Scope for each practice is confirmed in the engagement agreement, including systems, payers, and queues.
Claims stall in the gap between the visit and the payment
A charge that sits unbilled, a claim that rejects for a missing NPI, and a denial that nobody opens are three different problems with the same symptom: cash arrives late. Small practices often ask one person to code, submit, post, and call payers. That person triages the loudest task. Medical billing support is a staffed queue for those steps, with the practice keeping clinical control of the record.
What the work includes
- Coding to ICD-10 and CPT so the claim matches the documented work
- Eligibility and benefits verification a day before the appointment
- Electronic claim submission through the practice EHR and clearinghouse
- Claim scrubbing that corrects inconsistencies before the file leaves
- Follow-up on claim status within 3–5 days of submission
- Denial management that returns rejected claims to a person quickly
- Patient statements and collection of patient payments
- Bi-weekly reporting with the practice on revenue and open work
How the work moves
Step 1
Confirm the claim path
We identify the billing NPI, rendering provider, payer IDs, and whether claims leave through a clearinghouse or a direct payer connection. Enrollment gaps are flagged before a batch fails.
Step 2
Build the claim from the encounter
Charges, diagnoses, and modifiers come from the record and the fee schedule already loaded. Missing referring-provider data or an authorization number stops the claim instead of creating a preventable denial.
Step 3
Submit and read the acknowledgement
An accepted clearinghouse status is not a payment. We distinguish a file acknowledgement from a payer acceptance so staff do not close a claim that the payer has not taken.
Step 4
Work exceptions
Rejections are corrected and resubmitted. Denials are routed to the denial workflow. Patient balances that remain after posting move to statement rules the practice has approved.
Operational benefits
- A visible unbilled and rejected queue
- Fewer claims that fail for demographic or identifier errors
- Posting that matches the remit instead of a lump payment
- Time back for the in-office team that currently owns every payer call
Common challenges
- Timely filing limits differ by payer and by state prompt-pay rules
- A clean claim can still be denied for medical necessity or coverage
- Secondary claims need the primary adjudication, not a copy of the original charge
- Out-of-network billing follows a different patient-cost conversation
Technology
Billing runs in the practice management module the practice already uses. Claim files move through a clearinghouse that can return 277 acknowledgements and 835 remits. We will not represent a direct integration as live until the connection is tested with that practice's vendor.
Where specialty changes the work
Office-based professional billing is the default. Facility claims on a UB-04 are not part of this service. Specialties with heavy procedure coding use the same claim path, with different edits, which are described on the specialty pages.
Questions
Do you bill only Medicare?
The proposed scope covers commercial, Medicare, Medicaid, and other payer types the practice is enrolled with. Enrollment itself is a separate credentialing workflow. A claim cannot be paid in-network by a payer that has not enrolled the provider.
Can you work inside our existing software?
That is the expectation. The assessment asks which system holds charges and whether we receive a login, a work queue, or a file. We do not require a change of EHR to discuss billing.
What do you need from the practice each day?
Completed encounters, a way to ask a documentation question, and a person who can approve write-offs. We do not need patient records sent through the public website form.
How long is onboarding?
There is no published week count. The first claims go out after system access works, open items are sorted, and any missing enrollment is known. The assessment names those dates for that practice.
Can older unpaid claims be included?
Aged claims are in scope only when the agreement says so. They are a separate queue from current encounters. The practice still decides write-offs.
Does the practice keep its own system access?
Yes. The EHR and the practice-management system stay the practice's. Billing uses the access the vendor agreement allows, and the practice can still open a claim.