Services
Get the claim right before it leaves the building
Most revenue is lost before a claim is ever submitted, in a mistyped policy number, a missed modifier, or an eligibility check nobody ran. This is the part of the cycle where accuracy compounds, and where the cheapest fixes live.
Every denial has a birthplace, and for most practices it is here. A claim built on unverified eligibility, coded without the documentation to support the level billed, or entered with a transposed member ID is a claim that will come back, thirty to forty-five days later, when the fix costs several times what prevention would have.
We work the front half of the cycle as one connected process rather than four separate tasks. Eligibility is verified before the encounter where the schedule allows it. Codes are assigned from the documentation, not from a superbill habit. Charges are entered against the fee schedule that actually applies to that payer. Payments are posted and reconciled so the next month's reporting reflects reality.
The point is not that these are difficult tasks individually. It is that they are usually distributed across people who never see the downstream consequence of getting them wrong, and nobody is measuring which step is leaking. We measure, and we report which one it was.
Billing & Coding
Services in this group
Sold individually or bundled. Most engagements combine two or three.
Medical Billing
Claim creation, scrubbing, submission and follow-up through to payment.
About Medical BillingMedical Coding
CPT, ICD-10-CM and HCPCS coding from documentation, by CPC-certified coders.
About Medical Coding
Payment Posting & Reconciliation
Payment posting looks like clerical work and quietly determines whether anyone can tell what is actually happening to your revenue. Posted carelessly, an underpayment becomes a contractual adjustment and vanishes: no denial, no appeal, no report line, no way to notice it is recurring across a payer. We post against remittance advice, reconcile to the deposit, and separate genuine contractual adjustments from shortfalls that warrant follow-up. For out-of-network claims that distinction matters even more, because an underpayment posted as an adjustment is a dispute nobody will ever file.
Eligibility & Benefits Verification
Most denials are decided before the claim exists. Coverage that lapsed, a plan the practice is not contracted with, a member ID captured wrongly at the desk. Each becomes a denial four to six weeks later, when the fix costs several times what verification would have. We verify coverage and benefits ahead of the encounter where the schedule allows and at the point of service where it does not, confirm network status, and establish patient responsibility so it can be discussed before treatment rather than billed afterwards. In walk-in settings this cannot be done the day before, so the workflow has to be built for the desk, which is where most implementations fail.
FAQ
Questions we get asked
Do you code, or do we send you our codes?
Either. If your providers or in-house coders assign codes, we bill from what you send and flag anything that looks likely to deny. If you would rather we code from the documentation, that is a separate service line and is scoped separately. See Medical Coding.
Which code sets do you work with?
CPT, ICD-10-CM and HCPCS Level II, with the modifier sets that apply to your setting. Emergency and urgent care work has its own profile of evaluation and management levels, critical care time and procedures performed during the encounter, and it is handled differently from routine outpatient billing.
How quickly do claims go out?
Our target is submission within one business day of receiving complete documentation. Where documentation is incomplete we come back to you rather than guessing, because a claim submitted on an assumption becomes a denial and then an appeal, which costs everyone more than the question would have.
Related
Complete solutions
End-to-End Revenue Cycle Management
Every service we offer, run as one engagement, from registration through to disputes.
About End-to-End Revenue Cycle ManagementER Billing Services
Emergency department revenue cycle: high volume, high out-of-network exposure, unpredictable payer mix.
About ER Billing ServicesUrgent Care & Clinic Billing
Walk-in volume, mixed payers and thin admin capacity, billing built for how urgent care actually runs.
About Urgent Care & Clinic Billing
Start with a free billing audit
We review a sample of your recent claims and your current A/R aging, and report where revenue is being lost. The report is yours whether or not you engage us.