Medical Billing & Revenue Cycle Questions

Medical billing is the process of translating the care a provider delivers into a claim, submitting that claim to the responsible payer, and following it through to payment. It covers patient and insurance information capture, charge entry, coding review, claim submission, payment posting, denial handling and collection of any remaining patient balance.

A medical billing company takes on the administrative work of getting a practice paid. That typically includes eligibility verification, coding support, claim preparation and submission, payment posting, denial and appeal work, accounts receivable follow-up, patient billing questions and reporting on how the revenue cycle is performing.

Revenue Cycle Management (RCM) is the end-to-end management of a patient's financial encounter — from scheduling, registration and eligibility verification, through coding, claim submission and adjudication, to payment posting, denial resolution, accounts receivable and final collection. Billing is one part of RCM; RCM is the whole cycle and the reporting around it.

We work denials from both ends. Existing denials are triaged by reason code, payer and dollar value, then corrected, rebilled or appealed where appropriate. At the same time we categorize denial reasons to find the pattern behind them — an eligibility step being skipped, a modifier applied incorrectly, a payer policy that changed — and address it in the upstream workflow so the same denial stops recurring.

Yes. We provide CPT, HCPCS Level II and ICD-10-CM coding support, including modifier review and feedback to providers when documentation does not support the code being billed. Coding is applied with the specialty-specific conventions and payer policies relevant to your service lines.

Yes. We verify active coverage, plan-level benefits, patient responsibility such as copays and deductibles, and whether a service requires prior authorization. Because a large share of preventable denials originate before the visit, verification is one of the highest-value steps in the cycle.

Yes. We support commercial and government payer enrollment, CAQH profile setup and attestation maintenance, revalidations, and tracking of expirable documents. We follow up with payers until effective dates are confirmed, and report status while applications are in process.

Yes. We analyze A/R by aging bucket, payer and provider, then work accounts on a prioritized basis — high-value claims and those approaching timely filing limits first. Every account touched is documented, and reporting shows how balances are moving between aging buckets rather than only the total outstanding.

Our teams are cross-trained across Chiropractic, Family & Internal Medicine, Orthopedic, Physical Therapy, Acupuncture, Language Interpreting, DME, Urgent Care, Primary Care, Mental Health, Behavioral Health, Psych & Sleep Disorders, Dental, Home Health and Pharmacy. Multi-disciplinary practices can be supported under one contract.

In most cases yes — we work inside the system your practice already uses, with access provisioned by your team at the permission level required for billing work. During onboarding we confirm the specific system, the access needed and how documents and remittances will be exchanged, so you are not asked to change platforms in order to change billing partners.

Onboarding starts with a review of your current billing workflow, payer mix, systems and open A/R. From there we agree on scope and responsibilities, arrange system access, document the workflow, and set the reporting cadence and points of contact. Open A/R is addressed as part of the transition so claims already in flight are not left behind.

Request a free consultation using the form on this site, or call +1 (512) 325-5653. We will discuss your specialty, provider count, current systems and where your revenue cycle is under strain, then outline what support would look like for your practice.

Medical billing companies generally price one of three ways. A percentage of collections is the most common, where the fee is a share of what is actually collected, which aligns the biller's incentive with yours. Per-claim pricing charges a flat amount for each claim submitted, which can suit high-volume, low-value claims. A dedicated-staffing or FTE model charges a fixed monthly rate for assigned team members, which tends to fit larger organizations. Rates vary with specialty, claim volume, average claim value and how much of the cycle is outsourced, so compare on scope as well as headline rate — a low percentage that excludes A/R recovery, credentialing or patient billing is not the cheaper option. Ask us for a quote based on your actual volumes.

It depends on your size and your current collection performance, and an honest comparison includes more than salary. In-house billing costs wages plus payroll taxes, benefits, software and clearinghouse fees, training and certification, workspace, and the risk that one person's absence stops your cash flow. Outsourcing converts most of that into a variable cost that scales with collections. For solo providers and small practices outsourcing is usually less expensive outright; for larger groups the decision is often less about cost per claim and more about capacity, specialty coding depth and continuity when staff leave. The figure that matters is net collections after fees, not the fee itself.

Ask questions with verifiable answers. Who specifically works on your account, and who do you call when something is urgent? Will they work inside your existing EHR and practice management system, or require a platform change? How are denials categorized, and what do they change upstream as a result? What happens to your existing open accounts receivable during the transition? What does monthly reporting contain, and can you see a sample? Can they provide references from practices in your specialty? Be wary of vendors quoting guaranteed collection percentages or publishing performance statistics they cannot substantiate.

Expect the first full month to be transition and the second to be the first clean comparison. Claims submitted in the first weeks take the normal payer adjudication time to pay, typically two to six weeks depending on the payer, so cash effects lag the work. Aged accounts receivable inherited at transition is worked in parallel and usually produces recoveries within the first 30 to 60 days. Denial trends take a full reporting cycle to become visible, which is why the first month-end review matters more than day-to-day activity.

Yes. Independent providers and small offices are a core part of who we support, and they often benefit most, because billing in a small practice usually depends on one or two people who are also running the front desk. We provide full billing coverage without adding headcount, continuity when staff are out, and reporting concise enough for a provider to read in a few minutes. There is no minimum provider count.

A clean claim rate of 95% or higher is the widely used target, meaning at least 95 of every 100 claims are accepted on first submission without correction. For accounts receivable, under 35 days from charge to payment is the common benchmark, with a healthy practice keeping the share of A/R older than 90 days low. Both vary by specialty and payer mix — surgical practices with authorization-heavy workflows behave differently from a high-volume urgent care. What matters more than hitting a single benchmark is whether the numbers move in the right direction month over month, and whether you can see why they moved.

Yes, and it is one of the first things we look at. Aged accounts receivable is worked on a prioritized basis: high-value claims and anything approaching a payer's timely filing deadline come first, because those are the balances that become permanently uncollectible. Every account touched is documented, and reporting shows movement between aging buckets rather than only the outstanding total. Some aged balances will not be recoverable — claims past filing limits usually cannot be revived — and we will tell you which category yours fall into rather than billing you to chase them.