Frequently Asked Questions

Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services provided by healthcare providers. The process involves patient registration, insurance verification, charge capture, claims submission, payment posting, denial management, and patient collections. Professional medical billing companies handle this entire revenue cycle to maximize collections and minimize denials.

Outsourcing medical billing typically results in higher collection rates (95%+ vs 85-90% in-house), faster payment cycles, reduced overhead costs, better compliance, and allows your staff to focus on patient care. Professional billing companies have dedicated experts, advanced technology, and established payer relationships that most practices cannot replicate cost-effectively in-house.

We work with healthcare practices of all sizes and specialties, including family medicine, cardiology, behavioral health, physical therapy, dental, pediatrics, dermatology, emergency medicine, and multi-specialty groups. Our billing specialists have expertise across 30+ medical specialties and can handle both small solo practices and large multi-location groups.

Most practices see measurable improvements within 60-90 days. Initial setup and data migration typically take 2-4 weeks. You'll notice cleaner claims and faster submissions within the first month, improved denial rates by month 2, and significant collection improvements by month 3. Full revenue cycle optimization usually occurs within 4-6 months.

We need your practice management system access, patient demographics, insurance information, current fee schedules, provider credentials (NPI, tax ID, licenses), payer contracts, historical billing data (6-12 months), and your current denial reports. We'll provide a comprehensive onboarding checklist and work with you to gather everything needed for a smooth transition.

Medical billing services typically cost 4-8% of collections, depending on practice size, specialty complexity, and services included. This percentage-based model aligns our success with yours—we only earn when you collect. This is often less expensive than in-house billing when you factor in salaries, benefits, software, training, and overhead costs.

Our pricing includes full revenue cycle management: patient registration, insurance verification, charge entry, claims submission, payment posting, denial management, patient billing, collections follow-up, detailed reporting, compliance monitoring, and ongoing support. There are no hidden fees for claim resubmissions, appeals, or software access.

We offer flexible contract terms starting at 6-12 months, with month-to-month options available after the initial period. We believe in earning your business through results, not binding contracts. Most clients stay with us long-term because of the value we provide, not contractual obligations.

Practices typically see 15-30% revenue increase in the first year through improved collection rates, reduced denials, faster payment cycles, and better coding accuracy. When you factor in eliminated staff costs, software expenses, and training overhead, most practices achieve positive ROI within 3-6 months. We provide detailed ROI analysis during our free assessment.

We have no setup fees for standard implementations. Our transparent percentage-based pricing covers all billing services. The only potential additional costs would be for highly customized integrations or special reporting requirements, which we always discuss upfront. Most practices pay only the percentage of collections with no surprise fees.

Standard implementation takes 2-4 weeks from contract signing to go-live. This includes data migration, system integration, staff training, and workflow setup. Complex multi-location practices or custom integrations may take 4-6 weeks. We provide a detailed implementation timeline and dedicated project manager to ensure a smooth transition.

We minimize disruption through careful planning and phased implementation. Most practices experience no patient-facing changes. We can run parallel with your current system initially if needed. Our team handles the heavy lifting during setup, requiring only 2-4 hours of your staff's time for training and knowledge transfer.

No, we integrate with all major practice management and EHR systems including Epic, Cerner, athenahealth, eClinicalWorks, Kareo, AdvancedMD, and others. We adapt to your existing workflows and technology rather than forcing you to change systems. If you need to upgrade your software, we can recommend and assist with implementation.

We provide comprehensive training on our processes, communication protocols, reporting access, and system integration. Training typically includes 2-3 virtual sessions covering patient registration workflows, charge entry (if handled in-house), and how to use our reporting portal. We also provide ongoing support and additional training as needed.

Yes, we maintain full HIPAA compliance with SOC 2 Type II certification. We execute Business Associate Agreements (BAA) with all clients, use encrypted data transmission, maintain secure servers, conduct regular security audits, provide staff HIPAA training, and have comprehensive breach notification procedures. Patient data security is our top priority.

We integrate with 50+ practice management and EHR systems including Epic, Cerner, athenahealth, eClinicalWorks, NextGen, Allscripts, Kareo, AdvancedMD, DrChrono, CareCloud, and many others. Our integration team can work with virtually any system that allows secure data exchange.

We use 256-bit encryption for data transmission and storage, maintain secure cloud infrastructure with redundant backups, implement role-based access controls, use multi-factor authentication, conduct regular security penetration testing, maintain detailed audit logs, and follow strict HIPAA protocols. All staff undergo background checks and annual HIPAA training.

Yes, our client portal provides 24/7 access to real-time dashboards showing collections, aging accounts, denial rates, payer performance, and 30+ key performance indicators. Reports can be customized by provider, location, payer, or procedure. You can export data anytime and schedule automated report delivery.

Our cloud infrastructure has 99.9% uptime with redundant systems and automatic failover. In the rare event of an outage, we have manual backup processes to ensure claims continue processing. We maintain offline access to critical data and can resume operations within hours. We've never experienced a complete service disruption.

We have specialized billing teams for 30+ medical specialties including family medicine, internal medicine, pediatrics, cardiology, behavioral health, physical therapy, dental, dermatology, emergency medicine, surgery, and more. Each specialty has unique coding requirements, payer rules, and common denial patterns that our expert teams understand thoroughly.

Our certified medical coders specialize by clinical area and stay current on specialty-specific CPT, ICD-10, and HCPCS codes. We maintain coding expertise in complex areas like cardiology device implants, behavioral health therapy sessions, physical therapy time-based codes, surgical procedures, and specialty-specific modifiers. Regular training ensures compliance with latest coding updates.

Yes, we offer comprehensive credentialing services including initial provider enrollment, payer network credentialing, re-credentialing, CAQH profile management, and privilege applications. We handle all payer communications and track renewal dates. Credentialing typically takes 60-120 days depending on payers and complexity.

Our first-pass acceptance rate averages 96-98% across all specialties, compared to industry average of 80-85%. This is achieved through automated claim scrubbing, pre-submission validation, accurate coding, proper documentation, and real-time eligibility verification before claims submission.

We have a systematic denial management process: immediate denial identification, root cause analysis, correction or appeal preparation, timely resubmission (within payer deadlines), follow-up tracking, and trend analysis to prevent future denials. Our average denial recovery rate is 85-90%, with most denials resolved within 15-30 days.

Our clients typically maintain denial rates of 3-5%, well below the industry average of 10-15%. We achieve this through proactive denial prevention including accurate coding, proper authorization management, eligibility verification, clean claim submission, and addressing denial patterns before they become systemic issues.

Average payment timeline is 18-30 days from service date, depending on payer mix. Clean claims to commercial payers typically pay in 14-21 days. Medicare pays in 14-28 days. We track all claims and follow up on any unpaid after 21 days. Our clients see 40-50% reduction in days in accounts receivable compared to in-house billing.

Yes, we manage the full patient collection cycle including patient statement generation, payment plan setup, payment processing, collection calls (following FDCPA regulations), and third-party collection agency coordination if needed. We use patient-friendly communication and multiple payment options to maximize collections while maintaining positive patient relationships.