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Specialty — Primary Care

Medical billing and RCM for primary care practices

Primary care does not lose revenue on single large claims. It loses it across thousands of small ones, where a two percent eligibility failure rate is a full-time problem.

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Denial drivers
Eligibility, coverage changes
Coding pressure
E/M level accuracy
Where A/R ages
Small patient balances
Underpayment risk
Moderate
The challenges

What actually costs primary care practices money

Coverage changes between visits

Patients seen frequently change plans mid-year, and the eligibility check that passed in March fails in July.

E/M level accuracy

Consistent under-coding of established-patient visits is the single most common quiet loss in primary care.

Small balances, large volume

Patient responsibility amounts are individually small and collectively the largest A/R bucket.

Annual wellness and preventive rules

Preventive versus problem-oriented billing rules differ by payer and generate avoidable denials.

How we work a primary care account
  1. 1 Pre-visit eligibility on the full schedule, not a sample
  2. 2 E/M distribution reviewed against your own history, per provider
  3. 3 Patient balance cadence that does not fall on the front desk
  4. 4 Preventive-visit rules maintained per payer

Other specialties

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A physician listening to a patient’s heart with a stethoscope Cardiology An orthopedic physician explaining an X-ray to a patient Orthopedics A therapist in a counseling session with a client in a bright office Behavioral Health A physical therapist working on a patient’s shoulder in a sunlit clinic Physical Therapy A dermatologist examining a patient’s skin with a dermatoscope Dermatology A psychiatrist in a consultation with a patient in a modern office Psychiatry

How healthy is your primary care revenue cycle?

We will review your denials, A/R and payer performance and tell you what we find.

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  • No obligation, and you keep the findings either way
  • Under two minutes to request
  • No patient information needed to start
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