Medical Billing Services

What Our Medical Billing Service Covers

Our billing workflow is structured around the operational checkpoints where reimbursement is most often lost. Each function is owned by named billers, governed by documented SOPs and measured against payer-specific KPIs reviewed monthly with the practice administrator.

• Daily charge entry with CPT, ICD-10-CM and modifier validation against payer LCD/NCD policy
• Pre-submission claim scrubbing through clearinghouse edits and Afiablee custom rule sets
• Electronic claim submission to commercial, Medicare, Medicaid, MA, Medicaid MCO and workers' compensation payers
• ERA and EOB payment posting with contractual adjustment review and underpayment flagging
• Patient statement generation, payment plan setup and balance-after-insurance workflows
• Secondary and tertiary claim coordination, including Medicare crossover reconciliation

Reimbursement Challenges We Address

In-house billing teams typically face the same recurring pressures: turnover-driven knowledge gaps, payer policy updates that arrive without notice, growing patient responsibility balances and front-desk eligibility errors that surface only at the denial stage. Our role is to absorb that operational load and replace it with predictable claim throughput.

• Missed timely filing deadlines on aged charges
• Payment posting backlogs that distort AR reports
• Inconsistent modifier use across providers in the same group
• Patient balances that age into bad-debt write-offs

How We Work With Your Practice

Engagements start with a documented workflow assessment — current EHR, clearinghouse, payer mix, fee schedules, top denial categories and existing reporting cadence. From there we agree to KPI targets (clean claim rate, days in AR, denial rate, net collection ratio) and a monthly review schedule. Communication channels, escalation paths and PHI access roles are established before the first claim moves.