Medical billing and RCM for US practices
Medical Billing and Revenue Cycle Management Services
With 7+ years in medical billing and revenue cycle management, MEDCLAIM Services handles the work between the patient visit and the payment: coding review, clean claim submission, denial follow-up, A/R recovery and credentialing, so your team can stay focused on patients.
- Coding, billing, denials and A/R handled by one team
- Works inside your existing practice management or EHR system
- No access to patient data until the HIPAA paperwork your practice requires is in place
7+ yearsIn medical billing and revenue cycle management
Dedicated account managerYour main contact for billing questions
Multi-specialty teamBilling and coding across many specialties
Free billing auditNo patient data needed to get started
Where practice revenue usually leaks
Most practices do not lose money through one dramatic mistake. Revenue slips away in small, repeated gaps: an eligibility check skipped at check-in, a modifier left off a procedure, a denial nobody had time to appeal, a claim that aged past the payer's filing limit. Each one is easy to miss and hard to recover later.
Revenue cycle management closes those gaps by treating billing as a process rather than a task. Front-end checks prevent avoidable denials, coding review keeps claims accurate, and disciplined follow-up makes sure every claim is either paid correctly or worked until it is resolved.
Billing and RCM services
Hand over the full revenue cycle, or only the parts your team needs help with.
Revenue Cycle Management
The whole cycle run as one process: patient access, coding, claims, payments, denials and patient balances, with shared KPIs.
Learn more about Revenue Cycle ManagementMedical Billing
Charge entry, claim scrubbing, submission, payment posting and follow-up handled by a dedicated billing team.
Learn more about Medical BillingMedical Coding
E/M, procedure and diagnosis coding from the documentation, with modifier, NCCI and MUE checks before claims go out.
Learn more about Medical CodingCredentialing and Provider Enrollment
Medicare, Medicaid and commercial enrollment, CAQH upkeep and revalidation dates tracked so providers can bill from day one.
Learn more about Credentialing and Provider EnrollmentPrior Authorization
Authorization requirements checked, requests submitted with clinical support, and approvals matched to claims before the service date.
Learn more about Prior AuthorizationDenial Management
Denials worked by reason code and root cause, with corrected claims and appeals filed inside payer deadlines.
Learn more about Denial ManagementA/R Follow-Up and Recovery
Unpaid and underpaid insurance claims followed up by age, value and deadline, including old A/R left by a previous biller.
Learn more about A/R Follow-Up and RecoveryInsurance Eligibility Verification
Coverage, benefits, coordination of benefits and patient cost share confirmed before the visit, so claims start with the right payer.
Learn more about Insurance Eligibility VerificationPatient Billing
Clear statements, payment options and respectful follow-up for the balances patients owe after insurance.
Learn more about Patient BillingWorkers' Comp Billing
Work-injury claims billed to the right carrier with claim numbers, adjuster approvals, required reports and state fee schedules.
Learn more about Workers' Comp Billing
Built around how your specialty bills
Payer rules, code sets and denial patterns differ by specialty. Billing workflows are set up around the codes and edits your specialty actually runs into.
Cardiology Billing
Billing for echo, stress testing, cath lab and device monitoring, with professional and technical splits handled correctly.
Learn more about Cardiology BillingOrthopedic Billing
Surgical global periods, laterality and bilateral rules, fracture care, injections and bracing, plus work-injury claims routed to the right payer.
Learn more about Orthopedic BillingMental Health Billing
Billing for therapy practices: psychotherapy time codes, group practice NPIs, telehealth, clinician credentialing and session authorizations.
Learn more about Mental Health BillingPhysical Therapy Billing
Timed therapy codes and the 8-minute rule, GP modifiers, KX thresholds, plan-of-care certification and visit limits.
Learn more about Physical Therapy BillingInternal Medicine Billing
Adult chronic disease care: MDM-based E/M, chronic and principal care management, wellness visits, transitional care and risk adjustment documentation.
Learn more about Internal Medicine BillingRadiology Billing
Global, professional and technical component billing, imaging authorizations through benefit managers, contrast coding and ordering-provider rules.
Learn more about Radiology Billing
How working with us works
A structured start, then a predictable routine your team can rely on.
Step 1: Free billing audit
We review summary reports from your practice management system to find denial patterns, aging A/R and coding risks before you commit to anything.
Step 2: Onboarding and setup
We confirm system access, payer enrollments, fee schedules and current workflows, and agree on which tasks we own and which stay with your staff.
Step 3: Daily claim work
Charges are reviewed, scrubbed and submitted; remittances are posted; denials and unpaid claims are worked on a set schedule.
Step 4: Reporting and review
You get regular reporting on collections, denials and A/R, plus a standing review to decide what to fix next. Reports arrive monthly, with a review call to go through them.
In-house billing compared with outsourcing
What actually changes when billing moves from your office to a dedicated team.
| Area | In-house billing team | Outsourced to MEDCLAIM |
|---|---|---|
| Coverage | Depends on a few people; vacations, turnover and sick days slow claim work. | Work is shared across a team, so claims keep moving when someone is out. You also have a dedicated account manager as your main contact. |
| Cost structure | Salaries, benefits, training, software and clearinghouse fees, whether claim volume is high or low. | A fee set by the agreement, commonly a percentage of collections or a fixed monthly amount. We quote one of these models after a free audit, so the fee matches your volume and scope. |
| Denial follow-up | Often the first task dropped when the front office gets busy. | Worked on a defined schedule, with denial reasons tracked back to their cause. |
| Code and policy changes | Staff must keep up with code set updates and payer policy changes on their own. | Monitored by people who work across many payers and specialties every day. |
| Control and visibility | Direct, day-to-day control over every claim. | Agreed reporting and escalation rules; you keep ownership of, and access to, your own systems and data. |
Outsourcing is not the right answer for every practice. An audit is a low-risk way to see where the real gaps are first.
Who we serve
From solo practitioners to multi-location groups and hospital-affiliated practices.
Outsource Medical Billing
A practical guide to deciding between in-house and outsourced billing: scope, fee models, questions to ask, transition steps and contract risks.
Learn more about Outsource Medical BillingSmall Practices
Billing help for solo and small group practices: limited staff, tight cash flow, new provider credentialing and what to hand off first.
Learn more about Small PracticesHospitals and Large Groups
Professional billing for large multi-provider and hospital-based groups: facility interplay, coding consistency, contracts, analytics, credentialing at scale and compliance.
Learn more about Hospitals and Large Groups
Frequently asked questions
What does a medical billing company actually do?
A medical billing company turns patient encounters into payments. That includes checking coverage, reviewing codes, submitting claims, posting payments, appealing denials and following up on unpaid claims. Revenue cycle management looks at the whole process, from scheduling and eligibility through the final patient balance.
Will we lose control of our billing if we outsource?
No. Your practice keeps ownership of its data, payer contracts and practice management system. You agree up front which tasks are handed over, how issues are escalated and what reports you receive, and you can see claim activity in your own system at any time.
Do you work in our existing EHR or practice management system?
The aim is to work inside the system you already use rather than asking you to switch. We confirm system access during onboarding.
How is outsourced medical billing usually priced?
Billing companies typically charge a percentage of collections, a flat monthly fee, a per-claim fee or a hybrid of these. The right model depends on claim volume, specialty and scope of work. MEDCLAIM offers three of these models (percentage of collections, flat monthly fee and hybrid) and recommends one after reviewing your claim volume in a free billing audit.
How is patient information protected?
HIPAA treats a billing company that handles patient data for a practice as a business associate, so we agree the safeguards and paperwork your practice requires before any patient data is shared. Our website forms never ask for patient details.
How long does it take to switch billing companies?
It depends on system access, payer enrollment status and how much open A/R needs attention. During a switch the outgoing biller usually finishes its existing claims while new claims go to the new team, so nothing falls between the two. Most practices are fully onboarded within 2 to 4 weeks.
Explore MEDCLAIM Services
Services
Ten services covering the revenue cycle, from eligibility and authorization to coding, claims, denials and patient balances.
Learn more about ServicesSpecialties
Billing set up around each specialty's own codes, modifiers, denial triggers and authorization rules, across 25 specialties.
Learn more about SpecialtiesLocations
State-by-state billing pages covering each state's Medicaid program, regulators, workers' comp and auto-insurance rules.
Learn more about LocationsFree Billing Audit
A no-cost review of your denials, A/R and coding patterns, based on summary reports rather than patient records.
Learn more about Free Billing AuditOutsource Medical Billing
A practical guide to deciding between in-house and outsourced billing: scope, fee models, questions to ask, transition steps and contract risks.
Learn more about Outsource Medical Billing
Find out where your revenue is slipping
Start with a free billing audit. We review your denial and A/R reports, show you what we found, and you decide what happens next.