In most private practices, a consultation may last ten to fifteen minutes. The work surrounding it often takes just as long. Reviewing pathology results, writing referral letters & motivation documents, clarifying coding, correcting or following up on rejected claims are all necessary tasks that sit on either side of the patient encounter & extend the day long after the final consult ends.

None of this work can be left undone. It forms part of delivering responsible, high-quality care. The challenge arises when information has to be re-read, rewritten, reformatted or reconstructed each time it is needed. That is rework, & it remains one of the most underestimated cost drivers in private practice.

Rework does not appear as a single large expense. It accumulates quietly in minutes, in delayed payments, in repeated corrections & in the growing administrative burden placed on teams who spend their time fixing what could have been prevented.

For practice owners, that accumulation affects far more than efficiency. It influences margin, cash flow predictability, staff stability & long-term sustainability. If rework is placing pressure on your time, your team or your cash flow, it may be time to review how your systems are supporting your workflow.

Rework is rarely isolated, it is structural

When people think about rework, they often think about claim denials. While rejection rates vary by specialty & scheme, most practices have to manage a proportion of submissions that require correction or follow-up, particularly where manual processes or disconnected systems are involved.

In many cases, the underlying causes are coding inconsistencies, insufficient documentation, missing modifiers or outdated demographic information. These are common operational friction points. Each rejected or queried claim adds administrative backlog, increases staff time, disrupts cash flow & raises the overall cost of doing business.

More concerning is the fact that not all denied claims are fully recovered. In busy environments, some are written off or deprioritised because the effort required to resubmit outweighs the perceived benefit.

However, claim rework is only the visible part of the problem. Clinical rework often begins much earlier, inside the consult room.

Where rework actually starts: Documentation

Coding errors are frequently described as billing problems. In reality, many originate in documentation.

When clinical notes lack specificity, do not clearly demonstrate medical necessity or are captured in unstructured narrative form, coding becomes interpretative. Interpretative coding increases inconsistency, & inconsistency leads to queries & denials.

The same principle applies to motivation letters. If relevant clinical history is incomplete or difficult to extract, motivations may be weaker than they should be, resulting in preventable back-&-forth with funders.

Referral letters & pathology communication also contribute to this pattern. When information must be manually gathered from different parts of the record & rewritten each time, cognitive load increases & the risk of omission grows.

Ultimately, the issue is not a lack of effort but a lack of structure. Information captured once but not easily reusable will inevitably need to be reconstructed.

The financial multiplier effect

For practice owners, the cost of rework operates on three levels.

Direct financial cost

Every corrected claim requires time. Every delayed submission affects cash flow. Every unresolved denial reduces revenue. When multiplied across dozens or hundreds of patients each month, even small inefficiencies begin to affect profitability in meaningful ways.

Operational cost

Administrative teams stretched by rework have less capacity for proactive revenue cycle management, reporting & patient engagement. Doctors who spend additional minutes after each consult on repetitive documentation reduce their available clinical hours. Capacity shrinks without any obvious reduction in workload.

The human cost

This is often the most underestimated layer. Repetitive correction work is cognitively demanding. When skilled staff spend large portions of their day resubmitting claims, rewriting letters or fixing preventable errors, frustration builds & the risk of burnout increases.

Over time, this cycle contributes to reduced productivity, increased absenteeism, higher turnover risk, recruitment & training disruption & the loss of institutional knowledge.

For practice owners, turnover is not simply a cultural concern. Replacing experienced staff requires time, management oversight & onboarding investment, all while performance temporarily declines.

Rework contributes to burnout, & burnout increases the likelihood of further rework. It becomes a cycle that is both costly & difficult to sustain.

Why training alone is not enough

Continuous training in coding standards, scheme rules & documentation requirements is essential. Regular audits & reporting provide valuable oversight. However, even highly trained teams struggle when workflows are fragmented.

If eligibility checks happen inconsistently, patient demographic updates are not standardised, clinical documentation varies in structure & coding validation only occurs after submission, the system remains reactive.

Preventative systems reduce the likelihood of errors at source. The difference between reactive & preventative design determines how much rework your practice carries each month.

From reactive to structured: A practical maturity model

High-performing private practices tend to evolve through four stages.

1. Reactive: Claims are submitted & rejections are addressed as they arise. Patterns are not consistently analysed.
2. Managed: Denial reports are reviewed & staff receive periodic training. Improvements occur, but recurring issues remain.
3. Structured: Documentation templates are standardised. Eligibility checks are embedded in front-desk processes. Coding support & validation tools flag potential issues before submission.
4. Integrated: Clinical documentation, coding, billing & reporting systems are aligned. Information captured during the consult supports accurate coding, clean claims & strong motivations. Denial trends are visible in real time.

The shift from reactive to integrated practice design is where meaningful margin protection occurs.

The role of structured clinical support

Reducing rework requires improving how information flows through the practice. The AI-powered Healthbridge Clinical Assistant is designed around this principle, helping to convert existing clinical data into structured, reusable outputs within your normal workflow.

For example:

• Pathology Messenger converts lab results & patient history into clear, patient-ready communications.
• Referral Letters consolidate relevant data into specialist-ready documentation without rebuilding the file each time.
• Patient Summaries surface key risks & gaps quickly, reducing in-consult searching.
• Visit Summary Letters reinforce instructions & reduce follow-up clarification calls.
• Motivation Letters compile evidence-based history into structured submissions that support medical necessity.
• Medical History Summaries provide a comprehensive overview of a patient’s history for efficient review during consultation.

The objective is not speed for its own sake. When documentation is structured & aligned with billing workflows, coding becomes clearer & queries reduce. Clearer coding means less rework, stronger revenue & a more stable business.

Closing the loop: Reclaiming capacity

Earlier, we described the ten to fifteen minute consultation that can quietly become thirty once documentation & follow-up begin. The goal is not to shorten the consult. It is to prevent the second fifteen minutes from being spent reworking information that already exists.

In a practice seeing 25 patients per day, reclaiming even five minutes of preventable rework per consult translates into more than two hours of capacity daily. Over a month, that becomes days of recovered time. Over a year, it becomes strategic leverage, whether that means increased clinical capacity, improved cash flow management or reduced after-hours work.

For practice owners, reducing rework is not just about smoother administration. It is about protecting margin, strengthening cash flow predictability & building a practice that is sustainable. Practices that thrive are not necessarily those that are busiest. They are the ones that design their systems so that work done once continues to deliver value.

If you would like to understand how structured workflows & integrated systems could reduce rework in your practice, speak to one of our experienced Business Consultants or book a complimentary Practice Health Assessment at sales@healthbridge.co.za or click here and we will call you back to help you find the right solution.