Services
Medical Billing Services
We take over the day-to-day billing work between the visit and the deposit: reviewing charges, submitting clean claims, posting payments and following up on every claim that does not pay as expected.
- Claims checked against payer and NCCI edits before submission
- Electronic remittances (ERA/835) posted and reconciled to deposits
- Every unpaid or underpaid claim worked until it is resolved
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
What is included
Everything needed to turn a coded encounter into a correct payment.
Charge entry and review
Charges are entered or imported from your EHR and checked for missing information, wrong diagnosis pointers and unit errors before they go anywhere.
Claim scrubbing
Each claim is checked against payer rules and NCCI edits, so bundled procedures, missing modifiers and invalid code pairs are fixed before submission instead of after a denial.
Electronic claim submission
Professional claims go out in the 837P electronic format, the counterpart of the paper CMS-1500, and institutional claims in the 837I format, the counterpart of the paper UB-04 (CMS-1450), through your clearinghouse.
Rejection handling
Clearinghouse and payer front-end rejections, such as invalid member IDs or NPI mismatches, are corrected and resubmitted quickly, because a rejected claim has not reached the payer yet.
Payment posting
ERA/835 files and paper EOBs are posted to the right accounts, with contractual adjustments, patient responsibility and CARC/RARC denial codes recorded accurately.
Unpaid claim follow-up
Claims with no payer response are chased before they age past timely filing limits. Medicare's limit is one calendar year after the date of service, and commercial limits are set in each payer contract.
Patient statements
Patient balances are billed after insurance has adjudicated the claim, with clear statements and a defined follow-up cycle. Statements go out on a monthly cycle.
Reporting
Regular reports on charges, payments, adjustments, denials and A/R aging, so you can see how the practice is performing. You receive these reports monthly.
Official sources: CMS MLN: Medicare billing, CMS-1500 and 837P (external site), eCFR: 42 CFR 424.44 (time limits for filing claims) (external site), CMS Claims Processing Manual, Chapter 24 (277CA acknowledgments) (external site), CMS: health care payment and remittance advice (external site)
How it works
A repeatable routine, so claims move every day rather than in bursts.
Step 1: Access and setup
We get secure access to your practice management system and clearinghouse, review fee schedules and payer enrollments, and document your current workflow.
Step 2: Charge capture
Completed encounters are pulled every working day and checked against documentation and coding rules before charges are released.
Step 3: Scrub and submit
Claims are scrubbed for payer-specific edits and submitted electronically, with rejections corrected promptly. Clean claims are typically submitted within one business day of charge entry.
Step 4: Post and reconcile
Remittances are posted and reconciled against bank deposits, so missing payments and underpayments surface straight away.
Step 5: Work denials and A/R
Denials are corrected, appealed or adjusted according to agreed rules, and unpaid claims are followed up by payer and age.
Step 6: Report and improve
We review trends with you, such as a recurring denial reason or a slow payer, and fix the cause upstream.
Who it is for
Practices with a stretched front office
When the same people handle scheduling, check-in and billing, claim follow-up is usually what slips first.
Practices replacing a billing company
If reporting is thin or denials are piling up, a structured handover lets you change billers without losing open claims.
Growing and multi-provider groups
New providers and locations add enrollment, coding and payer complexity faster than most in-house teams can absorb.
Specialty practices
Modifier-heavy and authorization-heavy specialties benefit from billers who already know the edits their payers apply.
Rejections, denials and underpayments
Three different problems that need three different fixes. Treating them the same is a common reason money goes uncollected.
| Aspect | Rejection | Denial | Underpayment |
|---|---|---|---|
| What it means | The claim failed a format or data check and never reached adjudication. | The payer processed the claim and refused payment for some or all lines. | The payer paid, but less than the contracted or expected amount. |
| Where it shows up | Clearinghouse reports and payer acknowledgements (277CA). | The remittance advice (835 or EOB), with CARC and RARC codes. | Only when payments are compared against fee schedules or contracts. |
| How it is fixed | Correct the data and resubmit as a new claim. | Correct and resubmit, or file an appeal within the payer's deadline. | Dispute with the payer, citing the contracted rate. |
Frequently asked questions
What is the difference between medical billing and medical coding?
Coding translates the provider's documentation into standard codes: CPT and HCPCS for procedures and services, ICD-10-CM for diagnoses. Billing uses those codes to build claims, submit them, post payments and follow each claim through to resolution. Because one depends on the other, codes are reviewed as part of claim preparation.
What is a clean claim?
A clean claim has no errors or missing information, so the payer can process it without asking for more. That means correct patient and payer details, valid codes that pass payer edits, the right modifiers and a diagnosis that supports medical necessity for each service.
How quickly are claims submitted after a visit?
Typically within one business day of receiving complete charge information. The sooner charges are released after the visit, the sooner the payer's processing clock starts and the more margin there is before filing deadlines.
Can you take over claims that are already in A/R?
Open claims from a previous biller or in-house team can be worked as part of onboarding, prioritized by age and value so older claims are not lost to filing limits. We include this in onboarding as standard.
Do you handle patient balances as well as insurance?
Patient statements and balance follow-up can be included in medical billing or handled through a dedicated patient billing service, depending on what your practice needs. We set the scope with you at onboarding.
Related services and specialties
Related services
Medical Coding
E/M, procedure and diagnosis coding from the documentation, with modifier, NCCI and MUE checks before claims go out.
Learn more about Medical CodingA/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 Recovery
Specialties
Family Practice Billing
Every age in one practice: mixed payers, preventive coding from infants to seniors, office procedures, sports physicals and NP and PA billing.
Learn more about Family Practice BillingUrgent Care Billing
Walk-in E/M levels, procedures and supplies, in-house X-ray and lab, occupational medicine, S-codes and per-visit payer contracts.
Learn more about Urgent Care BillingPediatrics Billing
Age-banded well-child visits, vaccine administration and product coding, Vaccines for Children, EPSDT, screening codes and coverage for minors.
Learn more about Pediatrics Billing
See how clean your claims really are
A free billing audit shows your rejection and denial patterns, how long claims take to pay and where follow-up is falling behind.