Accurate, compliant billing for all medical specialties. Our certified billing specialists ensure claims are correctly coded, submitted promptly, and reimbursed at the highest allowable rates.
Medical practices struggle with complex billing requirements that impact revenue and compliance.
Incorrect CPT, ICD-10, or HCPCS codes lead to claim rejections, underpayments, and compliance issues.
Manual billing processes cause delays in claim submission, extending time to payment and hurting cash flow.
Claim denials due to billing errors result in significant revenue loss and require costly rework.
Improper billing practices expose practices to audits, penalties, and potential fraud allegations.
Constant updates to billing regulations require ongoing training, and turnover creates knowledge gaps.
Limited visibility into billing metrics and performance prevents proactive management.
Our comprehensive billing solutions combine expert staff, advanced technology, and proven processes.
End-to-end billing management from claim creation through payment collection.
Every dollar your practice earns travels through 8 critical stages. We manage all of them so you never lose revenue to process failures.
Demographics, insurance eligibility, and prior authorizations verified before the patient walks in. We catch denials before they happen.
Pre-VisitReal-time benefit checks confirm active coverage, copays, deductibles, and authorization requirements, eliminating surprise claim rejections.
Pre-VisitAccurate clinical documentation during the visit supports every code submitted. Gaps here cost physicians an average of 11-15% in lost revenue.
At VisitOur certified coders translate every diagnosis and procedure into precise CPT and ICD-10 codes, maximizing reimbursement while maintaining compliance.
Post-VisitClean claims are scrubbed and submitted electronically within 24 hours. We achieve a 98%+ first-pass acceptance rate across all major payers.
BillingEvery denied claim is reviewed, corrected, and appealed within 48 hours. We recover revenue most practices write off, with a documented appeal win rate above 90%.
RecoveryERA/EOB payments are posted daily. Underpayments are identified, flagged, and contested, ensuring you collect every contractual dollar owed.
CollectionsMonthly performance dashboards surface collection rates, days in A/R, denial trends, and payer behavior, giving you a live view of your financial health.
InsightsProfessional medical billing services deliver measurable results that transform your practice finances.
Expert billing and follow-up recovers more revenue from every claim. Faster submission, fewer denials, and persistent follow-up maximize your practice income.
Save 30-50% compared to in-house billing staff. Eliminate costs for salaries, benefits, training, software, and office space while improving performance.
Reduce days in A/R from 50-60 days to 30-35 days. Clean claims, prompt submission, and expert follow-up accelerate cash flow.
Free your clinical staff from billing tasks. Invest time in patient care, practice growth, and provider satisfaction instead of administrative burden.
Stay current with HIPAA, coding updates, and payer requirements without constant training. Expert teams manage compliance so you do not have to worry.
Access real-time dashboards and detailed reports on collections, denials, and revenue trends. Make informed decisions with complete financial visibility.
Understanding commonly billed CPT codes is fundamental to accurate claim submission, proper reimbursement, and denial prevention.
| Code | Description | Est. Range | Billing Notes |
|---|---|---|---|
| 99213 | Office visit, established patient, low MDM | $73-$100 | Most commonly billed E/M code. Document total time if using time-based billing |
| 99214 | Office visit, established patient, moderate MDM | $108-$145 | Requires moderate complexity MDM. Upcoding from 99213 without documentation is a top audit trigger |
| 99215 | Office visit, established patient, high MDM | $148-$195 | Frequently audited. Documentation must fully support high complexity MDM |
| 99243 | Outpatient consultation, moderate MDM | $130-$170 | Medicare does not recognize consultation codes. Verify payer-specific policies before submitting |
| 99283 | Emergency department visit, moderate MDM | $75-$115 | ED E/M codes do not require new/established distinction. Separate facility vs professional billing correctly |
| 99284 | Emergency department visit, moderately high MDM | $135-$190 | Document problems addressed, data reviewed, and risk of complications |
| Code | Description | Est. Range | Billing Notes |
|---|---|---|---|
| 36415 | Venipuncture, routine blood collection | $3-$5 | High volume, often missed during charge capture. Modifier 59 may be required with other collection procedures |
| 81002 | Urinalysis, non-automated, without microscopy | $3-$5 | CLIA-waived. Ensure valid CLIA certificate of waiver. Bill with appropriate diagnosis code for medical necessity |
| Code | Description | Est. Range | Billing Notes |
|---|---|---|---|
| 99381 | Initial preventive medicine evaluation, infant | $100-$140 | New patient well-child visit. Append modifier 25 and bill problem-oriented E/M if significant separate problem is addressed |
| 99391 | Periodic preventive medicine reevaluation, infant | $85-$120 | Established patient well-child visit. Follow payer-specific periodicity schedules |
| 99395 | Periodic preventive medicine reevaluation, 18-39 years | $110-$155 | Annual wellness for established patients. Distinguish from Medicare AWV codes G0438/G0439 |
| Code | Description | Est. Range | Billing Notes |
|---|---|---|---|
| 96372 | Therapeutic, prophylactic, or diagnostic injection (subcutaneous or IM) | $25-$35 | Bill in addition to drug/vaccine administered. Append modifier 59 or XE to additional units if multiple injections given |
| 99024 | Postoperative follow-up visit, included in surgical package | $0 (included) | No-charge tracking code for postoperative visits within global surgical period |
| 99497 | Advance care planning, first 30 minutes, face-to-face | $80-$110 | Medicare covers annually with no cost-sharing. Document discussion content, participants, and time. Add-on 99498 available |
CPT codes and reimbursement ranges are for educational reference only. Actual reimbursement varies by payer, region, and contract.
Each payer has distinct billing requirements, timely filing deadlines, and documentation standards. Understanding these differences is essential for maximizing reimbursement.
Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for healthcare services. It involves translating clinical services into billing claims using CPT/ICD-10 codes, submitting those claims to payers, and managing the revenue cycle from patient registration through final payment.
Medical coding converts diagnoses, procedures, and services into universal alphanumeric codes (CPT, ICD-10, HCPCS). Medical billing uses those codes to create and submit claims to insurance companies. Coders focus on accuracy; billers focus on getting those claims paid.
Most electronic claims are processed within 7-14 business days for commercial payers and 14-30 days for Medicare/Medicaid. Our team tracks all outstanding claims and follows up proactively to prevent aging.
The most common denial reasons include: missing or invalid prior authorization, incorrect patient information, duplicate claim submissions, medical necessity not established, timely filing deadline exceeded, and coding errors. Our sub-5% denial rate is achieved through proactive prevention at each step.
Most billing companies charge 4-9% of collections depending on specialty and volume. Medages charges only for what gets collected with no setup fees, no monthly minimums, and no long-term contracts. Contact us for a custom quote.
The most important billing KPIs are: clean claim rate above 95%, days in AR below 35, denial rate below 5%, first-pass resolution rate above 90%, and net collection rate above 96%. Medages provides monthly dashboards tracking all of these for your practice.
Our certified billing specialists recover lost revenue and accelerate your cash flow. Schedule a free consultation to see how much more you could be collecting.