MEDIA
Your Claims Are Being Submitted — But Is Your Practice Collecting Everything It Should?
For a busy medical or dental practice, seeing claims leave the billing system can create a reassuring feeling:
The work was completed. The claims were submitted. Payments are arriving.
Billing must be under control.
But claim submission is only one checkpoint in a much larger financial process.
A claim can be submitted and rejected.
It can be submitted and denied.
It can be accepted and underpaid.
It can be paid correctly but posted incorrectly.
It can be partially paid while the remaining balance sits untouched.
It can be transferred incorrectly to patient responsibility.
It can remain outstanding for months without meaningful follow-up.
So the fact that claims are being submitted tells a practice remarkably little about whether it is collecting everything it should.
The more important question is:
What happens after the claim leaves the practice?
Submitted Does Not Mean Accepted
Electronic claims pass through several stages before payment.
CMS explains that electronic Medicare claims first undergo front-end edits to determine whether they meet required transaction standards. Claims containing certain errors may be rejected and must be corrected and resubmitted before they can even proceed through normal adjudication. (CMS)
This distinction matters because a rejected claim is different from a denied claim.
A rejection may mean the claim never successfully entered the payer's adjudication process.
If rejected claims are not monitored and corrected promptly, a practice may believe work has been billed when the payer is not actually processing it.
This is why claim acceptance and first-pass performance matter.
Accepted Does Not Mean Paid
After a payer accepts a claim, the claim must still be adjudicated according to coverage requirements, coding rules, authorization requirements, contract terms and the patient's benefits.
The result may be full payment, partial payment, denial, patient responsibility or another adjustment.
HFMA reported in September 2026 that 11.65% of healthcare claims were denied on first pass in 2025. HFMA also noted that resolving denials consumes substantial administrative resources and cited an analysis estimating the average cost of appealing a denied claim at more than $57. (HFMA)
A practice therefore needs more than claim submission.
It needs a system for determining what happened to every claim afterward.
Payment Does Not Necessarily Mean Correct Payment
When a payment arrives, the revenue-cycle process is still not finished.
The payer's remittance contains important information about what was allowed, what was paid, what was adjusted, what became patient responsibility and why amounts were reduced.
CMS explains that electronic remittance advice uses standardized adjustment information to show the reason and value of claim and line-level adjustments. (CMS)
Those details matter.
Imagine that a payer consistently reimburses a service below the contracted amount. If payments are simply posted and the remaining balance is automatically adjusted away, the practice can lose money repeatedly without creating an obvious denial.
Nothing is sitting in a denial queue.
The claim technically paid.
But the practice still did not receive everything it expected.
For this reason, strong revenue cycle management should include attention to underpayments and unusual adjustments—not just unpaid claims.
Denials Require More Than Resubmitting the Claim
Not every denial has the same cause.
A denial might result from eligibility, authorization, coding, medical necessity, missing documentation, payer requirements, coordination of benefits, timely filing or another issue.
Effective denial management therefore requires more than correcting individual claims.
The practice needs to understand why the denial happened.
If ten claims were denied because of the same front-desk workflow, correcting those ten claims addresses the immediate balances but does nothing to prevent the next ten.
HFMA describes denial management as both resolving denied claims and identifying how similar denials can be prevented in the future. (HFMA)
That makes denials an operational measurement as much as a billing problem.
Recurring denial patterns can reveal weaknesses elsewhere in the practice.
Accounts Receivable Tells a Different Story Than Monthly Collections
A practice may have healthy deposits this month while old balances quietly accumulate in the background.
That is why accounts receivable aging is so important.
A/R reports divide outstanding balances according to how long they have remained unpaid. As balances move from 30 to 60 to 90 days and beyond, practices need to understand what is holding them up.
The AMA identifies days in accounts receivable as a key revenue-cycle measure and recommends that practices monitor how quickly revenue moves through the system. Recent AMA guidance has suggested aiming for approximately 95% first-pass resolution and reducing days in A/R toward 30 days, although individual results naturally vary by specialty, payer mix and practice circumstances. (American Medical Association)
The question should therefore not simply be, "How much did we collect this month?"
It should also be, "What money have we not collected, how old is it, why is it still outstanding and what is being done about it?"
Patient Responsibility Is Part of the Revenue Cycle Too
As deductibles, copays and coinsurance have increased, patient balances have become a significant part of practice revenue.
The AMA notes that collecting appropriate patient responsibility at the point of care can reduce accounts receivable, improve cash flow and decrease the administrative costs associated with back-end collection activity. (American Medical Association)
If eligibility information is inaccurate, estimates are not communicated, copays are missed or patient balances are not followed after the visit, the practice can deliver the service correctly, submit the insurance claim correctly and still fail to collect the full amount ultimately owed.
Revenue cycle performance must therefore account for both payer and patient revenue.
Payment Posting Should Create Information, Not Just Close Balances
Payment posting is sometimes treated as clerical work.
It is actually an important financial-control point.
Accurate posting allows practices to see what payers are doing.
Which services are being adjusted?
Which payers are generating unexpected reductions?
Which balances are being transferred to patients?
Which claims require follow-up?
Which trends are repeating?
If posting is inaccurate or adjustments are entered without appropriate review, leadership can lose visibility into what is really happening to its revenue.
A practice cannot manage what it cannot see.
Reports Should Answer Business Questions
A meaningful revenue-cycle report should do more than display how many claims were submitted.
Practice leadership should be able to understand whether claims are being accepted cleanly, how many are denied, why they are denied, how quickly money is being collected, how much A/R is aging, which payers are responsible for outstanding balances and whether collection performance is improving or declining.
The AMA specifically recommends that practices working with billing companies review timelines from visit-note closure through claim creation, claim submission and payer acceptance, together with aging and denial information. (American Medical Association)
Those measurements turn billing from a black box into a manageable business process.
The Better Question to Ask
If a practice owner asks, "Are our claims being submitted?" the billing team may be able to answer yes.
But that answer does not explain whether the revenue cycle is performing well.
A more useful set of questions is:
Are our claims being accepted?
Are they being paid correctly?
How quickly are they paying?
What percentage is being denied?
Why are those denials occurring?
Are denied claims being appealed?
Are underpayments being identified?
What percentage of A/R is older than 90 days?
Are patient balances being collected appropriately?
Can we explain why every significant balance remains outstanding?
Those questions reveal much more about the financial health of a practice than submission volume alone.
Submission Is an Activity. Collection Is the Outcome.
A successful revenue cycle does not end when the claim is transmitted.
It ends when the claim has been properly adjudicated, expected reimbursement has been received, adjustments have been validated, remaining responsibility has been assigned correctly and any unresolved balance has been appropriately worked.
That distinction can be the difference between a practice that simply bills and a practice that truly manages its revenue cycle.
Because ultimately, practices do not operate on claims submitted.
They operate on revenue collected.
Sources consulted: Centers for Medicare & Medicaid Services guidance on electronic healthcare claims and remittance advice; American Medical Association revenue cycle management guidance; Healthcare Financial Management Association research on denials; Medical Group Management Association revenue-cycle resources.