Seven Medical Billing Myths Physicians Still Believe (And What’s Actually True)

Ask ten physicians why their revenue cycle isn’t doing better, and you’ll hear a few familiar answers. None of them is foolish. Most were once close to true, or are true often enough to feel safe. That’s exactly why they stick around. Here are seven worth retiring, and what to do instead.

Myth 1: “A denied claim is a lost claim.”

A denial is an opening move, not a verdict. Premier’s 2023 survey of hospitals and health systems found that nearly 15% of claims were initially denied, and more than half of denied claims were eventually paid. The survey covered hospitals, so your own numbers will differ, but the message applies to practices too: the ones that appeal recover money; the ones that write off never see it.

Myth 2: “Our EHR (electronic health record) handles billing from start to finish.”

EHRs are great at the data-entry side: pulling in codes, flagging obvious mismatches, routing claims. They can’t decide whether a denial is worth appealing or whether a modifier truly applies. Even with AI (artificial intelligence) tools, results are mixed. In a May 2026 MGMA (Medical Group Management Association) poll of practice leaders, 46% said new AI tools had made their providers more productive, while 27% saw no gain. Use the tools for speed, and keep a person in charge of judgment.

Myth 3: “Telehealth costs us money.”

That worry made sense when telehealth rules were a patchwork of temporary waivers. Today, the major Medicare flexibilities run through the end of 2027, and payers have built virtual care into their normal coverage. The real risk was never the visit type. It’s documenting and coding virtual visits casually, without the modifiers, place-of-service codes and detail payers expect. Fix that habit, and telehealth is just another visit.

Myth 4: “If the payer paid it, it was paid right.”

A payment isn’t the same as the correct payment. Rates come from your contracts and fee schedules, and it’s easy for a claim to be paid below what you agreed. Comparing remittances against expected rates, even on a sample each month, is one of the quietest ways to find revenue.

Myth 5: “We have plenty of time.”

Filing and appeal deadlines vary by payer and contract, and some are shorter than you’d expect. Put the deadline on the calendar when a denial arrives, and check your contracts for filing limits so a good claim never dies of old age.

Myth 6: “A low denial rate means we’re healthy.”

Benchmarks for practices are often quoted somewhere in the 5% to 10% range for first-pass denials, so a number in that band looks fine on a dashboard. But two practices can both post 7% and be in very different places. One loses a little across many causes, while the other loses a lot through one fixable process. MGMA polls over the years keep pointing to the same usual suspects: missing information, prior authorization and eligibility or demographic errors. The overall rate tells you very little. The reasons tell you where to look.

Myth 7: “Outsourcing billing means giving up control.”

There is a real version of this worry: a vendor with vague reporting and no clear way to escalate leaves you in the dark. But an in-house team without reporting discipline can be just as opaque, only closer. Control doesn’t come from who does the billing. It comes from regular, specific reporting and straight answers when you ask why a claim was handled the way it was.

FIVE QUESTIONS FOR ANY BILLING SETUP, IN-HOUSE OR OUTSIDE

How many claims were denied last month, and why?

How long are charges taking to reach a submitted claim?

What is the ageing on our accounts receivable?

Which denials did we appeal, and what happened?

Who do I call when something looks off?

The takeaway

Myths survive because they let us stop looking. A denial gets written off, a payment goes unchecked, a dashboard number goes unquestioned. The fix isn’t a new tool. It’s closing the small gap between what you assume is happening and what your data shows. AmFac Medical Management does this kind of review alongside practice teams, looking at denial patterns, payment accuracy and coding against the data.