GP Network Billing Optimisation
How we helped a network of 12 GP clinics recover $2.4M in annual billing leakage
The Problem
Inconsistent billing practices across 12 clinic sites, missed MBS item numbers, poor claim follow-up processes, and no centralised oversight of revenue cycle performance.
Our Approach
Comprehensive billing audit across all sites, redesign of end-to-end revenue cycle systems, standardised billing protocols, and targeted staff training programs.
The Outcomes
Achieved a 42% increase in net revenue, reduced average claim turnaround to 18 days, and lifted first-time claim acceptance rate to 95%.
Key Results
$2.4M
Annual Revenue Recovered
42%
Revenue Increase
18 days
Claim Turnaround
95%
First-Time Acceptance
The Challenge
This Sydney-based GP network operated 12 clinics across metropolitan and outer-suburban locations, employing over 40 general practitioners and 80 support staff. Despite strong patient volumes, the network's financial performance had plateaued, and leadership suspected significant revenue was being left on the table.
An initial assessment revealed a range of systemic issues. Billing practices varied dramatically from site to site, with no standardised protocols for item number selection, claim lodgement, or rejection follow-up. Reception and administrative staff had received minimal training on MBS billing requirements, and there was no centralised reporting to flag underperformance or leakage.
Key problems included:
- Inconsistent use of MBS item numbers across clinicians, with many defaulting to lower-value standard consultations regardless of the service provided
- Chronic Care Management items (721, 723) and Mental Health Treatment Plan items rarely billed despite eligible patient populations
- Claim rejections running at 18% with no structured follow-up process
- Bulk-billing practices applied inconsistently, with some sites bulk-billing patients who could have been privately billed
- No visibility over aged receivables or outstanding claims beyond 30 days
Our Approach
We deployed a phased engagement across three months, working closely with the network's operations team and clinical leadership.
Phase 1: Billing Audit & Gap Analysis
Our team conducted a comprehensive audit of billing data across all 12 sites for the preceding 12-month period. We analysed item number utilisation, rejection rates, aged receivables, and billing patterns by clinician and location. This data was benchmarked against comparable networks and MBS utilisation data published by Services Australia.
Phase 2: System & Process Redesign
Based on the audit findings, we redesigned the network's end-to-end revenue cycle. This included:
- Standardised billing protocols aligned to clinical workflows, ensuring the correct MBS items were captured at the point of care
- Automated claim lodgement with same-day submission targets
- A structured rejection management workflow with escalation pathways and 48-hour follow-up requirements
- Centralised reporting dashboards providing real-time visibility of billing performance by site, clinician, and item category
- Updated fee schedules and bulk-billing criteria across all locations
Phase 3: Staff Training & Embedding
We delivered tailored training to reception staff, practice managers, and clinicians across all 12 sites. Training covered MBS billing fundamentals, the new standardised protocols, rejection management procedures, and the use of the new reporting dashboards. Each site received a billing quick-reference guide and ongoing support for eight weeks post-implementation.
The Results
Within six months of full implementation, the network achieved measurable improvements across every key performance indicator:
- $2.4 million in annualised revenue recovered through correct item number utilisation and improved claim follow-up
- 42% increase in net revenue per consultation across the network
- Average claim turnaround reduced from 34 days to 18 days
- First-time claim acceptance rate improved from 82% to 95%
- Chronic Care Management and Mental Health Treatment Plan billing increased by 67%
- Aged receivables beyond 60 days reduced by 74%
The centralised reporting framework now provides the network's leadership team with weekly performance insights, enabling proactive management of billing performance across all sites.
“CHP identified gaps in our billing we didn't even know existed. The impact on our bottom line has been transformative — and the training means our team can sustain it long term.”
Dr Sarah Chen
Network Clinical Director
Services Used
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