Core service

Medical billing services for independent practices

We take the claim from charge capture to paid — scrubbing it before submission, posting the payment against what you were actually owed, and appealing it when a payer says no.

Get a free A/R analysis Book a 15-minute call

The problem this fixes

Billing isn't one task, it's a chain, and the chain breaks quietly. A missing modifier fails a scrub. A denial arrives and sits in a folder. A payment posts short and nobody checks it against the contracted rate. Each break is small. Together they're the difference between a practice that's comfortable and one that isn't.

In-house billing fails for a predictable reason: it's one or two people doing a job that requires specialty coding knowledge, payer-by-payer rule tracking, and relentless follow-up — usually while also running the front desk.

The compounding effect is what makes it dangerous. A practice with a nine percent denial rate and no appeals process is not losing nine percent of its revenue once — it is losing a share of that every month, plus the aged balances that build behind it, plus the underpayments nobody reconciled. None of it appears as an expense. It appears as revenue that simply never arrived.

What goes wrong when this is done badly

Four failure modes we see repeatedly, and each one is a process problem rather than an effort problem.

Rejections nobody watches

A claim rejected at the clearinghouse never reaches the payer, never appears on a remittance, and never shows up in denial reporting. An unmonitored rejection queue is one of the most common sources of aged A/R, and it is invisible unless somebody is specifically looking.

Payments posted without checking

A payment that arrives short of the contracted rate looks like a paid claim. Posting without reconciling against the fee schedule means underpayments are absorbed one at a time, and because each is individually small, nobody notices the total.

Follow-up by mood rather than by deadline

Working the claims that come to hand rather than the claims closest to a filing window is how a practice collects easy money quickly and loses hard money permanently.

Secondary claims never sent

Coordination of benefits is tedious and low-value per claim, so it gets deferred. Across a year it is a meaningful balance that ages out quietly.

What's included

Every item below is a deliverable, not a capability statement.

Charge entry

Charges captured from your EHR and entered against the correct provider, location, and payer.

Coding review

Certified coders validate ICD-10, CPT, HCPCS, and modifier selection against documentation.

Claim scrubbing

NCCI edits, MUE limits, LCD/NCD checks, and payer-specific rules applied pre-submission.

Electronic submission

Claims submitted via clearinghouse, with paper submission where a payer still requires it.

Payment posting

ERA and EOB posting reconciled against contracted rates, with underpayments flagged for recovery.

Secondary and tertiary billing

Coordination of benefits and downstream claims handled automatically.

Denial and rejection handling

Every rejection corrected and resubmitted; every denial root-caused and appealed.

A/R follow-up

Systematic follow-up by ageing bucket, prioritised by filing deadline and collectability.

Patient statements

Statements issued, payment plans supported, patient queries answered.

Reporting

Weekly and monthly performance reporting.

How it works

1 Data access We connect to your EHR/PM system with a signed BAA in place.
2 Baseline We audit your last 90 days: denial rate, A/R ageing, net collection rate, top denial reasons.
3 Parallel run Two weeks running alongside your existing process so nothing is dropped.
4 Full handover We take the cycle end-to-end.
5 Weekly review Your account lead reports on what was billed, paid, denied, and recovered.

Where a claim stops moving

Stage	What stops it	Where it shows up
Charge capture	A service performed and never charged	Nowhere — it is invisible unless charges are reconciled against the schedule
Scrubbing	An NCCI edit or missing modifier caught after submission instead of before	A denial two to three weeks later
Clearinghouse	A format or data rejection that never reaches the payer	No remittance at all, which is why rejections need their own queue
Adjudication	A denial with an appeal window attached	The remittance, with a CARC code that names the cause
Posting	A payment short of the contracted rate	Only if payments are reconciled against the fee schedule
Follow-up	A claim nobody has touched since submission	The ageing report, usually once it is too late

Each of these is a different fix. Treating them all as "billing problems" is what keeps them recurring.

What you get back

Weekly performance report with denial rate, A/R ageing by bucket, and collections against expected
Monthly financial summary with payer-level breakdown
A named account lead reachable by phone and email
Full visibility inside your own system — nothing is hidden from you
[CLIENT INPUT] response SLA on queries

Who this is for

Solo and small-group practices without a dedicated billing team
Practices whose biller has left or is retiring
Practices currently using a billing company that isn't working denials
Practices where the front desk is doubling as the billing department

What we measure

The numbers this service actually moves. You see all of them weekly, in your own system, with the benchmark alongside.

First-pass clean claim rate The share of claims paid on first submission with no rework. Every claim that fails first pass costs $25–30 to correct and adds two to three weeks before payment arrives, which makes this the number with the most leverage over everything else.
Days in A/R Total receivables divided by average daily charges: the average time it takes a billed dollar to reach your account. MGMA and HFMA benchmarks put a well-run outpatient practice at 30 to 40 days.
Denial rate Denials as a share of claims submitted. Under 8% is normal. Above it, the leakage is structural rather than incidental, and the fix belongs upstream of the appeal.
Net collection rate Payments received against the allowed amount, after contractual adjustments. It answers the question that actually matters: of the money you were entitled to collect, how much did you keep.

Benchmark ranges are sourced from MGMA and HFMA MAP Keys. MedBil's own figures are published only with a stated measurement window, per specification section 12.7.

Where this matters most

The specialties where this part of the cycle carries the most risk and the most recoverable revenue.

Gastroenterology Screening vs. diagnostic colonoscopy, modifier 33/PT, auth Dermatology Lesion coding by size and site, cosmetic vs. medical, pathology Physical Therapy Timed vs. untimed units, the 8-minute rule, therapy caps, plan of care Urgent Care High volume, S-codes, place of service, self-pay mix OB/GYN Global obstetric package, antepartum/postpartum splits, ultrasound Wound Care Debridement by depth, skin substitutes, HBOT, documentation of measurements

Proof

Start with your own numbers

We measure your denial rate, A/R ageing and net collection rate against industry benchmarks before you commit to anything. You keep the analysis either way.

90 days of claims data, no patient identifiers needed
A written analysis, not a sales deck
No contract, and no obligation to proceed
Client results published with a stated measurement window, once available

Questions about medical billing

Will I lose visibility into my own billing?

No. We work inside your system, so you can see every claim at any time.

What systems do you work with?

[CLIENT INPUT — list supported EHR and practice management systems]

Do you handle Medicare and Medicaid?

Yes, plus commercial payers, workers' compensation, and self-pay.

What happens to claims already in progress when we switch?

They stay with us. We pick up the existing A/R as part of onboarding.

How is this priced?

A percentage of what we collect. See our pricing page.