Medical billing & RCM for U.S. practices and ASCs
Take Control of Your Revenue Cycle
Medical billing, coding review and revenue cycle management for physician practices, groups and surgery centers. Prevent denials where they start, work every unpaid claim before its deadline, and see your numbers every month.
No-obligation assessment • Practice details only, no patient data
- BAA Before Data Access
- Works in Your EHR
- Fees Tied to Collections
- Monthly KPI Review
Executive Summary & Direct Answer
What is Revenue Cycle Management (RCM)?
- What it covers
- Every step from registration and eligibility to coding, electronic claims (837), payment posting from remittances (835), denial appeals and patient balances.
- How it is measured
- Days in A/R, the share of A/R over 90 days, clean claim rate, denial rate by reason and payer, and net collection rate — calculated the same way every month.
- How we work
- A Business Associate Agreement before any data access, work inside your existing EHR and practice management system, and a monthly review of results.
Clinical Precision Coding
Specialty-Tailored Revenue Cycle Protocols
Generic billing misses specialty rules. Each specialty has its own modifiers, bundling edits, coverage policies and payer requirements — and we work to them.
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Cardiology & Electrophysiology
Cardiac catheterization and PCI, nuclear and echo studies, device implants and checks.
Key Nuances Managed:
- Modifier 25 and 59 supported by documentation
- NCD and LCD coverage checks
- Prior authorization for advanced imaging
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Orthopedics & Spine Surgery
Joint replacement, arthroscopy, injections, DME and spine procedures.
Key Nuances Managed:
- Global surgical periods and modifiers 24, 58, 78, 79
- Implant invoices and contract carve-outs
- Laterality and multiple-procedure rules
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Behavioral Health & Psychiatry
Psychotherapy, psychiatric visits, group and crisis care, and telehealth.
Key Nuances Managed:
- Time-based psychotherapy codes
- E/M with psychotherapy add-ons (90833)
- Carve-out plans and authorizations
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Gastroenterology & Endoscopy
Screening and diagnostic colonoscopy, upper endoscopy, anesthesia and pathology claims.
Key Nuances Managed:
- Screening converted to therapeutic (PT / 33)
- Endoscopy family payment rules
- Patient cost-sharing for screening
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Ambulatory Surgery Centers (ASCs)
Facility claims, covered procedures, implants, packaged services and contract carve-outs.
Key Nuances Managed:
- Claim format by payer (837P / 837I)
- Multiple-procedure discounting checks
- Discontinued procedures (modifiers 73 / 74)
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Multi-Provider & Multi-Location Groups
Group and individual enrollment, new locations, and consistent coding across providers.
Key Nuances Managed:
- Reassignment and location enrollment
- Charge lag tracked by provider
- Reporting by provider, location and payer
The Revenue Cycle, End to End
End-to-End 8-Stage Revenue Cycle Engine
Every stage is checked before the next one starts, so problems are fixed where they begin instead of showing up later as denials.
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Stage 1: Patient Registration & Eligibility
Electronic eligibility checks (270/271) before the visit: coverage, deductible, copay and secondary insurance.
Fewer coverage denials
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Stage 2: Prior Authorization & Pre-Cert
Requirements checked by code and plan, requests submitted with clinical records, and approvals matched to what was performed.
Approvals match claims
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Stage 3: Coding & Documentation Review
ICD-10-CM, CPT and HCPCS codes and modifiers assigned from the documentation, with provider queries when notes are unclear.
Codes supported by notes
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Stage 4: Claim Scrubbing
Claims checked against NCCI edits, coverage policies and payer-specific rules before they are sent.
Errors caught before submission
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Stage 5: Clearinghouse Submission (EDI 837)
Electronic submission of professional (837P) and institutional (837I) claims; rejections worked the same day.
Proof of timely filing
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Stage 6: Denial Management & Appeals
Every denial categorized by CARC/RARC code, then corrected, appealed or closed with a recorded reason.
Every denial worked
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Stage 7: Payment Posting & 835 ERA
Electronic remittance posting, contractual adjustment checks and reconciliation of unapplied payments.
Accurate A/R
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Stage 8: Patient Billing & Reporting
Clear patient statements and a monthly report on collections, denials and A/R by payer.
Monthly review
Practice Revenue Health Check
See Where Your Revenue Cycle Is Losing Money
Get a focused review of your billing workflow, claims, denials, and accounts receivable.
Practice ROI Estimator
Estimate Your Recoverable Revenue
Slide to your current monthly practice collections for a rough estimate of revenue held up in unworked denials and slow A/R.
Illustrative Annual Recovery
+$68,400
From preventing repeat denials, working unpaid claims and checking payments against your fee schedule.
Illustrative Days in A/R Reduction
18 Days
Faster collection from cleaner claims and timely follow-up.
Illustrative estimate only, using a fixed assumption — not a quote or a promise. The free assessment gives you figures based on your own claims.
Free Assessment
Request Your Free Revenue Assessment
We review a sample of your recent claims and remittances for coding errors, missed modifiers, denial patterns and payer underpayments. No obligation.
Thank you — we have your request.
We reply within one business day.
Prefer to talk now? Call +1 (737) 332-2245.
Strategic Evaluation
In-House, Software or a Billing Partner
A plain comparison of how each approach usually works. Your own costs and results are what matter, so use it as a list of questions.
| Question | In-House Billing Staff | Billing Software Only | MedicalBilling & Coding Services |
|---|---|---|---|
| Who works denials?Correction, appeal and follow-up | Your staff, as time allows | Your staff — software flags them | The billing team, as part of the scope |
| What happens during absences?Vacations, illness, turnover | Work may pause | Work may pause | Covered by the team |
| How is it paid for?Cost structure | Fixed payroll and software | Subscription plus staff time | Percentage of collections |
| Who keeps up with rule changes?Codes, edits, payer policies | Your staff | Software updates edits; staff apply them | The billing team |
| What reporting do you get?Visibility for owners and managers | Depends on staff time | Standard software reports | Monthly report and review |
| Who controls the data?Ownership and access | You | You | You — we work in your systems |
Transparent Value-Aligned Engagement
Clear, Collections-Based Pricing
Our fee is a percentage of the payments we collect for you, quoted in writing. The quote lists what is included and anything priced separately.
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Front desk stays in house
Medical Billing
For practices that handle registration and eligibility themselves and want claims, payments and denials managed.
Quoted per practice
Percentage of collections
- Claim scrubbing and submission
- Rejection and denial work, including appeals
- Payment posting from remittances
- Follow-up on unpaid claims
- Monthly reporting and review
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End to end
Front end to final payment
Revenue Cycle Management
For practices that want the whole cycle managed, from eligibility and authorization to patient balances.
Quoted per practice
Percentage of collections
- Everything in Medical Billing, plus:
- Eligibility and benefits checks
- Coding review against documentation
- Prior authorization support
- Patient statements and billing questions
- Root-cause reporting by stage, payer and provider
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Groups, ASCs & projects
Custom Scope
For multi-location groups, ambulatory surgery centers, or a single project such as old A/R or credentialing.
Quoted per scope
Percentage, project or per-provider fee
- Facility and professional claims
- Contract and carve-out payment checks
- Credentialing and enrollment
- Old A/R projects
- Reporting by provider and location
How the rate is set
What Determines Your Medical Billing Rate?
The fee applies to payments actually collected — not to charges
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1. Clinical Specialty
Coding complexity, modifiers, authorizations and documentation review.
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2. Monthly Volume
Number of providers, claims and monthly collections.
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3. Payer & Patient Mix
Medicare, Medicaid, commercial, workers’ compensation and patient balances.
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4. Scope of Work
Which parts of the cycle we handle and which stay with your team.
Authoritative Knowledge
Healthcare RCM Knowledge Base & FAQs
Direct answers to common billing, coding and outsourcing questions from practice owners and managers.
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Core Definition
Medical Billing vs. Medical Coding: What is the Difference?
Medical coding translates the provider’s documentation into standard codes (ICD-10-CM, CPT, HCPCS). Medical billing uses those codes to create claims (CMS-1500 or UB-04), submits them, posts payments, works denials and collects patient balances.
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Pricing
How Do Medical Billing Companies Charge?
Most charge a percentage of collections; others charge per claim or a flat monthly fee. Check what the fee applies to, and which costs — clearinghouse, statements, credentialing — are separate.
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Denial Root Causes
Where Do Claim Denials Start?
Most denials begin before the claim is sent: coverage and eligibility (CO 27), missing authorization (CO 197), missing information (CO 16) and bundling or modifier issues (CO 97, CO 4). Fix them at the stage where they start.
Do we have to change our EHR or practice management system?
No. We work inside your existing EHR and practice management system with individual, role-based logins, so your providers and front desk keep their routines and you keep ownership of your data.
What happens to unpaid claims older than 90 or 120 days?
They are sorted by filing and appeal deadline, then by reason and value, and worked in that order — corrected, appealed with supporting records, or closed with a recorded reason when they cannot be recovered.
Who codes our claims?
Experienced coders who work from your providers’ documentation and send a query when a note is unclear, rather than guessing. Ask us about the team assigned to your specialty during the assessment.
How do you protect patient data?
We sign a Business Associate Agreement before any patient data is shared, use individual logins with role-based access to your systems, and never collect patient information through website forms.