Services

Everything between the visit and the deposit.

Take the full cycle or pick the piece that is costing you. Each service below can be scoped on its own, and every one of them reports into the same weekly summary.

The life of a medical claimA claim moves in four short steps from visit to charge entry, scrubbing and submission, then reaches payer adjudication. From there it is either paid, or denied with a reason code such as CO-97, reworked and appealed, and only then paid. Submission is a straight line; collection is the branch and the loop.VISITCHARGESCRUBSUBMITPAYERADJUDICATIONPAIDDENIED · CO-97REWORKED · APPEALEDSUBMITTING · ONE BUSINESS DAYCOLLECTING · WHERE THE MONEY STOPS
Every claim takes one of these two routes. The first is cheap. The second is the one that decides whether a practice collects.
01

Claim submission and scrubbing

Every CMS-1500 and UB-04 is checked against payer-specific edits before it leaves. Charges entered from your notes, claims out inside one business day.

  • Payer edit and LCD checks
  • Electronic and paper claims
  • Clearinghouse rejection rework
  • Daily submission log you can see
Claim submission and scrubbing in detail
02

Denial management and appeals

Denials get worked by reason code, not by whoever picks up the file. Root causes get fixed upstream so the same code stops coming back.

  • CARC and RARC triage
  • Corrected claims and appeals
  • Payer policy documentation
  • Monthly denial trend report
Denial management and appeals in detail
03

A/R follow-up and recovery

Aging worked oldest bucket first, with real payer calls behind it. If you have money sitting past 120 days, that is where we start.

  • Bucket-by-bucket workflow
  • Payer calls and escalation
  • Old A/R cleanup projects
  • Write-off recommendations
A/R follow-up and recovery in detail
04

Medical coding

Certified coders assign CPT, ICD-10-CM and HCPCS from your documentation, with modifier and E/M level review before billing.

  • CPT, ICD-10-CM, HCPCS
  • Modifier and NCCI review
  • E/M level audits
  • Documentation feedback for providers
Medical coding in detail
05

Coding and E/M audits

A retrospective sample of charts read against what was billed, showing where documentation and codes diverge in both directions.

  • Chart-to-claim comparison
  • E/M level distribution review
  • Modifier and NCCI findings
  • Written findings and remediation plan
Coding and E/M audits in detail
06

Eligibility and prior authorization

Benefits verified before the visit, authorizations tracked to approval. Fewer surprises at the front desk and fewer coverage denials later.

  • Benefit and deductible checks
  • Prior auth submission and follow-up
  • Coverage alerts before the appointment
Eligibility and prior authorization in detail
07

Credentialing and enrollment

Payer enrollment, CAQH upkeep, revalidations and re-credentialing tracked with deadlines, so a lapsed contract never stops your billing.

  • Commercial and government payers
  • CAQH profile maintenance
  • Revalidation calendar
  • New provider onboarding
Credentialing and enrollment in detail
08

Payment posting and reconciliation

Payments posted line by line from ERAs and EOBs, then reconciled against what actually hit the bank.

  • ERA and manual EOB posting
  • Line-level adjustment review
  • Deposit reconciliation
  • Underpayment identification
Payment posting and reconciliation in detail
09

Patient billing and support

Statements that patients can read, payment plans they can keep, and a number they actually reach when they call about a bill.

  • Statement cycles
  • Payment plan setup
  • Patient balance calls
  • Card and online payments
Patient billing and support in detail
10

Reporting you can act on

Weekly collections, aging and denial reporting in plain language, with a named account manager who can explain it.

  • Weekly collections summary
  • Aging by bucket and payer
  • Denial trends by reason code
  • A named person to ask
Reporting you can act on in detail
11

Virtual assistants and back-office staffing

Trained remote staff for the administrative work around billing — scheduling, intake, follow-up calls and back-office tasks.

  • Scheduling and appointment reminders
  • Patient intake and data entry
  • Insurance follow-up calls
  • Works inside your existing systems
Virtual assistants and back-office staffing in detail

Systems we work in

No migration required.

We log into your practice management system rather than moving you onto ours. Your staff learns nothing new, and your data stays where it is if you ever decide to leave.

AthenahealtheClinicalWorksTebra / KareoDrChronoAdvancedMDOffice AllyNextGenPractice FusionEpicCernerCollaborateMDSimplePracticeand others on request

Where we bill

Billing rules are state-shaped.

We bill in all 50 states. These are the ones where the Medicaid program, its managed care plans and the local payer mix change the work enough to be worth writing down.

Scope it

Not sure which piece to hand over?

Send us an aging summary. We will tell you where the largest recoverable balance is and which service actually addresses it.