What a billing review gives you: an example report
This is an example with a fictional practice and made-up figures, to show the format and the kind of findings you receive. It is not a real client or real results.
EXAMPLE · fictional practice · made-up figures
Billing review: “Example Orthopaedic Practice”
- Practice type
- Solo orthopaedic surgeon, in hospital and in rooms (fictional)
- Billing today
- In-house, one staff member
- Period looked at
- Three months of remittances and the current age analysis
1. Summary
- Most rejections came from two fixable causes: authorisation mismatches and dependant codes.
- Older patient portions were not being followed up after the first statement.
- Month-end reporting did not show collections against billing.
2. Rejections by reason (example)
| Reason | Claims (example) | Fixable? |
|---|---|---|
| Procedure differs from authorisation | 14 | Yes: update authorisation after theatre |
| Wrong dependant code | 9 | Yes: check at booking |
| ICD-10 not specific enough | 6 | Yes: capture full detail |
| Benefit exhausted | 3 | Partly: tell patient in advance |
3. Debtors by age (example)
| Age | Medical schemes | Patients |
|---|---|---|
| Current–30 days | R120 000 | R18 000 |
| 31–90 days | R35 000 | R22 000 |
| Over 90 days | R12 000 | R41 000 |
4. Claims and process observations
- Multiple-procedure modifiers were missing on some arthroscopy accounts.
- Theatre times weren’t shared with the anaesthetist’s practice on every case.
- Remittances were banked but not reconciled line by line.
5. Recommendations
- Check membership and dependant details at booking.
- Update authorisations after theatre when the procedure changes.
- Work rejections daily and follow up patient portions on a set schedule.
- Report collections against billing every month.
6. Quote
A fee for the practice as a percentage of what is actually collected, with no hidden costs, no setup fee and no annual increases. (Real reviews include your actual quote.)
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Tell us how your practice bills today. We’ll look at how claims are captured and submitted, where rejections and debtors build up, and what we’d change. Then we quote a fee for your practice. If it’s not a fit, you still keep the findings.
- Fees from 5% to 8% of what’s actually collected, quoted per practice
- No hidden costs, no setup fee, no annual increases
- Reply by phone, email or WhatsApp in business hours
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