Consulting
Medical Practice Management Services
Medical practice management is the business side of care: scheduling, registration, payer enrollment, claims, staff, compliance and the numbers that show whether it works. Its cost has outrun inflation: in MGMA's data, median operating cost per full-time physician in physician-owned multispecialty groups rose 71.6% from 2011 to 2024, while consumer prices rose 39.5%. We help you develop the policies, procedures, workflows and KPIs that run it, as a project or through a fractional COO.
The short answer
What is medical practice management?
The business side of care: scheduling, registration, payer enrollment, claims, staff and compliance. In MGMA's 2024 data, practices collected 72% of copays at the visit but only about 27% of other patient balances; insufficient documentation caused 53.0% of improper payments in Medicare's FY 2025 error-rate review. The Advixor Group helps you develop the policies, procedures, workflows and KPIs that run it, as a project or through a fractional COO.
SourcesMGMA Stat, July 30, 2026CMS improper payment data, FY 2025
Six Areas
What medical practice management covers
It covers six areas. Two have clear public numbers.
- Front desk: scheduling, registration, eligibility checks and collecting at the visit. In MGMA’s data for 2024, practices collected 72% of copays at the time of service but only about 27% of other patient balances.
- Records: documentation that supports every claim. In Medicare’s FY 2025 error-rate review, insufficient documentation caused 53.0% of improper payments, medical necessity 15.3%, no documentation 12.0% and incorrect coding 11.1%.
Sources MGMA Stat (July 30, 2026); CMS, 2025 supplemental improper payment data (November 2025).
The other four are payers (recredentialing and revalidation on each plan’s cycle), claims and appeals, people (hiring, onboarding and training) and compliance (written policies, HIPAA and OSHA training, internal reviews).
KPI Benchmarks
Physician practice management KPIs and their public benchmarks
| KPI | How it’s measured | Public benchmark (source; sample where published) | Rule it runs against |
|---|---|---|---|
| Days in A/R | Total A/R ÷ average daily charges | No public median; MGMA’s is members-only | Each payer’s payment deadline (chart below) |
| First-submission denial rate | Claims denied on first submission ÷ claims submitted | 7–8% for four years (MGMA benchmarking; sample not published); 8% single-specialty in 2023, as in 2019 (DataDive Practice Operations); under 5% is reachable, MGMA’s 2025 report suggests | Medicare appeal: 120 days to request a redetermination |
| Clean-claim rate | Claims with no defect when first filed ÷ claims filed | None with a named source and sample | Medicare’s 30-day and Medicaid’s 30- and 90-day deadlines count clean claims only |
| Net collection rate | Payments ÷ (charges − contractual adjustments) | None with a named source and sample | A Florida health insurer can’t deny a paid claim for the patient’s ineligibility more than 1 year after paying |
| Prior authorization | Requests per physician a week; staff hours; share denied | 40 a week, 13 hours; 32% of physicians say requests are often or always denied (AMA, December 2025, 1,000 physicians) | Medicare Advantage (items under its prior authorization rules) and Medicaid managed care, since 2026: 7 days standard, 72 hours expedited |
| Documentation accuracy | Error rate on audited claims | FY 2025: 8.44% of Part B payments improper, $9.62 billion (CERT sample of 49,061 claims, 11,920 Part B) | CERT asks for records within 45 calendar days |
Sources MGMA Stat (July 30, 2026; Mar 6, 2024) and DataDive guide (2025); 2025 AMA Prior Authorization Physician Survey; CMS CERT (FY 2025); 42 U.S.C. 1395u(c); 42 CFR 405.942, 422.568, 422.572, 438.210, 447.45; s. 627.6131, F.S.
Days in A/R
Healthcare practice management in 2026: what moved days in A/R
The revenue split is narrowing: in MGMA’s June 30, 2026 poll (221 responses), 47% of groups reported year-to-date revenue above 2025 and 36% below, against 56% and 30% a year earlier.
In MGMA’s July 28, 2026 poll (203 responses), 43% of groups said days in A/R were about the same as a year earlier, 32% higher and 22% lower. Groups with rising A/R blamed payers first: slower payment, initial denials, downcoding, medical-record requests, prepayment audits and slow appeals. Inside the practice, they named billing vacancies and turnover, hard-to-replace A/R staff and credentialing delays for new providers.
In MGMA’s 2025 data report, physician-owned practices raised the share of A/R 0 to 30 days old by about 2 to nearly 7 points in 2024 and kept 120-plus-day balances mostly flat; in hospital- and IDS-owned groups, the 120-plus-day share rose 9.5 to 15.9 points.
MGMA’s first check: run A/R aging by payer, not only in total, and take the slow payers’ numbers into payer contract talks.
Payment Clocks
Private practice management and the payers’ payment clocks
How the Social Security Act defines a clean claim
“The term ‘clean claim’ means a claim that has no defect or impropriety (including any lack of any required substantiating documentation) or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this part.”
Medicare pays interest on a clean claim paid after 30 days, and a Florida health insurer’s overdue payment “bears simple interest of 12 percent per year” (s. 627.6131(7)). The section’s terms “may not be waived, voided, or nullified by contract” (subsection 10), and it applies only to major medical policies (and certain dental-only contracts) from Florida-licensed health insurers, PPOs and EPOs included (subsection 15). Medicaid managed care contracts must hold plans to the same clean-claim clocks unless a plan and its providers agree to another schedule in their contract (42 CFR 447.46(c)).
Sources 42 U.S.C. 1395u(c)(2)–(3); 42 CFR 447.45(d); s. 627.6131(4), F.S. (2026). Read Oct 19, 2026.
How We Work
How our practice management consulting works
We report the KPIs above on a schedule we agree on with you, oversee your biller or billing company, and handle payer prior authorizations or redesign that workflow. Each project follows four steps: we map the work from first call to paid claim, fix the costliest problems first, train your team and review the results. The fee depends on the scope: we go over your needs first and quote it in writing.
Practice management consulting
We work on practice management in three ways:
- One-on-one ongoing consulting: personalized sessions with seasoned advisors on business, operational, regulatory and administrative questions, with executive-level recommendations (healthcare consulting).
- A project: operational efficiency work evaluates your processes and helps you develop the policies, procedures, workflows, SOPs and productivity metrics to run them, with periodic operational reviews and recommendations.
- Ongoing oversight: a fractional COO oversees day-to-day business activities and develops and monitors your KPIs.
What’s included
What our medical practice management service includes
Credentialing
Enrollment and credentialing with commercial plans, Medicare and Medicaid, then recredentialing and revalidation.
Learn morePayer contracting
Payer contracting: applications, participation agreements and negotiation support.
Learn moreHR and staff training
Job descriptions, onboarding, in-service training and HR policies; every employment decision stays yours.
Learn moreCompliance
Written policies, mock surveys, risk assessments and coordinated staff training on HIPAA, OSHA and fraud, waste and abuse.
Learn moreDocumentation audits
Monitoring of your clinical documentation against quality and operational standards.
Learn moreHealthcare KPIs
A guide to the KPIs medical practices track.
Learn moreQuick answers
Medical practice management: vendors, systems and day-to-day help
Whether a vendor is a business associate, switching systems, day-to-day oversight, behavioral health practices and what a consultant does. Raise anything else in a consultation.
Is a practice management company, or a cloud-based system, a HIPAA business associate?
What should we plan for before changing practice management systems?
Do you offer day-to-day practice management services?
Do you handle practice management for behavioral health and therapy practices?
What does a medical practice management consultant do?
Talk to an advisor
You care for patients. Who’s taking care of the business?
Tell us where your practice is today. We will tell you what we would do first.
Official sources
- MGMA Stat, read Oct 19, 2026: margin and operating cost (Oct 16, 2025); days in A/R (July 30, 2026); revenue (July 2, 2026); claim denials (Mar 6, 2024); DataDive guide (2025)
- AMA, 2025 Prior Authorization Physician Survey (administered December 2025), read Oct 19, 2026
- CMS, Comprehensive Error Rate Testing and 2025 supplemental improper payment data (November 2025), read Oct 19, 2026
- 42 U.S.C. 1395u(c) (2024 edition); eCFR, current as of Oct 15, 2026: 42 CFR 405.942, 422.568, 422.572, 424.44, 438.210, 447.45 and 447.46; 45 CFR 160.103 and 164.502. Read Oct 19, 2026
- Florida: s. 627.6131, F.S. (2026); AHCA, Request for Exceptional Claims Processing (10/01/2021). Read Oct 19, 2026