Turn your practice data into decisions.
We help physician practices understand their revenue, operations and quality, and act on what the numbers show.
Visits and collections by monthVisits Collections
Collections by payerQ3
- Medicare41%
- Commercial38%
- Medicare Advantage12%
- Medicaid6%
- Self pay3%
Annual wellness visitsYTD
of active Medicare patients completed
412 patients still due
$49.6K at the local Medicare rate
Illustrative sample dashboard
Practical analytics across the whole practice
Three areas, one approach: measure what matters, and show leaders exactly where the money and the time are going.
Financial Analytics
Provider productivity, payer mix, reimbursement, denials, A/R and cash flow. Find the revenue you earned but did not collect.
Explore Financial →Operational Analytics
Scheduling, access, no-shows, referrals and visit volume. See where capacity is lost and where patients slip away.
Explore Operational →Clinical & Quality Analytics
Patient populations, quality measures and care gaps, measured against your own clinical standards.
Explore Clinical →A practical path from data to decisions
Discover
We agree on your goals and the questions leadership needs answered.
Access data
We work with your team to securely gather the data we need.
Clean & model
We standardize, reconcile and model the data so the numbers tie out.
Analyze & visualize
Clear, practical reporting your leaders can use every month, with every issue sized in dollars.
Review & monitor
A findings review, then monthly refreshes that track progress.
per office visit separates mid-size practices from health systems in Wake County
We matched 531,319 Medicare office visits to the size of the group that billed them. Groups of 11 to 50 clinicians billed level 4 or 5 visits 48% of the time. Health systems billed them 72% of the time.
Read the case study →Clean Claim Rate
The share of claims paid on first submission without edits, rework or denial. It is the earliest signal of trouble in the billing process.
Common target for physician practices: 95% or higher.
More insights →A practical path from data to decisions
We fit into the way your organization already works, partnering with your team so insights land where your staff will actually use them.
Discover
A working session to agree on goals, key questions and the metrics that matter to your leaders.
Access data
A BAA is signed first. We then work with your team to securely gather the data we need.
Clean & model
We standardize payers, providers, CPT and denial codes, and reconcile totals to your own reports.
Analyze & visualize
Clear, practical reporting for your leaders, plus a dollar-sized findings list.
Review & monitor
A findings review with leadership, then monthly refreshes and exception alerts.
Starting with what you already have
Most engagements begin with twelve months of history so trends and seasonality are visible.
- Clear, practical reporting your leaders can use every month
- A findings review with every issue sized in dollars or hours
- A prioritized action list for billing and front-office teams
- Monthly refreshes with trend tracking
| Data | What it shows |
|---|---|
| Charges | Billed services by date, provider, CPT, units and payer |
| Payments & adjustments | Posted payments, write-offs and remittance detail |
| Denials | Denied lines with reason codes and amounts |
| A/R aging | Open balances by payer and aging bucket |
| Appointments | Scheduled, completed, no-show and cancelled visits |
| Fee schedules | Charge rates and key payer contract rates |
From kickoff to first findings
| Week | Your team | MedPractice Analytics |
|---|---|---|
Week 1 | Sign BAA, help us gather data | Discovery session, receive data, confirm completeness |
Week 2 | Answer a few data questions | Clean, model and reconcile to your totals |
Week 3 | None | Build dashboards and size each finding |
Week 4 | Findings review meeting | Deliver dashboards and action list |
You can't manage what you can't see
Billing systems are built to bill, not to explain. Our analytics answer the questions physicians and administrators actually ask.
Three ways to work with us
Practice Assessment
A four-week review of twelve months of data, with dashboards and a sized action list.
Analytics Buildout
Custom reporting built around your specialty, payers and providers, designed to refresh every month.
Monthly Monitoring
Ongoing refreshes, exception alerts and a monthly review with practice leadership.
See your practice finances clearly
Your systems already capture the data. Pulling it together shouldn't take days. These analyses show where revenue comes from, where it slips, and what to act on first.
We don't do your billing or replace your systems. We give your leadership the view your billing reports leave out.
Built around your existing systemsPhysician Productivity & Compensation Reporting
How is each physician's productivity trending, and what does it mean for the compensation plan you already use?
Payer Payments & Fee Schedule Review
Which payers pay less than expected on your most common codes, and do your charges still make sense?
Payer Mix & Reimbursement
Which payers pay well, which pay slowly, and how is your mix changing?
Denial Analysis
Which denials can we prevent, which can we appeal, and which are lost?
A/R & Cash Flow
How old is our money, and where is it stuck?
Charge Lag & Missed Charges
How long from visit to claim, and are services going unbilled?
Collections Performance
Of what we are owed, how much do we actually collect?
Cost & Profitability
What does it cost to deliver care, by provider and location?
Use every hour of capacity
An empty slot can't be billed later. These analyses show where schedules leak, where patients wait, and where referrals go.
Patient Access
How long do new patients wait for an appointment?
No-Shows & Cancellations
Which patients, days and visit types miss most, and what does it cost?
Schedule Utilization
How full are provider templates, really?
Referral Sources & Leakage
Who sends us patients, and are those referrals growing or shrinking?
Visit Volume & Trends
How is demand changing by provider, location and visit type?
Front-End Readiness
Are eligibility and prior authorizations done before the patient arrives?
Know your patients, track your quality
Understand the needs of your patient populations and measure performance against your clinical standards and reporting programs.
Patient Population Profiles
Who are our patients by age, payer, condition and geography?
Quality Measure Tracking
Where do we stand on the measures we report?
Care Gap Lists
Which patients are due for a screening, follow-up or recall?
Procedure Utilization
How do procedure patterns compare across providers?
Built for how your specialty bills
Every specialty has its own codes, payers and failure points. We tailor each analysis to yours.
Gastroenterology
Endoscopy volume, facility versus professional splits, and authorization-driven denials.
General Surgery
Global period tracking, modifier accuracy, and prior auth for high-dollar procedures.
Orthopedics
Surgical case mix, implant reimbursement, and therapy and imaging referrals.
Cardiology
Diagnostic testing volume, medical-necessity denials and imaging utilization.
OB/GYN
Global maternity billing, provider productivity and high-volume scheduling.
Ambulatory Surgery Centers
Case volume, payer mix and reimbursement per case for physician-owned ASCs.
Clean Claim Rate
The share of claims paid on first submission, with no edits, rework or denial. Every claim that fails the first pass costs staff time and delays cash.
Target: 95% or higher for most physician practices.
When it drops, check: registration errors, missing authorizations, and coding edits on new procedure codes.
Denials by root cause
Grouping denial codes into a few root causes turns a long list into a work plan.
Front-end causes are fixed at scheduling and registration. Coding causes are fixed with providers and coders. Payer causes go to appeals.
$ denied by root cause12 months
Medicare rates, coding and practice size in Wake County
What does Medicare actually pay for the services local practices bill most, and do independent practices code and charge the way the health systems around them do? We used 2024 Medicare data for Raleigh, Cary, Morrisville and Apex to find out.
Public data, matched by provider
We matched each provider's Medicare billing to the group they practice in using the National Provider Identifier. Code tables count only services billed by at least three providers, so no single practice drives a result.
| Billing data | CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024 |
|---|---|
| Group size | CMS Doctors and Clinicians directory, North Carolina |
| Area | Raleigh, Cary, Morrisville and Apex |
| Specialties profiled | Family medicine, dermatology, physical therapy |
| Providers matched | 1,821 of 2,097 providers who billed established office visits |
Three prices for every service
Each code table below shows three averages per service. The gaps between them matter as much as the numbers themselves.
What the practice billed
Set by each practice's own fee schedule. Medicare ignores it when paying, but it drives patient balances and out of network claims.
What Medicare allows
The approved amount for the service in this area. It is the benchmark most commercial contracts are negotiated against.
What Medicare sent
About 77% of the rate across the area. The patient or a secondary insurer owes the remainder, which the practice still has to collect.
Where Medicare dollars go in western Wake County
Top five codes by Medicare payment across all specialties.
| Code | Service | Providers | Medicare paid |
|---|---|---|---|
99214 | Established office visit, moderate complexity | 1,799 | $23.6M |
J0178 | Aflibercept injection (retina care) | 17 | $20.1M |
99213 | Established office visit, low complexity | 1,593 | $9.8M |
J0177 | Aflibercept high dose injection | 15 | $8.6M |
66984 | Cataract surgery with lens implant | 46 | $5.0M |
Office visits are the most widely billed service in the area, which makes how they are coded one of the largest levers on practice revenue.
Mid-size groups bill far fewer high level visits
Health systems with more than 250 clinicians billed 72% of established office visits at level 4 or 5. Groups of 11 to 50 clinicians billed 48%, a gap of 24 percentage points.
Applied to area Medicare rates ($80.42 for a level 3 visit, $112.34 for level 4), a mid-size group averages $95.64 per established visit and a health system $106.82. That is $11.18 per visit, or about $11,180 for every 1,000 Medicare visits.
Share of visits billed at level 4 or 5
Visits per band: 52,928 · 64,881 · 79,798 · 276,367. Allowed per visit: $98.14 · $95.64 · $98.00 · $106.82.
Family medicine
| Code | Service | Providers | Charge | Medicare rate | Medicare paid |
|---|---|---|---|---|---|
99214 | Established office visit, moderate complexity | 177 | $261.64 | $118.68 | $78.10 |
G0439 | Annual wellness visit, subsequent | 130 | $285.96 | $120.36 | $120.36 |
99213 | Established office visit, low complexity | 159 | $178.91 | $83.81 | $53.80 |
99215 | Established office visit, high complexity | 73 | $360.55 | $167.48 | $118.14 |
90677 | Pneumococcal conjugate vaccine (PCV20) | 38 | $531.62 | $283.89 | $283.89 |
Finding: the wellness visit gap
Medicare pays the annual wellness visit in full, $120.36 with no patient share, and it was the second largest source of family medicine revenue. Yet 54 of the 184 family physicians who billed established office visits show no wellness visits in the data. 23 of them saw at least 50 Medicare patients for a single visit level.
Primary care visit coding also varies widely. Among 273 family and internal medicine providers with 100 or more established visits, the share billed at level 4 or 5 ran from 40% at the 10th percentile to 99% at the 90th.
Fee schedule: level 4 visits were charged at 1.8 to 2.7 times the Medicare rate (10th to 90th percentile).
Level 4 or 5 share, primary care providers
Dermatology
| Code | Service | Providers | Charge | Medicare rate | Medicare paid |
|---|---|---|---|---|---|
99213 | Established office visit, low complexity | 46 | $158.79 | $86.32 | $56.96 |
99214 | Established office visit, moderate complexity | 40 | $226.18 | $120.62 | $80.21 |
17110 | Destruction of benign skin lesions, up to 14 | 40 | $202.08 | $103.24 | $72.42 |
11102 | Skin biopsy, first lesion | 45 | $190.63 | $84.79 | $59.49 |
17000 | Destruction of precancerous lesion, first lesion | 44 | $127.94 | $49.56 | $34.26 |
Finding: a different coding pattern, and the lowest charges
Dermatologists billed 57.5% of established visits at level 3 and 34.4% at level 4, the reverse of the area as a whole. Much of their work is billed as procedures alongside the visit, which pulls visit levels down.
They also set the lowest charges relative to Medicare of any specialty profiled.
Fee schedule: level 3 visits were charged at a median of 1.77 times the Medicare rate, against 2.31 times across all specialties in the area.
Established visit mix
Physical therapy
| Code | Service | Providers | Charge | Medicare rate | Medicare paid |
|---|---|---|---|---|---|
97110 | Therapeutic exercise, each 15 minutes | 357 | $70.75 | $22.27 | $17.06 |
97530 | Therapeutic activities, each 15 minutes | 277 | $70.12 | $29.99 | $23.19 |
97112 | Neuromuscular re-education, each 15 minutes | 277 | $69.84 | $25.91 | $20.01 |
97140 | Manual therapy, each 15 minutes | 300 | $63.19 | $19.71 | $15.09 |
97161 | Physical therapy evaluation, low complexity | 206 | $187.73 | $94.80 | $69.52 |
Finding: small units, wide pricing
Medicare paid $15 to $23 for each 15 minute treatment unit, so therapy revenue is built one unit at a time. Patients averaged 10.9 units of therapeutic exercise alone over the year, which makes unit capture and documentation of minutes central to the bottom line.
Pricing varied more than in any other specialty. For the same 15 minute exercise unit, charges ran from $36 at the 10th percentile to $150 at the 90th.
Fee schedule: therapeutic exercise was charged at 1.7 to 6.6 times the Medicare rate (10th to 90th percentile).
Charge to Medicare rate, therapeutic exercise
Bar length scaled to the highest observed ratio, 7.3×.
Know where you sit
Compare your visit mix, wellness visit volume and units per patient to peers of your size and specialty. A large gap is a question worth answering.
Look at the spread
Variation between providers in the same specialty often points to documentation habits, not patient differences.
Review your charges
A charge master that has drifted affects patient balances and gives up ground in payer negotiations.
Read it with care
- Visit levels reflect patient complexity as well as documentation. A lower mix is a reason to review, not proof of undercoding.
- The data covers Medicare fee for service only.
- CMS hides any row with fewer than 11 patients, so a provider with no wellness visits in the data may have billed a small number.
- Averages are weighted by services. Group size is based on CMS directory counts and does not confirm ownership.
- Results are shown by group size and specialty only. We do not single out individual providers or practices.
The same analysis, all payers, every provider
- Visit level mix by provider, location and payer
- Your rates and charges compared code by code
- A documentation sample reviewed with your coding team
- Monthly tracking so changes hold
Sources: Centers for Medicare & Medicaid Services, Medicare Physician & Other Practitioners, by Provider and Service (2024) and Doctors and Clinicians National Downloadable File. Analysis by MedPractice Analytics.
Webinars
Thirty-minute sessions on practical analytics for practice leaders.
Your patients' data, handled with care
We work with protected health information, so every engagement follows HIPAA requirements from day one.
- A Business Associate Agreement is signed before any data is shared
- Data moves only through encrypted, access-controlled channels
- We request the minimum data necessary for each analysis
- We follow your IT and security policies, with access only as approved
- Data is deleted at the end of an engagement on a documented schedule
Healthcare data experts, working for physician practices
MedPractice Analytics brings health-system revenue cycle and business intelligence experience to practices that don't have an analytics team of their own.
Our background spans hospital and physician billing data, revenue cycle reporting, and Medicare cost reporting. We built this firm so independent practices can get the same clarity large health systems rely on, built around the way they already work.
Request a meeting
Tell us about your practice. We'll set up a 30-minute call to walk through your goals and what a first analysis would look like.
Reach us directly
We reply within one business day.