01 · Patient registration
Capturing accurate demographics and insurance details at intake. One wrong digit in a member ID is one of the most common reasons claims are rejected, so clean data here protects everything downstream.
Everything between the visit and the deposit
U.S. medical billing isn't one task — it's a chain of about ten steps, and money leaks at every weak link. Here's exactly what each step is, and how we handle it for you.
The revenue cycle, field by field
The ten steps of the U.S. billing process
02 · Insurance verification & eligibility
Confirming coverage is active and the service is covered — including copays, deductibles, and limits — before the visit, so claims aren't dead on arrival.
03 · Prior authorization
Many procedures and medications need the payer's approval in advance. We obtain and document these so services aren't denied after they're performed.
04 · Charge capture
Recording every billable service performed. Missed charges are pure lost revenue, so we reconcile encounters against what's actually submitted.
05 · Medical coding
Translating diagnoses and services into ICD-10, CPT, and HCPCS codes with correct modifiers — kept accurate, compliant, and audit-ready.
06 · Charge entry & claim creation
Building the claim in the formats payers require, such as the professional CMS-1500 or institutional UB-04.
07 · Scrubbing & submission
Running each claim through automated checks for conflicts and payer rules, then submitting through a clearinghouse — driving a high first-pass rate.
08 · Adjudication & payment posting
The payer decides what to pay; we read the remittance (ERA/EOB), post payments and adjustments, and flag underpayments against the contract.
09 · Denial management & appeals
Working denials fast — and tracing each to its cause. If a code or payer repeatedly triggers denials, we fix the upstream problem.
10 · A/R follow-up & patient billing
Chasing aging accounts receivable payer by payer, then clear patient statements and responsive support for balances owed.
What you can hand to us
Core services
End-to-end billing
The complete cycle above, run by a dedicated team — so your front desk and providers can focus on patients.
Coding & audits
Certified coding plus periodic internal audits to catch under-coding, over-coding, and compliance risk early.
Denial & A/R recovery
A focused project to clean up aging A/R and rework denied claims you may have already given up on.
Credentialing & enrollment
Payer enrollment and re-credentialing so new providers can bill without weeks of stalled applications.
Patient billing & support
Clear statements and a responsive line for patient questions — the part of collections that shapes your reviews.
Reporting & analytics
A live view of collections, denial trends, and A/R aging, plus a monthly review in plain language.
Plain-English glossary
Billing terms, decoded
Clean claim
A claim with no errors, accepted and paid on first submission. The higher your clean-claim rate, the faster you're paid.
Days in A/R
Average time to collect after a service. Lower is healthier; rising A/R days signal a billing problem.
ICD-10 / CPT / HCPCS
The U.S. code sets for diagnoses (ICD-10) and procedures/supplies (CPT, HCPCS) every claim depends on.
EOB / ERA
The Explanation of Benefits and its electronic version — the payer's statement of what was paid, adjusted, or denied.
Modifier
A two-character add-on to a code giving the payer extra context, like a bilateral or distinct service.
Clearinghouse
The intermediary that checks and routes claims between your practice and the many payers you bill.
Not sure which step is costing you?
That's exactly what the free audit answers. We'll review your recent claims and point to the specific gaps.
Get a free revenue audit →