Medical Billing and Revenue Cycle Management

Your charges reach us the same way they reach your current biller: through your practice management system, on whatever schedule you already run.

What happens next is the part that differs. Before a claim is submitted, somebody with clinical training reads the documentation against the codes. Not a scrubber looking for format errors, and not a biller working from a superbill with no chart in front of them. A person who can tell whether the note supports the level of service billed, and who can say why the care was warranted if a payer later asks.

Claims that clear that review go out. Claims that do not come back to your provider with a specific question, while the encounter is still recent enough to remember.

Then we work what comes back. Denials get read, categorized and either corrected or appealed, and the appeals get written by someone who can argue medical necessity rather than resubmit the same claim and hope. A/R over 30 days gets chased. You get a monthly report that says what was billed, what was collected, what is still outstanding and why.

Coding is where most of the money is lost, and it is lost quietly. Undercoding does not generate a denial. It generates a smaller cheque, every time, for years, and nothing in your practice management system flags it.

Our coders hold CPC or equivalent certification and work across CPT, ICD-10 and HCPCS. They are the ones who catch a level four visit documented as a level three, a bundled service that needed modifier 59, or a diagnosis code that does not support the procedure it was paired with.

The MD review sits alongside that. A certified coder can tell you the code is wrong. Somebody with clinical training can tell you whether the note supports the code you want to bill, which is a different question and the one that decides an appeal.

If you already have billing you are happy with, this piece is available on its own, priced per encounter.

Solo and small-group practices tend to break in the same place. One person handles billing. That person learns three or four payers well and works the rest by trial. When they leave, and eventually they do, the knowledge leaves with them and the A/R quietly ages past appeal windows while you are hiring.

You do not have the volume to justify a billing department, and you should not have to build one.

What outsourcing changes for a practice your size is the failure mode. Denials get worked on a schedule instead of when there is time. Somebody is watching the filing deadlines. When your front desk enters insurance wrong, it gets caught before the claim goes out rather than 45 days later.

Before you switch, run the numbers properly. Salary is the obvious line, but the ones that decide the comparison are the software you are paying for, the write-offs you have stopped noticing, and the claims nobody had time to appeal.

We are based in Fresno, California and bill for practices across the United States. Medical billing is not a local service. Your claims go to payers, not to a building down the road, and the only thing proximity changes is whether you can drive to a meeting.

What matters instead is whether your billing team knows your payers. A biller who has worked Medi-Cal for a decade is worth more to a California practice than one who happens to share a zip code. If you are in a state we have not worked before, we will tell you that in the first call rather than after you have signed.

You get named people on your account and a phone number that reaches them during business hours, Pacific time.