Let’s face it: time is money. And in healthcare, the time and cost implications of medical billing rework are significant. Industry experts consistently reference a statistic — dating back over a decade — that places the average expense of reworking a denied claim at approximately $25. In reality, that cost has likely increased over time due to fragmented systems, more complex payer requirements, and ongoing coding challenges.

The operational and financial burden of administrative rework is significant, and it only continues to worsen as claim denials rise. Nearly 75% of providers reported increases in claim denial frequency between 2022 and 2024, with 38% reporting denial rates reached 10% or more and 11% reporting they reached 15% or higher.

In 2024, 40% of medical biller respondents to a Tebra survey reported denial rates had increased in the past 12 months. Some Affordable Care Act plans now deny 20% of in-network claims on average.

Fortunately, the process of getting paid in healthcare follows several clearly defined steps. We’ll refer to these as "significant components of the medical billing workflow.” These predictable stages enable providers and billing company owners to pinpoint vulnerable areas and drive process improvement.

This guide will empower you to reduce medical billing rework with specific strategies designed to overcome common obstacles. By understanding the interconnectedness of these stages — and how integrated technology can help — you can address problematic areas to positively impact your operational efficiency and cashflow. 

The medical billing workflow is not a single task but an end-to-end process that includes the following steps in a specific order:

These significant components of the medical billing workflow are interdependent. Each depends on the accuracy of the one before it, and errors at any point may impact a provider’s ability to receive proper and timely reimbursement. 

Similarly, when a medical billing company oversees one or more of these stages, inaccuracies — regardless of direct responsibility — can affect the company’s capacity to achieve requisite performance indicators and benchmarks and to maintain smooth cashflow. 

Even with fully electronic processes, it costs approximately $19 to produce and submit a claim and reconcile payment. This is based on labor time and doesn’t include the follow-up or system costs.

For providers, any amount exceeding the initial $19 because of rework constitutes lost revenue. For medical billing companies paid on collections, delayed cash flow can pose a significant challenge. And remember: if any part of the medical billing process is manual, the total cost goes up.

It’s helpful to group significant components of the revenue cycle into 3 general stages, each with a critical goal:

As you strive to reduce rework, ask, does each stage of the medical billing workflow achieve its intended goal? If not, why? Where do breakdowns occur with significant components of the medical billing workflow? What are the barriers? 

For example, a medical practice struggling to collect outstanding patient balances may need to update its financial policy or offer additional (digital) payment options. A medical billing company struggling to submit clean claims may need to help its provider client improve front-end data capture or enhance mid-cycle clinical documentation.

While medical billing challenges may shift with payer rules or staff turnover, you may encounter the following common pain points and medical billing obstacles:

Fortunately, with proactive planning, medical practices and billing companies can address billing challenges and reduce rework by following these best practices:

In addition to the best practices listed above, you can leverage these other strategies to boost significant components of the medical billing workflow:

Numerous opportunities exist to minimize costly and time-intensive rework in medical billing. These opportunities are present in all significant components of the medical billing workflow, including patient eligibility verification, clinical documentation, medical coding, as well as claim creation, review, and submission. 

Continuous assessment enables medical practices and billing organizations to navigate medical billing obstacles successfully and identify and address specific areas for improvement. Implementing structured process enhancements alongside robust technology like Tebra’s integrated software reduces rework in the near term and establishes a strong foundation for lasting operational efficiency. Learn more and sign up for a demo today.