Modifier errors, RFA prior authorization denials, and spinal injection bundling edits quietly drain thousands from your practice every month. Med Claims specializes in pain management billing, so your claims go out clean, your denials get reversed, and your revenue cycle runs without you chasing it.
Most billing companies apply general billing rules. This means your RFA claims, spinal cord stimulator trials, and nerve block submissions are going through the same generalist workflow as a dermatology practice down the street.
We don’t work that way. Med Claims is built around the documentation requirements, payer-specific edits, and code-level complexity that pain management actually demands. Our billers know the difference between 64483 and 64484. They know when modifier 59 applies versus XS. They know what Aetna requires to establish medical necessity on an SCS trial, and they make sure your documentation supports it before the claim goes out.
Less rework. Fewer denials. More of what you’re owed, faster.
One partner. End-to-end billing coverage. No dropped claims, no unanswered questions at all.
We verify coverage and benefits before procedures happen, not after. For high-stakes authorizations like spinal cord stimulator trials, RFAs, and implantable pumps, we manage the full prior authorization workflow, so your team isn’t on hold with payers.
Our coders work in pain management. Epidural steroid injections, facet joint blocks, trigger point injections, and neurostimulation. Every procedure is coded accurately with the right CPT, ICD-10, and modifier combination to maximize reimbursement and minimize rejection risks.
Claims are scrubbed against payer-specific edits before submission. We catch errors before they become denials, not after.
Every denial gets a root-cause review and a filed appeal. We track patterns, fix upstream issues, and recover revenue that other billing companies write off.
Every approved payment is posted promptly and reconciled against the original claim. No unposted remits. No unexplained write-offs at all.
Monthly dashboards show claim volume, first-pass rates, denial reasons, payer performance, and collection trends in plain language, without needing an analyst to interpret them.
If your practice treats personal injury patients on a lien basis, you know the challenge. Care gets delivered today, and payment comes sometimes after a settlement that could take years. Med Claims manages the full lien recovery lifecycle, so your practice isn’t left funding patient care indefinitely.
We build airtight documentation packages, negotiate directly with adjusters, and, when necessary, take cases to lien trial. Our team understands both the medical and legal sides of the equation, which means we construct cases that hold up under scrutiny and move toward resolution faster.
We don’t learn your specialty on the job. Our billers understand the nuances of interventional pain procedures, including bundling rules, modifier stacking, fluoroscopy guidance billing, and the documentation requirements that payers actually scrutinize. That knowledge shows up in your collection rate.
A clean claim filed once costs a fraction of a denied claim appealed twice. Our pre-submission scrubbing process catches errors before they reach the payer to protect your cash flow and your staff’s time.
We integrate with your existing documentation system. Whether you’re on AdvancedMD, Kareo, NextGen Healthcare, or Oracle Cerner, we build our process around yours, not the other way around. Your team doesn’t change anything. We adapt.
Most billing companies report denials. We resolve them. Every denied claim gets a root-cause review and a filed appeal with supporting documentation. We track denial patterns across your account and fix the upstream issues that cause them.
You get clear monthly reports with the numbers that matter, including first-pass acceptance rate, collection rate by payer, denial reasons by procedure, and outstanding AR aging. You always know where your revenue stands.
We have a dedicated billing expert, not a ticket system. When you or your office manager has a question, you reach someone who knows your account, not a chatbot or a general support queue.
Here’s what working with us looks like:
We begin with a comprehensive billing audit of your current process. We identify denial patterns, coding gaps, and revenue leakage before we take over. We execute your BAA, connect with your EMR, and assign your dedicated billing expert. Most practices are fully onboarded within 5 to 7 business days with zero interruption to ongoing billing.
Before each claim goes out, we verify insurance coverage and benefits, confirm prior authorization status, and code procedures accurately using pain-specific CPT and ICD-10 combinations, apply the correct modifiers, and scrub against payer edits. Claims go out within 24 hours of receiving complete documentation.
We monitor every claim through adjudication. Denials get reviewed, appealed, and tracked for patterns. Approved payments are posted and reconciled against each claim. You receive a monthly performance report with everything broken down by payer, procedure, and denial reason.
Our billers are trained on interventional pain procedures, including RFAs, epidural steroid injections, spinal cord stimulator trials, nerve blocks, trigger point injections, and the specific coding, modifier, and documentation requirements each one demands. A generalist biller adapts to your specialty. We were built for it.
Yes, and not just the billing. We understand the documentation that needs to accompany these claims, including medical necessity narratives, prior authorization requirements, fluoroscopy guidance billing rules, and payer-specific coverage policies. We flag documentation gaps before the claim goes out, so they don’t become denials after.
Most practices are fully onboarded within 5 to 7 business days. We handle the setup on our end, including EMR integration, payer enrollment review, credential verification, and BAA execution, so your team doesn’t carry the transition burden. Billing continues without interruption throughout.
Yes, always. A BAA is executed with every client before we access any patient or billing data. Full HIPAA compliance is the baseline for us.
Every denial gets a root-cause review and a filed appeal with supporting documentation. We also track denial patterns across your account. If the same procedure is getting denied repeatedly, we identify the upstream cause (coding, documentation, authorization gap) and fix it. We don’t just manage denials. We reduce them over time.
Yes. We work with AdvancedMD, Kareo, NextGen Healthcare, Oracle Cerner, and most major EHR platforms. If you’re using a custom or less common system, we assess compatibility during onboarding before making any commitments.
Monthly performance dashboards covering claim volume submitted, first-pass acceptance rate, denial rate by payer and procedure, collection rate, outstanding AR by aging bucket, and payment posting summary. Everything in plain language. No analyst required to interpret it.
Yes, through a separate but integrated service. If your practice treats PI patients on a lien basis, we manage documentation, adjuster negotiations, lien reductions, and, when necessary, lien trial support. Talk to our lien team directly for a case-specific consultation.
Most pain management practices that come to us are surprised by what a billing audit uncovers. Denials that were never appealed, modifiers that were never applied, and procedures that were undercoded for years. A free audit takes 30 minutes of your time and shows you exactly where your revenue cycle is leaking.