01 / BEFORE THE VISIT
Coverage and authorization gaps
Verify available benefits, network status, referrals, and payer requirements. Flag unresolved items for staff before service when timing allows.
Physician billing services
One connected process for professional billing
Medbilling RCM manages billing for independent physicians and medical groups. We connect documentation, coding, claims, payments, denials, and A/R follow-up so work does not stop at submission.
Outsource the full cycle or assign the functions your team needs help with. We scope the workflow around your specialty, payer mix, staffing, and current systems.
Full-service or modular supportExisting-system planningVisible denial and A/R follow-up
Where claims get stuck
Find the problem before the claim
A rejected or denied claim may point to an earlier gap: inactive coverage, an authorization requirement, incomplete documentation, a provider record mismatch, or a payer edit.
Our workflow sends the finding back to the step that created it. That gives your staff a clear correction to make on the current account and a way to prepare the next claim differently.
02 / BEFORE SUBMISSION
Documentation and claim data
Review coding support, provider identity, place of service, modifiers, units, and the payer details needed for a professional claim.
03 / AFTER THE RESPONSE
Repeat denials and aging A/R
Separate rejections from denials, work the account, and record the root cause so recurring patterns lead to a workflow change.
What we manage
Billing from first check to final payment
Professional billing needs consistent handoffs across the front office, clinical documentation, coding, billing, and follow-up. The contracted scope identifies who owns each handoff.
01Eligibility and prior authorization
Check available coverage and authorization rules, document responses, and route exceptions before service where practical.
02Charge capture and coding review
Reconcile encounters to charges and review documentation-supported diagnosis, procedure, E/M, modifier, unit, and service details.
03Professional claim submission
Prepare 837P claims, validate patient and provider fields, and track clearinghouse rejections separately from payer denials.
04Payment posting and reconciliation
Post remittance activity, apply approved adjustments, reconcile patient responsibility, and flag payment variances.
05Denials, appeals, and A/R
Route corrections and appeals within payer deadlines, prioritize aging accounts, and document follow-up through resolution.
06Reporting and additional support
Review defined performance measures. Credentialing, patient billing, and MIPS support can be scoped when available and contracted.
Professional claim controls
What needs to match on a physician claim
A valid file format does not by itself make a service payable. These are the common checks that connect a claim to the service and payer rules. Specialty and payer requirements may add more.
| Control point | What we check | Why it matters |
|---|---|---|
| Claim channel | Electronic 837P or CMS-1500 data when paper submission is permitted | An invalid format can reject before adjudication. |
| Provider identity | Billing and rendering NPI, taxonomy, group linkage, enrollment, and service location | Provider and payer records must align with the service. |
| Service context | Date, place of service, diagnosis linkage, procedure, units, and modifiers | These fields describe what occurred and the applicable payment rules. |
| Documentation | Medical necessity and service detail, including level, time, or separate service support when relevant | The record must support what is billed. |
| Payer requirements | Coverage, authorization, referral, edits, and filing deadline | Passing a format check does not override payer policy. |
| Payment response | ERA or EOB, adjustments, patient responsibility, and variance | The balance must be closed correctly or routed for follow-up. |
Claim rules and coding decisions are reviewed for the contracted payer and specialty scope.
Flexible engagements
Choose the billing support your practice needs
The scope can change with your staffing and claim volume. Responsibilities, approval points, reporting, and A/R ownership are documented before transition.
Full-service billing
Transfer the contracted cycle from verification and charges through claims, posting, denials, A/R, patient balances, and reporting.
Best fitPractices replacing or avoiding a full billing department.
Modular support
Assign defined functions such as coding review, authorization, posting, denials, A/R, credentialing, or reporting.
Best fitPractices with an internal team and a clear capacity or expertise gap.
Team augmentation
Add structured queues, specialist review, and reporting while practice staff retain daily ownership.
Best fitGroups handling backlogs, growth, leave coverage, or payer-specific issues.
How an engagement works
Agree on ownership before cutover
- Assess the current cycle
Review agreed samples of rejections, denials, A/R, payments, and enrollment.
- Define scope and access
Map practice and Medbilling RCM responsibilities, systems, approvals, and security needs.
- Validate the transition
Test claims, remittances, reports, and exception handling before cutover.
- Review and improve
Discuss aging, denial causes, payment variances, and assigned actions regularly.
Systems and oversight
Technology assists. People decide.
Automation can flag missing claim fields, sort recurring denial reasons, process structured remittance data, and prioritize queues. Documentation questions, coding judgment, appeals, and contract exceptions still need human review.
During scoping, we confirm access to your EHR, practice-management system, clearinghouse, payer portals, and reports. Interface or integration capability is validated before any workflow is promised.
A Business Associate Agreement should be executed before protected health information is exchanged.
Visibility for practice leaders
Reports that show what happened to the account
Measurement points should be defined before comparing performance. Clearinghouse acceptance and payer acceptance are different; so are rejections and denials.
Claim acceptance and rejectionsInitial denials and root causesDays in A/R and aging distributionPayments and payment variancesAdjustments and write-offsPatient balances and follow-up activity
Reporting reviews should identify the account owner, next action, and payer pattern behind each material trend.
Common questions
Answers before you change your billing workflow
What do physician billing services include?
Scope may cover eligibility, authorization, charge capture, coding review, 837P submission, payment posting, denials, A/R, patient billing, credentialing, and reporting. The agreement defines which functions stay with your practice.
How is physician billing different from hospital billing?
Physician professional services generally use the 837P electronic transaction or CMS-1500 paper form when permitted. Hospital facility services use an institutional billing workflow with different claim and payment requirements.
Can you work with our in-house team?
Yes. You can scope selected functions while your practice retains the rest. We document queue ownership, approvals, handoffs, and reporting during onboarding.
How do you handle denied claims?
We check the denial reason and account history, then choose the appropriate correction, documentation, reconsideration, appeal, or payer follow-up. Repeated causes are routed back to the responsible workflow.
Can you work with our current EHR?
Engagements are planned around existing systems where practical. Access methods, interfaces, clearinghouse connections, file formats, and testing are confirmed during scoping.
How much does physician billing cost?
Pricing depends on specialty, provider count, claim volume, payer mix, existing A/R, technology, and the work included. A proposal follows a review of the practice's needs.
How long does onboarding take?
Timing depends on access, data quality, enrollment, clearinghouse setup, security review, testing, and transferred A/R. The implementation plan defines milestones and the cutover date.
How is patient information protected?
A Business Associate Agreement should be in place before PHI exchange. Administrative, physical, and technical safeguards, incident terms, access removal, and data return are reviewed during contracting.
What should we ask a billing company?
Ask who owns each step, how claims and denials are measured, what systems are supported, how coding and security are reviewed, what reports you receive, and how records are returned.
What happens during the assessment?
We review agreed billing information and discuss where accounts are getting stuck. Confirm the data requested, written findings, confidentiality terms, and any limitations when scheduling.
Next step
Find where revenue gets stuck
Bring your denial, payment, and aging questions to a physician billing specialist. An assessment can help identify whether the immediate issue sits in verification, documentation, coding, claim data, posting, credentialing, or follow-up.
Or call (888) 551-2526. Please do not share patient information during an initial inquiry.
