifically about underpayment detection. Do they flag payments that fall below your contracted rates? Most billing companies post EOBs without checking them against contracted rates. If the answer is unclear, they do not do it.
• Ask about credentialing timelines. What is their average time from application to approval? Do they manage CAQH maintenance and re-credentialing deadlines? These are specialized workflows — many billing companies hand them off to a third party they barely oversee.
• Ask for references from your specialty. Strong cardiology billing does not mean strong primary care billing. Get references from practices that match your size and specialty.

What Physician Billing Services Cost and What Results to Expect

Physician billing services are priced one of three ways. Here is what each model means in practice and what to watch for with each.

Most physician practices that move to Medtransic's physician billing services see collections increase 15 to 25 percent within the first 90 days. The gains come from three sources: better E/M coding accuracy, higher add-on code capture, and structured denial management that recovers revenue previously written off.

Medtransic starts every physician billing engagement with a free revenue recovery audit. We review your last 90 days of claims — coding patterns, denial reasons, underpayments, and credentialing gaps. We show you in dollar terms exactly where revenue is being lost. Most physicians are surprised by the total.