Practice owner answers
Revenue-cycle questions, answered plainly.
Each answer gives you the practical issue, how we approach it, the CMS or AMA source we checked and the date we checked it.
All answers
Questions practice owners ask us most.
How much do medical billing services cost?
There's no honest single price for every practice. What you'll pay depends on your claim volume, specialty, payer mix and service scope, and on whether the work covers coding, denials, patient balances, credentialing or reporting. Before you compare proposals, get the exact services, exclusions, minimums and change terms in writing.
What is denial management in medical billing?
Denial management is the process of finding out why a claim wasn't paid as expected, deciding the right next action, completing it, and stopping the same avoidable failure from repeating. A useful process works from the payer's response (the CARC and RARC codes on the 835 remittance) and the claim record. It doesn't guess from a dashboard total.
How should a medical practice manage A/R follow-up?
Start with an accurate account-level worklist, then prioritize by timely filing limits, value, age, payer response and the next action you can take. Every material balance needs an owner, a dated note and a next step. Aging buckets alone (0-30, 31-60, 61-90, 90+ days) don't tell you whether a balance is collectible or why it's still open.
What is medical provider credentialing?
Credentialing is the verification of a clinician's identity, education, training, licenses and other qualifications. It's different from privileging and from payer enrollment. Start early, and make sure every application, including the CAQH ProView profile many payers use, is complete, consistent and backed by current documents.
What is payer enrollment for a medical practice?
Payer enrollment is the process that lets an eligible provider or organization participate, bill and get paid under a payer's rules. For Medicare, CMS directs providers through NPI, PECOS and the relevant Medicare Administrative Contractor (MAC), which issues the PTAN. Commercial plans and state Medicaid programs have their own requirements.
What should a practice review in a payer contract?
Review the payment terms and fee schedule, the services and locations covered, notice and amendment language, audit and recoupment terms, dispute paths, data duties, renewal and termination. Legal questions belong with a health-care attorney. An operational review makes sure your team can actually follow the agreement, from timely filing to prior authorization.
What should a physician prepare before starting a medical practice?
Start with a written business and operating plan. Licensing, entity and legal advice, insurance, staffing, technology, payer strategy, credentialing, enrollment, billing and patient access all need owners and dates. Set up your revenue cycle before the first appointment. If you wait for the first unpaid claim, you're already behind.
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