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 including practice managers, reception teams, and practice nurses. Despite strong patient volumes averaging 280 consultations per day across the network, the group's financial performance had plateaued over the previous two financial years, and leadership suspected significant revenue was being left on the table.
The network's CEO commissioned an initial assessment after noticing that per-consultation revenue was trending below comparable networks in the Services Australia MBS utilisation data. That assessment revealed a range of systemic issues rooted in the network's rapid growth from four to twelve sites over five years, during which operational standardisation had not kept pace.
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 formal training on MBS billing requirements. Several practice managers had been promoted from reception roles without structured education on billing compliance. There was no centralised reporting to flag underperformance or leakage, and each site operated its billing function largely independently.
Key problems identified during the initial assessment included:
- Inconsistent use of MBS item numbers across clinicians, with many GPs defaulting to Level B standard consultations (item 23) regardless of the duration or complexity of the service provided. Level C and Level D consultations were billed at rates well below expected benchmarks
- Chronic Disease Management items (item 721 GP Management Plans, item 723 Team Care Arrangements, and item 732 Reviews) were rarely billed despite large chronic disease patient populations at most sites. Across the network, only 6% of patients with identified chronic conditions had a current GP Management Plan on file
- Mental Health Treatment Plan items (item 2715) were under-utilised, with clinicians frequently billing standard consultation items for mental health appointments that met the criteria for the higher-value mental health-specific items
- Health Assessment items (items 701, 703, 705, 707, and 715) were billed at less than one-third of the expected rate based on the network's patient demographics
- Claim rejections were running at 18% across the network, with no structured follow-up process. Rejected claims were often simply written off rather than investigated and resubmitted
- Bulk-billing practices were applied inconsistently, with some sites bulk-billing all patients regardless of concession status while others applied private billing. There was no network-wide fee schedule or bulk-billing policy
- No visibility over aged receivables or outstanding claims beyond 30 days. The network's total outstanding receivables at the time of engagement were $420,000, of which $180,000 was aged beyond 90 days
Our Approach
We deployed a phased engagement across three months, working closely with the network's operations team and clinical leadership. The engagement was structured to deliver early wins while building sustainable systems for long-term performance.
Phase 1: Billing Audit and Gap Analysis (Weeks 1-4)
Our team conducted a comprehensive audit of billing data across all 12 sites for the preceding 12-month period. The audit methodology included:
- Extraction and analysis of all MBS claims data by site, clinician, item number, and date of service
- Item number utilisation benchmarking against the Services Australia MBS utilisation data for comparable practices by geography and size
- Rejection rate analysis by rejection reason code, identifying the most common causes of claim failure at each site
- Aged receivables analysis categorised by payer type (Medicare, DVA, WorkCover, private health fund, patient co-payment)
- Clinician-level billing pattern analysis identifying individual practitioners with the greatest variance from expected billing profiles
- Patient record sampling at each site to assess whether clinical documentation supported higher-value item number selection where applicable
- Reception workflow observation at four representative sites to identify process gaps in the billing chain from patient check-in to claim lodgement
The audit report quantified the total estimated revenue leakage at $2.4 million annually and identified the five highest-impact intervention areas ranked by recoverable value.
Phase 2: System and Process Redesign (Weeks 5-8)
Based on the audit findings, we redesigned the network's end-to-end revenue cycle, working with the operations team and site practice managers:
- Standardised billing protocols aligned to clinical workflows, including decision-support prompts within the practice management software to guide correct item number selection at the point of care
- Chronic disease management workflow: A systematic approach to identifying eligible patients, generating GP Management Plans and Team Care Arrangements, scheduling reviews, and coordinating allied health referrals. Each site was provided with patient identification lists based on diagnosis coding
- Automated claim lodgement with same-day submission targets. Claims were to be submitted within the practice management system before end of day, eliminating the multi-day delays that had been common at several sites
- Structured rejection management workflow with escalation pathways and 48-hour follow-up requirements. A dedicated billing coordinator role was established at the network level to manage rejections across all sites
- Centralised reporting dashboards providing real-time visibility of billing performance by site, clinician, and item category. Dashboards were designed in the practice management system's reporting module and distributed weekly to practice managers and monthly to network leadership
- Updated fee schedules and bulk-billing criteria across all locations. The network adopted a consistent mixed-billing model: bulk billing for concession card holders and children under 16, private billing for non-concessional adults with fees benchmarked against the AMA recommended fee schedule
Phase 3: Staff Training and Embedding (Weeks 9-12)
Staff training was the critical enabler for sustained change. We delivered tailored training programs to three distinct audiences across all 12 sites:
- Reception and administration staff (four-hour workshop per site): MBS billing fundamentals, the new standardised billing protocols, patient check-in and fee communication procedures, rejection identification and escalation, and operation of the new reporting dashboards
- Practice managers (two-day intensive program): Revenue cycle management principles, dashboard interpretation and performance management, rejection root cause analysis, debtor management procedures, and their role in coaching reception staff on billing accuracy
- Clinicians (90-minute evening session per site): MBS item number selection criteria with worked examples, chronic disease management billing workflow, mental health item billing, health assessment eligibility and billing, documentation standards supporting correct item number selection, and the commercial impact of billing accuracy on practice sustainability
Each site received a printed billing quick-reference guide covering the most common item numbers, selection criteria, and documentation requirements. We provided ongoing phone and email support for eight weeks post-training to address questions as staff embedded the new processes.
Ongoing Support (Months 4-6)
Following the initial three-month engagement, we provided quarterly billing performance reviews for two additional quarters. These reviews assessed adherence to the new protocols, identified any emerging leakage patterns, and provided refresher coaching where needed.
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, driven primarily by appropriate use of Level C and Level D consultation items and increased chronic disease management billing
- Average claim turnaround reduced from 34 days to 18 days
- First-time claim acceptance rate improved from 82% to 95%
- Chronic Disease Management and Mental Health Treatment Plan billing increased by 67%, with GP Management Plan coverage for chronic disease patients rising from 6% to 38% within nine months
- Health Assessment billing increased by 84%, with systematic identification of eligible patients driving significant volume
- Aged receivables beyond 60 days reduced by 74%, recovering $133,000 of the $180,000 in previously written-off aged debt
- Staff billing confidence scores (self-assessed) improved from an average of 2.8 to 4.3 out of 5 across reception and administration teams
The centralised reporting framework now provides the network's leadership team with weekly performance insights by site and clinician, enabling proactive management of billing performance. The network has since adopted quarterly billing audits as a standard operational practice, ensuring sustained performance and early identification of any emerging leakage.
“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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