Medical billing for group practices

Reporting that survives a partner meeting

The reason group practices ask for provider-level reporting is rarely curiosity. It is that compensation, hiring decisions and partner conversations all depend on knowing which provider generates what, and a practice-level total cannot answer any of those questions.

So the monthly pack reports collections, denial rate, days in A/R and net collection rate per provider and per location, alongside the group figure. Where a provider sits outside the group's range, the report says why: a payer mix difference, an enrolment gap, a documentation pattern, or a genuine volume difference.

That last distinction matters more than it sounds. A provider with a high denial rate because their notes do not support the level billed needs a coding conversation. A provider with a high denial rate because a payer has not finished processing their enrolment needs a credentialing conversation. Reported as one number, both look like underperformance.

Credentialing as an operation, not an event

In a group, credentialing never finishes. Each new hire needs enrolment with every contracted payer before they can bill. Each existing provider carries revalidation dates, quarterly CAQH attestations, licence renewals, DEA registrations and malpractice certificates. Any one of them lapsing can stop that provider's claims, and in some cases invalidate claims already submitted.

We run it as a pipeline with a status per provider and per payer, advance alerts on every expiring document, and a fixed follow-up cadence on every open application. The dashboard tells you, on any given day, which providers can bill which payers.

Mixed specialties under one roof

A group with primary care, behavioural health and physical therapy is running three different rule sets. Timed codes and licence-level modifiers in one, the 8-minute rule and plan-of-care certification in another, E/M accuracy and care management in the third. Coders pooled across all three are adequate at each and expert at none.

Coders are assigned per specialty line and stay there, with a coding lead per line who owns the documentation feedback back to those providers.

Multi-location practicalities

Place of service, fee schedules and in-network status can all differ by site. Where a group has several locations, each one is configured separately and reported separately, because a problem at one site is invisible in a combined number.