Medical billing is the part of running a practice that nobody went to school for, and it is the part that decides whether the work you already did gets paid. We enter charges, scrub and submit claims, post payments and chase what does not come back, inside the system you already use. You keep seeing patients. We keep the money moving.
What our medical billing services include
Every encounter that closes in your EHR becomes a charge within one business day. We enter it from the signed note or superbill, run it through payer-specific edits and the current quarter's NCCI procedure-to-procedure and MUE tables, and submit it within 48 hours of receiving the encounter. When the remittance comes back we post it line by line, not as a lump sum, so a 99214 that paid at the 99213 rate is visible the day it lands. Anything denied or unpaid at 30 days goes into follow-up with a named owner and a next action. Clearinghouse rejections are corrected the same day rather than left in the inbox, and secondary claims go out as soon as the primary posts. The point is that nothing sits.
The problems practices bring us
The pattern is familiar by now. A/R over 90 days has crept past a third of total receivables. There is a denial queue nobody has opened since the last biller left, and some of those denials are already past the appeal window. The front desk has turned over twice in a year, so eligibility checks are hit or miss and registration errors are producing CO-16 denials by the dozen. Medicare annual wellness visits are being billed as 99397 instead of G0438 or G0439 and denied as non-covered. None of this is a moral failure. It is what happens when billing is one of six jobs a person holds. We take it off the desk, and we start by telling you exactly how much is recoverable and how much is already gone.
We work inside your existing EHR and PM
We do not move your data or make you buy software. Our billers work inside Tebra, AdvancedMD, eClinicalWorks, athenahealth, DrChrono, Practice Fusion, Office Ally, NextGen and TherapyNotes every day. You grant role-based logins, we sign a BAA before we touch anything, and every claim, payment and note we enter is in your system with our user stamped on it. That matters for two reasons. You can audit our work whenever you want without asking permission. And if you ever leave, nothing needs to be exported or rebuilt, because it was never anywhere else.
The denials we see most, and what fixes them
CO-16 means the claim lacked information, and the RARC beside it says what: N382 for a bad patient identifier, M77 for a place of service the payer does not accept for that code. CO-97 with a modifier 25 dispute means the payer bundled an E/M visit into a procedure done the same day, and the remedy is documentation showing a separately identifiable service, not a resubmission with the same modifier. CO-29 is timely filing. Medicare allows 12 months from the date of service, many commercial plans allow 90 to 180 days, and once the window is gone there is no appeal on the merits, only proof of an earlier submission. CO-4 is a procedure code that needed a modifier and did not have one, often a 26 or TC split on imaging. PR-204 means the service is not covered under the plan, and the fix belongs at check-in, not in the appeal queue. We track each of these by payer and by provider so the same one stops repeating.
What you get every week and every month
A weekly A/R report lands in your inbox every Monday. It shows charges, payments, adjustments, denials received, denials resolved and aging by bucket, with the 90-plus bucket broken out by payer so you can see where the old money is sitting. You have a dedicated US-based account manager who knows your payers and your providers and does not need the history explained. Once a month we hold a review call to go through trends, unpaid claims over a threshold you set and any write-offs we are recommending, which you approve or decline. There is no long-term contract. After the first 90 days the agreement runs month to month, and if we are not earning the fee you can walk.
What other billing companies leave out
Two things usually go unmentioned on billing company websites. First, underpayments. A claim that pays is not a claim that paid correctly, and a CO-45 contractual adjustment can hide a payer paying an old fee schedule. We load your contracted rates and compare every allowed amount against them. Second, the front end. A large share of the denials we clean up were decided before the patient sat down, by an eligibility check that never happened or a referral that was never attached. So we pair eligibility verification with billing wherever a practice will let us, and we tell you which registration errors are producing which denials.
How the free billing audit and 30-day trial work
Before you commit to anything we run a free billing audit on your last 90 days of claims. You give us read-only access to your PM system, and within 5 business days we send back a written summary: aging by bucket and payer, denial volume by reason code, claims approaching filing deadlines and an estimate of what is recoverable versus what is gone. If you want to proceed, the first 30 days run as a trial. We work new claims alongside your existing process, you compare the two, and you can stop at day 30 with no fee if the numbers do not hold up. Pricing is a percentage of collections, so the fee only exists when the money does.
What Is Included
- Claims out within 24 to 48 hours of a signed note
- Scrubbed against NCCI edits and payer rules before release
- Payments posted line by line with CARC and RARC codes intact
- Denials worked by reason code with a named owner
- Weekly A/R report every Monday, monthly review call
| Medicare timely filing limit | Claims must be received within one calendar year of the date of serviceSource: CMS, Medicare claim submission period |
|---|---|
| Coding edits applied to every claim | NCCI procedure-to-procedure pairs and medically unlikely edits, updated quarterlySource: CMS, National Correct Coding Initiative |
| Adjustment codes on every remittance | Payers explain every adjustment with CARC and RARC codes maintained by X12Source: X12, Claim Adjustment Reason Codes |
| Business associate requirement | A written BAA is required before a billing company may handle PHISource: HHS, HIPAA Privacy Rule |
Medical Billing Services: Common Questions
We charge a percentage of what we collect, typically 4 to 7 percent depending on specialty, claim volume and how much cleanup the existing A/R needs. There are no setup fees, no per-claim charges and no software fees. If we do not collect, we do not get paid, which keeps our incentives lined up with yours.
No. The first 90 days are a fixed initial term so that both sides can judge the work on a full quarter of data. After that the agreement runs month to month and either party can end it with 30 days written notice. We keep clients by doing the work, not by holding them to paper.
We start with the free audit so we know what is open and what is about to expire. Then we agree a cutover date with you and your current biller. New claims from that date are ours, and we inventory every open claim before it so nothing falls between two vendors. Most transitions take two to three weeks.
That is your choice. Some practices leave the old A/R with the outgoing biller to finish, and some hand it to us as a separate cleanup project priced on its own. Either way we tell you up front which claims are still recoverable and which are past the filing or appeal window, so you are not paying anyone to chase dead balances.
Yes to both. We sign a Business Associate Agreement before receiving any access, and our staff work under role-based logins that are logged in your own system. PHI is never sent through email or the website contact form. We can provide our BAA template or work from yours.
Within 48 hours of receiving the encounter, and usually the next business day. Clearinghouse rejections are corrected and resent the same day they appear. If your providers close notes late, we will tell you, because a claim cannot go out before the documentation exists and slow charting is the most common cause of slow billing.
Yes, because payers do. Medicare wants place of service 10 when the patient is at home and 02 when they are elsewhere, some commercial plans still want POS 11 with modifier 95, and a few want GT. We keep a telehealth rule per payer in your PM system so the claim leaves right the first time.