What a billing team actually does after the visit
Medical billing starts when a provider signs a note and ends when the last dollar of the visit is either collected or correctly written off. In between sit a series of handoffs where revenue quietly leaks: a charge that never gets entered, a claim rejected by the clearinghouse and never corrected, an underpayment posted as if it were correct, a denial that waits until the appeal window has closed.
Our billing service takes ownership of those handoffs. We work inside your existing practice management system, so your front desk keeps registering patients and your providers keep documenting exactly as they do today. You see every claim, payment and denial in your own system, and you get a monthly review that explains what moved and why.
How claims move through our workflow
- Charge review and entrySigned encounters are checked for missing charges, diagnosis pointers and modifiers before they become claims.
- Scrubbing before submissionEach claim is checked against National Correct Coding Initiative (NCCI) edits, payer-specific rules and the data elements a clean claim needs, so problems are fixed before a payer ever sees them.
- Submission and acknowledgement trackingClaims go out electronically as 837P or 837I transactions. Clearinghouse rejections and payer acknowledgements are worked, not left in a queue.
- Payment posting and variance reviewElectronic remittances (835) are posted, contractual adjustments are checked against your fee schedules, and short payments are flagged for follow-up.
- Denials and follow-upEvery denial is categorized by its adjustment reason code and either corrected, appealed or closed with a documented reason. Unpaid claims are followed up by age and by payer filing limit.
What changes for your staff
Most practices keep front-desk work in house: scheduling, registration, collecting copays and scanning insurance cards. That work matters to billing, so we share what we see. If a pattern of eligibility denials points to registration, we tell you which payer and which field, and suggest the fix. When documentation is the problem, we send specific queries rather than general reminders.
- No new software to learn: we work in the system you already use.
- One named account manager who knows your payers and providers.
- A monthly review of collections, denials and accounts receivable, with the actions behind each number.
How pricing works
Medical billing services are usually priced as a percentage of net collections, so the fee rises and falls with what is actually collected. The rate depends on your specialty, claim volume, payer mix and how much of the revenue cycle you want us to cover. We quote after a short review of your volume and workflow, and the agreement lists every included task. See how our pricing works or read what to compare when choosing a billing company.
When billing alone is not enough
If denials start upstream — missing authorizations, eligibility gaps, credentialing delays — billing cannot fix them after the fact. In that case full revenue cycle management covers the front end as well. If the immediate problem is a backlog of old unpaid claims, start with accounts receivable recovery.