Primary care
Medical billing for primary care practices
Lots of visits at small claim values, with a long payer list. One denied office visit doesn't look like much, so it's easy to leave it sitting.
It's free, and you can keep your current biller
Where primary care billing goes wrong
- Small claims get ignoredA denied office visit doesn't seem worth an hour on the phone, so it goes to the bottom of the pile. Do that all year and it adds up to a number you'd notice.
- Preventive and problem visits on the same dayA patient comes in for a physical and mentions her knee. That visit needs the right modifier and separate documentation, or one part may not get paid.
- Coverage changes between visitsYou've known a patient for ten years, so nobody at the desk asks about his card, and he changed plans when he retired. Eligibility has to be checked each time anyway.
- Care management left unbilledYour nurses may already be making calls that could count toward a program, but only work documented at the time can be billed.
Common primary care billing checks
- Office visits9921399214 Level is selected by medical decision making or total time, and the note must support it.
- Preventive plus problem visit9939625 Modifier 25 goes on the separate E/M visit and depends on separately documented work.
- Medicare wellnessG0438G0439 Frequency limits apply.
- Chronic care management99490 Consent and clinical staff time must be on record.
These codes are examples. Rules change by year and payer, so we check current guidance.
Where to start
- Medical billingWe prepare, check, submit and follow up on claims within your agreed scope.
- Denial managementDenied claims worked by cause and deadline, and tracked to an outcome.
- Insurance verificationWe check coverage before the visit and tell your front desk about the problems.
- Care management billingWe check prerequisites first, then support the billing for CCM, CPO, RPM and PCM.
Further reading: the basics of billing CCM and CPO and what a medical billing audit should check.
Questions
Questions about primary care billing
Do you work with small primary care offices?
Yes. We set this up for independent and physician owned practices, including solo providers. There's a monthly minimum, so if the numbers don't make sense for you, we'll say that.
Can you help us start billing for chronic care management?
Yes, on the billing side. We can check what your records support and handle the billing, and your clinical team provides the care and documents the time.
Do you handle patient statements?
We can talk about it. Tell us how you handle patient balances today and we'll define what's in scope in your proposal.
Find out what your primary care claims are leaving behind
Send us your denial and A/R reports and you'll have a written report within 48 hours, for free. You can keep your current biller while you decide.
