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Frequently Asked Questions

About Med Claims

What exactly does Med Claims do, and why should I trust you with my billing?

Med Claims manages the entire revenue cycle for medical practices, from billing, coding, and claim submission to denial management, AR follow-up, and credentialing, as well as lien-based collections for workers’ compensation and personal injury cases.

We don’t outsource your work to a call center or rotate it through junior staff. Specialists with hands-on experience in your payer mix and specialty manage every account.

If your current billing situation is producing denials, slow collections, or unworked AR, that’s exactly the problem we solve, and we can show you where the gaps are before you commit to anything.

That’s the most common thing we hear, and it’s fair. Most billing companies overpromise, underdeliver, and disappear into the background once you’re signed. We operate differently. You get transparent reporting, direct access to your billing team, and a fee structure tied to your collections or a flat monthly invoice, as you prefer. We also start every engagement with a free billing audit, so you know exactly what you’re walking into. No vague promises at all. Just a clear picture of what’s broken and what we’ll do to fix it.

Yes. All data handling, transmission, and storage is HIPAA-compliant, and we sign a Business Associate Agreement (BAA) with every provider we work with before any information is exchanged. If you’ve been burned with vendors who weren’t dead serious about compliance, that risk doesn’t exist here at all.

We work with solo practitioners, small practice groups, and large multi-specialty groups. A solo provider often has more to gain from outsourcing billing than a large group does, because a single missed denial or underworked AR bucket represents a much larger percentage of your revenue. No account is too small for us to do it right.

Most in-house billers are handling too much, from scheduling, patient calls, prior auths, and billing to aggressively follow up on denials and aging AR. That’s where revenue leaks. We either take over the billing function entirely or work alongside your team to handle the functions where in-house bandwidth runs out. We’re not here to replace your staff. We’re here to make sure nothing falls through the cracks.

Book a free billing audit. We review your current collections performance, denial rates, and AR again, and tell you exactly where you’re losing money and what fixing it would be worth. There’s no cost, no commitment, and no sales pitch. Just a clear picture of your current billing health.

Revenue Cycle Management (RCM)

What is revenue cycle management, and why does my practice need it?

Revenue cycle management is the full financial process behind a patient visit, from verifying their insurance before they arrive, to coding the encounter correctly, to following up until every dollar is collected. When any piece of that chain breaks, whether it’s a missed authorization, a coding error, an unanswered denial, revenue disappears. Most practices are losing 10-20% of collectible revenue to broken RCM without knowing it. We close that gap.

The risk is invisible. In-house billing teams rarely have the capacity to aggressively work denials, monitor payer rule changes, and maintain clean AR aging simultaneously. The claims that don’t get followed up on don’t generate error messages. They just go uncollected. A billing audit almost always reveals 6-18 months of recoverable revenue sitting in aging AR that no one chased. That’s the real cost of the status quo.

You can engage us for the specific functions where you need support. Some practices use us for billing and coding only. Others bring us in to work on denials and AR while keeping front-desk functions in-house. We configure around your needs, not a fixed package.

Most practices see measurable improvement in their denial rate and AR aging within the first 60-90 days. Collections typically improve within the first full billing cycle. We give you reporting visibility throughout, so you’re not guessing. You can see the change in the numbers.

No. A high denial rate and aging AR are fixable. They’re just symptoms of process problems. We’ve taken on practices in genuinely difficult billing situations and recovered significant revenue within the first few months. The first step is always a free audit to understand what’s recoverable and what’s not.

Medical Billing

What does clean claim submission actually mean, and why does it matter?

A clean claim is one submitted with no errors, with correct patient information, accurate codes, proper modifiers, and complete documentation.

Payers process clean claims faster and deny them far less. When claims are submitted with errors, you wait weeks for a rejection, then correct and resubmit. This adds 30-60 days to your payment timeline.

We build clean claim practices into every submission, so you don’t lose time and revenue to avoidable rework.

Within 24 to 48 hours of receiving complete encounter documentation. Every day of delay is a day added to your payment timeline. Speed and accuracy together are what get you paid faster.

All of them, including major commercial payers, Medicare, Medicaid, state Medicaid programs, workers’ compensation carriers, and personal injury lien cases. If a payer has a claims process, we navigate it.

We work on it immediately. Denials aren’t filed away. In fact, they’re investigated, corrected, and resubmitted or appealed before payer deadlines expire. Most billing teams let denials age because there’s no dedicated workflow for them. That’s exactly how revenue disappears. We treat every denial as a collections opportunity.

Yes. We handle professional (physician) billing and facility/outpatient billing depending on your practice structure and payer agreements.

Billing compliance is built into our process, not bolted on. Our coders stay current on annual CPT and ICD-10 updates, payer-specific rules, and specialty billing guidelines. We conduct internal audits and flag anything that creates exposure. If you’re worried about your current billing practices, a coding audit is the fastest way to find out where the risk is.

Medical Coding

How do I know my coding is accurate right now?

Most practices don’t know until they have an audit. Undercoding (billing lower-level E/M codes out of habit or fear of audit), overcoding (billing higher than documentation supports), and missing modifiers are all common. Any of these costs you money or creates compliance risk. A coding audit takes the guesswork out of it and shows you exactly where you stand.

Yes. Our coders hold CPC, CCS, and specialty-specific credentials. They’re not general billers who also do coding. In fact, they’re trained coders with experience in the specific specialties we serve. Coding quality is not an area we cut corners on.

Many billing companies use billers who do basic coding rather than certified, specialty-trained coders. The difference shows up in your reimbursement. Specialty-specific coding, particularly in cardiology, orthopedics, pain management, and behavioral health, requires knowledge of CPT code bundles, modifier rules, and payer-specific policies that general billers frequently miss. We staff for specialty expertise, not generalist coverage.

Specialty coding is where we earn our keep. Cardiology involves cardiac catheterization codes and hemodynamic documentation. Orthopedics requires fracture care modifier distinctions. Pain management involves interventional procedure codes with fluoroscopy add-ons. Behavioral health applies H-codes for Medicaid programs. We have coders experienced in each specialty, not one generalist trying to cover everything.

We correct it, we track it, and we identify the root cause to prevent it from recurring. Our QA process catches most errors before a claim goes out. When an issue surfaces post-submission, we own it and fix it. You’ll never be left managing our mistakes alone.

Eligibility and Benefits Verification

Why does eligibility verification matter enough to dedicate a whole service to it?

Because claims submitted for patients with lapsed coverage, incorrect plan information, or non-covered services are denied. And that denial comes back to you weeks after the visit, when the patient is long gone and collecting from them is much harder. Verifying eligibility before the appointment prevents denials before they happen. It’s the cheapest insurance you can buy for your billing cycle.

Always before. 24 to 48 hours ahead of every scheduled appointment. Your team knows the patient’s coverage status before they walk through the door, not after the claim bounces.

Yes. For workers’ comp patients, we confirm claim status, adjuster contact information, and authorization details before the visit. For personal injury patients, we verify lien eligibility and attorney engagement so collections are properly structured from day one, not sorted out after treatment is complete.

We notify your office immediately so you can contact the patient before the appointment, giving you the option to reschedule, collect payment upfront, or make an informed decision about how to proceed. You don’t find out after the visit is complete.

If verification is happening consistently, ahead of every visit, with workers’ comp and PI cases included, then you may not need us for this piece. But most practices with in-house verification are doing spot checks, not systematic pre-visit verification for every appointment type. The gaps are where denials come from. We cover the full workflow every time.

Appointment Scheduling

Why would I outsource appointment scheduling? Can't my front desk handle it?

Front desk staff handle scheduling alongside patient check-in, phone calls, prior auths, and a dozen other things simultaneously. When scheduling volume is high, call abandonment rates rise, and patients who can’t get through quickly book elsewhere. We provide dedicated scheduling capacity that extends your front office without adding headcount and keeps your patient access rates where they need to be.

No. Our schedulers operate within your system, follow your protocols, and represent your practice. The experience is consistent for your patient.

Yes, across multiple providers, departments, and locations under a coordinated workflow. For practices that have struggled with scheduling consistency across sites, centralized scheduling through us often improves both patient access and provider utilization.

Yes. Reminders and confirmations are built into the scheduling workflow. No-show rates drop when patients receive timely, consistent outreach, and that directly protects the revenue on your schedule.

Denial Management

How much revenue is my practice losing to unworked denials right now?

More than most practice managers realize. Industry benchmarks put the average denial rate at 5-10% of billed claims, and of those, nearly 65% are recoverable with proper appeal. If you’re not working on denials systematically, you’re leaving a significant portion of your billed revenue on the table. A billing audit tells you exactly how much.

The most frequent causes are:

  • Incorrect or missing patient information
  • Coding errors or unsupported code combinations
  • Missing or expired prior authorizations
  • Timely filing deadline lapses
  • Duplicate claim submissions
  • Medical necessity disputes

Immediately. Payers have appeal deadlines, often 30-180 days, depending on the payer, and missing one means forfeiting the payment entirely. We don’t let denials sit in a queue. They’re worked on as soon as they arrive.

Yes. Denial data is analyzed by reason code, payer, provider, and procedure. When a specific payer consistently denies a particular code or modifier combination, we identify the pattern and adjust the billing workflow upstream to prevent the same denial from recurring. Reactive denial management isn’t enough. We use denial data to fix the source.

Yes. We regularly take over AR with significant backlogged denials and work through them systematically. We assess what’s still within appeal timelines, prioritize by dollar value, and pursue every recoverable claim. Most practices are surprised by how much is still collectible.

Look at your denial rate trend. Is it going down quarter-over-quarter? Look at your AR over 90 days. Is it shrinking? If neither is improving, denials aren’t being worked effectively. We can show you a benchmarked comparison of your current denial performance against industry standards and against what your practice should be achieving.

Payment Posting

Isn't payment posting just data entry? Why does it require a dedicated service?

Poorly done payment posting creates a chain reaction of problems, including inaccurate AR reports, missed underpayments, incorrect patient balance billing, and compliance risk if adjustments aren’t applied correctly.

A payer that consistently underpays by $15 per claim across hundreds of claims a month is quietly costing you thousands, and you’ll never see it in a disorganized payment posting process. Accurate posting is what makes every downstream financial report trustworthy.

Yes. We reconcile every posted payment against your contracted fee schedules and flag discrepancies. Payer underpayment is common and systematically overlooked by practices without dedicated posting staff. We initiate payer inquiries and adjustment requests when payments don’t match what your contract entitles you to.

Yes, ERA (Electronic Remittance Advice) posting and manual paper EOB posting both. No remittance type falls through the cracks.

Completely. Your AR reports, collection rate calculations, and revenue projections are only as accurate as your payment posting. If ERA files aren’t posted promptly or adjustments are misapplied, you’re making business decisions based on incorrect data. Clean posting means clean reporting means decisions you can actually trust.

Accounts Receivable (AR) Follow-up

How much of my AR is actually collectible at this point?

More than you think. And we can tell you exactly how much before you spend a dollar with us. AR aging analysis is part of our free billing audit. We look at what’s outstanding by payer, by age bucket, and by denial reason, and identify what’s still within collection windows and what’s at risk of becoming write-off. Most practices have recoverable revenue in their AR that their current billing process simply isn’t reaching.

We don’t wait for claims to age into a problem. Our structured AR follow-up workflow activates at 30 days, with escalating actions at 60, 90, and 120+ days. For high-dollar claims, follow-up starts earlier. The goal is to keep your AR aging profile concentrated in the 0 to 60-day range, not the 90+ day range, where collection rates drop sharply.

Yes. We regularly take on practices with significant backlogged AR. We triage by collectibility, prioritize claims still within payer appeal windows and patient collection viability, and work systematically from there. Practices are frequently surprised by how much aged AR is still recoverable with proper follow-up.

Yes. After insurance processes, patient responsibility balances are identified. And we coordinate patient billing statements and follow-up outreach according to your practice’s policies. Patient AR is often the most neglected piece, and with rising deductibles, it’s increasingly significant.

Track your net collection rate and your AR aging distribution over 6-12 months. If your net collection rate isn’t consistently above 95% and your over-90-day AR isn’t shrinking, follow-up isn’t achieving what it should. We can benchmark your practice against industry standards in a free audit.

Credentialing and Contracting

Why does credentialing matter so much? Can't I just see patients and sort it out later?

Credentialing directly controls whether you get paid. Until a provider is fully enrolled with a payer, claims submitted under that NPI are either denied outright or reimbursed at out-of-network rates, sometimes 40-60% less than your contracted rate.

For a new provider or new practice location, every week of credentialing delay is a week of revenue lost. We start the process early and track every application to minimize that gap.

Commercial payers typically take 60-120 days. Medicare and Medicaid enrollments can take longer, occasionally up to 180 days or more for certain states. We start applications proactively and follow up aggressively to keep timelines as short as possible. We also help practices understand retroactive billing windows so no revenue is permanently lost during the credentialing period.

Yes. We manage the entire process, from NPI registration, CAQH profile setup, and primary source verification to payer-specific applications. Starting from scratch is exactly where credentialing delays hurt most, and where having an experienced team managing the process makes the biggest difference.

More than you think. And we can tell you exactly how much before you spend a dollar with us. AR aging analysis is part of our free billing audit. We look at what’s outstanding by payer, by age bucket, and by denial reason, and identify what’s still within collection windows and what’s at risk of becoming write-off. Most practices have recoverable revenue in their AR that their current billing process simply isn’t reaching.

Yes. Contracting negotiation is a service many practices never pursue because they don’t know it’s possible. But fee schedules are often negotiable, particularly for high-volume specialties, practices in underserved areas, or providers with strong quality metrics. We help you understand what your market supports and negotiate contracts that reflect your value.

Workers’ Compensation

Workers' comp billing is complicated. Why should I trust you to handle it?

Because workers’ comp billing, especially in California, is a specialty in itself. It uses a completely different fee schedule (the Official Medical Fee Schedule, or OMFS), different claim forms (DWC forms), different documentation standards (the MTUS treatment guidelines), and a separate regulatory body (the Workers’ Compensation Appeals Board).

Billing workers’ comp cases through a general medical billing workflow produces denials, underpayments, and disputes. We know the California workers’ comp system in depth and bill to its specific rules.

In California, when you treat an injured worker under a lien, that lien must be filed with the Workers’ Compensation Appeals Board (WCAB) to preserve your right to payment. If the lien isn’t filed correctly and on time, the carrier or employer’s attorney can challenge your ability to collect, even if the treatment was medically appropriate.

JET filing is the electronic system for submitting these liens, and we handle filing, confirmation, and ongoing tracking so your collection rights are protected.

We provide lien litigation support, including documentation preparation, lien status tracking, and coordination with your legal team. A disputed lien doesn’t have to mean forfeited revenue. With proper back-end support, most disputes are resolved in the provider’s favor when documentation is thorough and organized.

Workers’ comp billing, lien filing, and lien litigation support are currently offered exclusively in California due to the state’s unique regulatory framework. Workers’ comp collection services for out-of-state providers are available on a case-by-case basis. Contact us to discuss your specific situation.

Yes. Workers’ comp collection is specifically designed for this situation, like in the case of outstanding balances where the carrier has delayed, underpaid, or denied without adequate reason. We pursue these balances through systematic follow-up, formal disputes, and, where necessary, WCAB proceedings. Old doesn’t mean uncollectable.

Personal Injury

I'm hesitant to treat PI patients because getting paid takes so long. How does Med Claims change that?

The wait time in personal injury is tied to the pace of the legal settlement, not to anything in your billing process. But what you can control is how well your lien is documented, filed, and tracked, and how aggressively it’s collected once the case settles.

We manage the entire lien lifecycle so that when the settlement arrives, your collection is handled promptly and completely. And with our PI attorney networking services, you’re also getting a steadier flow of cases that offset the wait with volume.

A PI lien is a legal instrument that secures your right to be paid from the patient’s settlement proceeds. It allows you to treat patients who can’t pay out of pocket today, without losing your claim to payment later.

The lien must be properly documented and served on the responsible parties to be enforceable. We handle lien drafting, service, and tracking so your collection rights are protected from day one of treatment.

This is one of the most common concerns for PI providers. Lien negotiation is a standard part of personal injury settlement. Attorneys will typically negotiate medical liens down as part of case resolution. We represent your interests in this process to maximize recovery within what the settlement allows. In most cases, providers who have professional lien management recover significantly more than those who manage liens in-house.

Motor vehicle accidents, slip and falls, premises liability injuries, workplace accidents handled outside of workers’ comp, and other personal injury cases where the patient is under attorney representation and treatment is provided on a lien basis.