Author: Jd Medlink

The Average Time Medicare Claims Processing Takes For Clean Claims

Posted on February 8, 2021March 18, 2026 by Jd Medlink

One of the most common questions we receive from clients is: “How long should it take to get paid by Medicare?” The answer depends on your specialty, your MAC jurisdiction, and whether your claims are truly clean when submitted.

## Our Data: 10,100 Medicare Claims

We analyzed 10,100 Medicare claims submitted by MedLink clients across multiple specialties. Here is what the data showed:

**Overall Average: 14.02 days from submission to payment**

A few observations from this data:

– **Podiatry** consistently processes fastest. This is likely due to simpler coding patterns and lower denial rates for common procedures.
– **OB/GYN and Orthopedics** are the slowest. Both specialties involve complex procedures with higher rates of medical necessity reviews and authorization requirements.
– **Family Practice** falls near the middle, which aligns with the mix of E/M services and preventive care that typically have straightforward adjudication.

## Blue Cross Data: 11,700 Claims Across 6 States

We also analyzed 11,700 Blue Cross claims across six states. The key finding: **payment variance of 6.07 days** between the fastest and slowest state.

This variance is significant and is primarily driven by:
– State-specific claims processing infrastructure
– Local plan policies and medical necessity criteria
– Provider-specific contract terms

## What Makes a “Clean” Claim?

A clean claim is one submitted without errors or missing information that would cause the payer to request additional information before processing. The key elements of a clean claim include:

1. Accurate patient demographics (name, DOB, insurance ID)
2. Correct provider NPI and taxonomy code
3. Valid and supporting diagnosis codes (ICD-10)
4. Appropriate CPT codes with modifiers if required
5. Place of service code matching the actual service location
6. Referring provider information when required

In our experience, the majority of claims that extend beyond 30 days are not actually being processed slowly — they were never truly clean when submitted.

## What Should You Do If Claims Are Taking Longer?

If your Medicare claims are regularly exceeding 20–25 days, investigate:

– Are claims being submitted within 24–48 hours of service?
– What is your clean claim rate at your clearinghouse?
– Are you tracking denials back to root causes?

MedLink’s standard is 48-hour claim filing. If you want to benchmark your practice against these numbers, reach out for a free revenue cycle review.

How to Sell a Medical Practice: Top 5 Variables to Consider

Posted on February 1, 2021March 18, 2026 by Jd Medlink

Selling a medical practice is one of the most complex financial transactions a physician will undertake. Unlike selling a consumer business, medical practices involve credentialing, patient relationships, ongoing insurance contracts, and regulatory considerations that require careful planning.

Here are the five variables we believe most impact the outcome of a practice sale.

## 1. Accounts Receivable Treatment

The accounts receivable (AR) at the time of sale is often the most contentious negotiating point. There are two main approaches:

**Seller Collects Outstanding AR**
The seller retains rights to all outstanding claims at the time of sale and continues billing activity for a defined period post-closing (typically 90–180 days). This is simpler for the buyer but requires the seller to maintain billing operations temporarily.

**Buyer Acquires AR at Discount**
The buyer may agree to purchase the AR at a discounted value (often 50–70 cents on the dollar, depending on age and payer mix). This gives the seller a clean break but typically results in less total recovery.

*Our recommendation: Have your billing partner provide a clean aging report at least 90 days before closing so you can negotiate from an informed position.*

## 2. Municipal Unemployment Rate

This is a variable most sellers overlook. The local unemployment rate affects:
– The size and sustainability of your patient base
– Staff recruitment costs for the buyer
– The likelihood of commercial insurance retention post-sale

A practice in a growing metropolitan area with low unemployment commands a higher multiple than the same practice in a declining market.

## 3. Independent Auditors

Before listing your practice, engage an independent healthcare valuation firm. They will use methodologies such as:

– **EBITDA multiples** (common for larger practices)
– **Revenue multiples** (simpler, used for smaller practices)
– **Widget analysis** — calculating the value based on the number of billable encounters, average reimbursement, and payer mix

Do not rely solely on your accountant or attorney. A healthcare-specific valuation expert understands nuances that general advisors miss.

## 4. Restrictive Covenants

Any purchase agreement will include restrictive covenants. There are four primary types:

1. **Non-Competition** — Prevents you from practicing medicine within a defined geographic radius for a defined period
2. **Non-Solicitation** — Prevents you from actively recruiting patients to a new practice
3. **Anti-Raiding** — Prevents you from hiring your former staff members
4. **Confidentiality** — Restricts your ability to disclose practice financials, systems, or patient data

These covenants are negotiable. Geographic radius, duration, and carve-outs (e.g., you can still see existing patients who seek you out) are all points to negotiate before signing.

## 5. Transition Planning

The most valuable thing you can do before selling is build a practice that runs without you. That means:

– Documented systems and workflows
– Staff capable of operating independently
– Clean, up-to-date billing records
– A healthy AR with no significant outstanding denials

Buyers pay premiums for practices that are operationally clean and financially transparent.

## Final Thought

A well-prepared practice sale can fund your retirement, support your staff, and ensure your patients continue receiving good care. Start planning 12–24 months before your target sale date, and engage the right advisors early.

Medical Practice Aging | How Does My Practice Compare With My Peers

Posted on January 25, 2021March 18, 2026 by Jd Medlink

When a practice wants to understand the health of its revenue cycle, the insurance aging report is the first place to look. But reading that report — and knowing what “good” looks like — requires context.

## The 3 Components of Insurance Aging

Every aging report you generate from your practice management system should break down each payer’s balance into three components:

1. **Charge** — The amount billed to the insurance company
2. **Contractual Adjustment** — The portion of the charge that has been written off per your contract with the payer
3. **Payment** — What the payer has actually paid

The net balance remaining (Charge minus Adjustment minus Payment) is your outstanding AR. This is the number that matters.

## What Are the Benchmarks?

Benchmarks vary depending on the source, but here are two commonly referenced standards:

**MGMA (Medical Group Management Association)**
MGMA data suggests that a healthy practice should have approximately **57% of insurance AR in the current bucket** (0–30 days).

**Collection Agency Standard**
A more aggressive benchmark — often used by revenue cycle consultants — is **62% current**.

The gap between 57% and 62% might seem small, but at scale, it represents meaningful dollars. A practice with $500,000 in monthly charges that improves its current percentage from 57% to 62% is collecting an additional $25,000 per month faster.

## Why Benchmarks Are Subjective

Raw aging benchmarks have a flaw: they are influenced by your fee schedule. If your charges are set too low (at or near Medicare reimbursement rates), the contractual adjustment column will be small — making your aging look healthier than it actually is.

**Best practice for fee schedule pricing:** Set your fees at **120–150% of Medicare reimbursement**. This ensures:
– You have room to accept commercial payer contracts at market rates
– Your aging report accurately reflects true payer behavior
– You are not inadvertently leaving money on the table with non-contracted payers

## How to Use This Data

When reviewing your aging report, ask:

– **What percentage of my AR is over 90 days?** Anything over 15–20% warrants investigation.
– **Which payers have the most aging over 60 days?** These are your denial problem payers.
– **Is my fee schedule masking true collection problems?** Run a comparison against Medicare fee schedules.

## Bottom Line

Aging reports are a window into the health of your revenue cycle. If you do not have a clear picture of where your AR stands relative to industry benchmarks, start there. It is the foundation of every other improvement you will make.

Need help reading your aging report or setting up benchmarks? Contact MedLink Services for a free revenue cycle review.

Adjudication | Where The Purchase Funnel and Medical Practice Meets

Posted on January 19, 2021March 18, 2026 by Jd Medlink

Every marketer is familiar with the purchase funnel: Awareness → Consideration → Research → Purchase. It turns out this same framework maps almost perfectly onto the medical practice revenue cycle — and understanding that alignment helps diagnose exactly where revenue is leaking.

## Stage 1: Awareness — Clear Financial Policy

The first stage in the funnel is the patient becoming aware of their financial responsibility. This happens before any service is rendered, and it is largely driven by your front desk team.

A clear, written financial policy that is reviewed and signed by every new patient establishes expectations early. Patients who understand their copay, deductible, and billing process are more likely to pay — and less likely to dispute balances later.

**Where practices fail:** Relying on verbal-only communication, or skipping the financial policy conversation entirely during busy check-in periods.

## Stage 2: Consideration — Accurate Demographic Data

Just as a consumer considers a purchase by gathering information, your billing team needs accurate data to process a claim. This is the demographic and insurance verification stage.

Front desk staff must collect:
– Full legal name and date of birth
– Current insurance card (front and back)
– Primary and secondary insurance if applicable
– Correct referring provider if required by the plan

**Where practices fail:** Outdated insurance information in the system, or staff who skip verification for returning patients because “we have them in the system.”

## Stage 3: Research — Eligibility and Insurance Verification

Before the consumer commits, they research. In your revenue cycle, this is eligibility verification — confirming that the patient’s insurance is active, the provider is in-network, and the patient’s specific plan covers the service.

Running eligibility checks the day before (or morning of) each appointment catches:
– Lapsed coverage
– Changed plans
– Out-of-network scenarios
– Pre-authorization requirements

**Where practices fail:** Assuming prior eligibility verifications are still valid, or skipping verification for established patients.

## Stage 4: Purchase — Claim Filing

The conversion point. In the purchase funnel, this is where money changes hands. In your revenue cycle, it is the submission of a clean claim.

Time is money here. The longer the gap between date of service and date of claim submission, the longer it takes to collect — and the higher the risk of timely filing denials.

MedLink’s standard: **Claims submitted within 48 hours of service.**

## The Post-Purchase: Patient Collections

One area the classic funnel misses is the post-claim patient balance. After insurance pays, the remaining patient responsibility must be collected. The research is clear:

– **Collecting at time of service is 6x more effective** than billing after the visit
– Text and email payment reminders significantly outperform paper statements
– Practices that communicate expected patient balances at check-in collect more, with fewer disputes

## Putting It Together

The practices with the healthiest revenue cycles treat every step of the process with intentionality — from the financial policy conversation at check-in to the 48-hour claim filing standard to the patient balance follow-up process.

If any stage in your funnel is broken, revenue leaks. If you want to identify where your funnel has gaps, reach out for a free revenue cycle assessment.