Medical Billing & Revenue Cycle Management
Full-cycle medical billing and RCM for private practices, group practices, and outpatient facilities — coding review, claim submission, denial management, A/R cleanup, and coding audits coordinated with credentialing.
Why practices lose revenue — and where we fix it
Most revenue leaks are not billing problems in isolation. They are eligibility problems, prior-auth problems, credentialing problems, or documentation problems that surface as denials weeks later. Fixing the denial without fixing the source just moves the leak. Our engagement starts with a review of the last 90 days of denials by CARC/RARC reason code, aging by payer, and encounter-to-claim lag.
From there we take over the daily workflow: claim scrubbing to NCCI/MUE and payer edits, timely submission, payment posting reconciled against ERAs and EOBs, denial work within timely-filing windows, appeals with supporting documentation, and patient statements handled with a defined escalation ladder.
What we handle
Charge capture & coding review
ICD-10-CM, CPT, HCPCS, and modifier review against NCCI/MUE and payer medical policy.
Claim submission & scrubbing
Clearinghouse submission, edit resolution, and rejection turnaround inside timely filing.
Payment posting
ERA/EOB posting reconciled to bank deposits, contractual adjustments, and patient balances.
Denial management & appeals
Daily denial work, corrected claims, and appeals with clinical documentation packets.
Aged A/R cleanup
Work every claim in the aged bucket, appeal or write off, and hand back a current A/R.
Coding audits & compliance
Chart-level coding audits, upcoding/undercoding review, and HIPAA-aligned workflow review.
Metrics we report to you
- Days in A/R and A/R aging by bucket (0–30, 31–60, 61–90, 91–120, 120+)
- Clean claim rate and first-pass resolution rate
- Denial rate by CARC/RARC and by payer
- Net collection rate and gross collection rate
- Charge lag (date of service to date of submission)
- Payer mix and payer-level yield
We do not publish or guarantee specific improvement percentages — recovery depends on payer mix, specialty, documentation quality, and the state of A/R at intake.
How we work with your EHR/PM
Disclosures
PF Consulting Firm is not a law firm and does not provide legal, tax, or clinical advice. Reimbursement and denial outcomes depend on payer contracts, medical policy, clinical documentation, and coverage rules that are controlled by the payer and government programs. We do not guarantee reimbursement amounts, collection rates, or specific timelines.
The provider is responsible for the accuracy and completeness of clinical documentation and for the lawful coding of services rendered. Coding is applied to the documentation supplied; we do not create documentation for services not performed and will not code around missing documentation.
Stop the leaks. Bill it once, bill it right.
Ask for a 90-day denial-and-A/R review — no obligation, and a clear picture of what your revenue cycle should look like.
Medical billing FAQ
What is medical billing?
Medical billing is the process of translating clinical documentation into claims, submitting them to payers, posting payments and adjustments, working denials and appeals, and following up on aging accounts receivable. It sits inside the broader revenue cycle, which starts at eligibility verification and prior authorization and ends at final patient balance resolution.
What is revenue cycle management (RCM)?
RCM is the end-to-end management of a practice's financial workflow: eligibility and benefits verification, prior authorization, charge capture, coding review, claim submission, payment posting, denial management, appeals, A/R follow-up, and patient statements. Good RCM depends on clean credentialing, current fee schedules, and accurate documentation on the clinical side.
What coding standards do you follow?
Claims are coded to ICD-10-CM diagnoses, CPT and HCPCS Level II procedure codes, and NCCI/MUE edits. We also apply CMS LCD/NCD guidance where applicable and each payer's specific medical policy. All coding is performed and reviewed by staff trained on current CMS and AMA guidelines; clients remain responsible for the accuracy of the underlying clinical documentation.
Do you handle denials and appeals?
Yes. We work denial worklists daily — CO-16 documentation, CO-197 auth, CO-50 medical necessity, and other common reason codes — file corrected claims and payer appeals within timely-filing windows, and escalate patterns for the practice to fix upstream (documentation, front-desk eligibility, coder templates).
Do you clean up old A/R?
Yes. A/R cleanup is a common engagement: work every claim in the aged bucket, appeal what's appealable, write off what isn't collectible, and hand back a clean, current A/R. We report progress by aging bucket (0–30, 31–60, 61–90, 91–120, 120+) and by payer.
How is medical billing priced?
Most billing companies price on a percentage of collections, a per-claim fee, or a fixed monthly retainer, or some combination. The right structure depends on volume, specialty, and payer mix. We quote after a discovery call and never take a percentage of patient co-pays collected at the front desk unless explicitly agreed.
Do you coordinate with credentialing?
Yes. Denials for provider-not-enrolled, term-date, and taxonomy issues are usually credentialing problems, not billing problems. When we handle both, we resolve them at the source. See our Medical Credentialing page.
Are you HIPAA compliant?
Yes. We sign a Business Associate Agreement (BAA) with each covered entity, use access controls and audit logging, and follow the HIPAA Privacy, Security, and Breach Notification Rules for PHI we access on the client's behalf.