What full-service medical billing includes
Medical billing is more than submitting claims. A claim is decided by what happened before the visit — whether coverage was checked, whether an authorization was on file, whether demographics were right — and by what happens after it: whether payments were posted against the contract, whether denials were worked, and whether anyone called about the claims that went quiet. We take all eight stages, because revenue leaks at the handoffs between them.
- Eligibility and benefits verification before every visit
- Prior authorization filed and chased to a decision
- Registration and intake QA, where errors cost nothing to fix
- CPT, ICD-10 and modifier review against the documentation
- Charge entry, claim scrubbing and electronic submission
- Line-by-line payment posting against your fee schedule
- Denials worked daily, with root causes reviewed monthly
- AR follow-up ranked by recovery odds and filing deadline
How pricing works
Billing is priced as a percentage of what we collect, so we are paid more only when you are. Credentialing is priced per application and front-office coverage monthly. We quote after a free review of your aging summary and denial reasons, because the right percentage depends on your specialty, payer mix, claim volume and how much legacy AR needs working.
When you compare billing companies, ask what the percentage is calculated on, which work is included and which is billed separately, how long the contract runs, and what it costs to leave. Our terms are month to month with 30 days' notice, and your data leaves with you at no exit charge.
Switching billing companies without a cash gap
The risk in switching is not the new claims; it is the AR your old vendor stops working. Before cutover we review your open AR, your contracts and your current vendor's termination clause, sign a BAA and put the plan in writing. At cutover, new claims move to us, and legacy AR either runs out with your old vendor or becomes a defined recovery project, prioritised by recovery odds and filing deadline.
First-pass acceptance in weeks four to six shows whether the front end is fixed. By day 90, net collection, days in AR and denial rate reflect a full cycle with us — and that is when to judge us.
The numbers we manage to
Every account is reported monthly by provider, location and payer, against four targets:
- Clean claim rate of 95% or higher — under 90% signals a front-end problem
- Under 40 days in AR — past 50, cash is sitting in unworked claims
- Denial rate under 5%, with the top reasons by payer
- Net collection rate of 96% or higher, measured against what your contracts entitle you to
In your software, with a named person
We work inside the practice management system and clearinghouse you already use — athenahealth, eClinicalWorks, Tebra / Kareo, AdvancedMD, SimplePractice, DrChrono, TherapyNotes, Practice Fusion, Office Ally, Open Dental and others — and the licence stays in your name. You get a named account lead rather than a shared queue, a fortnightly status call, and a reply within one business day.