Medical billing, coding & documentation
A submitted claim is not the same as a paid claim.
Charges are entered, claims go out, and then the work fragments: rejections in the clearinghouse, denials in the payer portal, corrected claims in a spreadsheet, and documentation questions in someone's inbox. We run those queues as one workflow and correct the cause, not just the claim.
Clean claims are the beginning. Follow-through and root-cause correction are what protect revenue.
Who it fits
Practices this service is built for
- Practices where claims are submitted but denials are worked inconsistently
- Providers who want documentation and coding feedback in plain language
- Groups adding a service line, setting, or payer mix and unsure how it should be coded
- Owners who cannot currently explain why a specific balance is unpaid
What is included
- Charge capture review and claim submission
- ERA/EOB posting and payment reconciliation
- Rejection, denial, appeal, and corrected-claim handling
- Aging follow-up with documented payer contact
- CPT, HCPCS, ICD-10-CM, and modifier review
- Pre-bill and focused retrospective documentation review
- Provider-facing documentation feedback and education
What you still own
- Clinical documentation and the final content of the note
- Timely note completion and provider sign-off
- Fee schedule decisions and financial policy
- Patient collections policy and refund approvals
- Access to the EHR, clearinghouse, and payer portals
Deliverables & reporting cadence
- Weekly action tracker with owner and due date
- Monthly denial-reason and payer trend summary
- Documentation feedback summary per provider
- Monthly owner review with next-step priorities
Explicitly out of scope
- Guaranteed reimbursement or approval of any claim
- Changing clinical documentation on a provider's behalf
- Coding services without access to supporting documentation
- Formal external coding audits or legal opinions
How it works
A four-step workflow
- 01
Baseline review
Review current charge flow, coding patterns, denial reasons, and aging.
- 02
Scope and access
Confirm responsibilities, queues, role-based access, and reporting cadence.
- 03
Operate the queues
Daily submission, posting, rejection, denial, and follow-up work.
- 04
Correct the cause
Feed denial and documentation findings back into prevention.
Questions
Billing & Coding FAQ
Next step
Start with a Revenue Readiness Review.
We map providers, payers, services, systems, current A/R, authorizations, and credentialing status before recommending scope.
Book a Revenue Readiness ReviewPlease note: Do not include patient names, dates of birth, member IDs, diagnoses, records, claim documents, or other PHI.