Frequently asked questions
The billing questions practices ask us most
Straight answers on denials, cash flow, pricing, onboarding, security and reporting — from a team that has been serving healthcare organisations since 2004.
Denials & claims
- Why are so many of our claims getting denied, and how do you reduce denials?
- Most denials trace back to a handful of repeatable causes — eligibility not verified, missing prior authorisation, coding or modifier errors, demographic mismatches and timely-filing misses. We categorise every denial by root cause, rework and appeal the recoverable ones, and then fix the upstream step so the same denial stops recurring.
- What is a clean claim rate and how do you improve ours?
- Your clean claim rate is the share of claims accepted by the payer on first submission with no edits or rework. We scrub claims against payer-specific rules, CPT/ICD validity and your fee schedule before submission, and report the rate every month so you can see it move.
- How do you handle appeals and resubmissions?
- Denied claims are queued by dollar value and appeal deadline. We prepare the appeal packet with the supporting documentation the payer requires, submit it within the filing window, and track it to a written decision instead of closing it as unrecoverable.
- Can you help with prior authorisations that delay reimbursement?
- Yes. We initiate authorisations before the visit or procedure where the payer requires one, track pending requests, and escalate stalled cases so the service is not performed without coverage in place.
Collections & cash flow
- How do we reduce AR days and recover aged balances?
- We work your AR by aging bucket and payer, starting with the highest-value recoverable balances. Aged AR — including balances a previous biller wrote off — is worked as a dedicated project alongside current claims so today's cash flow is not interrupted.
- How quickly are claims submitted after a visit?
- Our standard is clean-claim submission within 24–48 hours of receiving complete charge and documentation data from your team.
- Do you handle patient balances and statements?
- Yes — patient statements, balance questions, payment plans and a HIPAA-trained billing helpdesk are part of the full revenue cycle service.
- What happens to claims already in progress when we switch?
- During transition we agree who works the existing AR. In most engagements we take over the open AR as well, so nothing sits untouched while the changeover happens.
Pricing & contracts
- Do you charge a percentage of collections or a flat fee?
- Practice billing is priced as a percentage of collections — 3.99% for Basic and 5.99% for Full Revenue Cycle — so you only pay on revenue we help collect. Payer, clinical trials and project work is quoted per project, per FTE or per transaction. Final rates are confirmed in your written proposal after the free audit.
- Is the billing audit really free?
- Yes. The audit is a no-cost review of a sample of your claims, denials and aged AR, with a written summary you keep whether or not you engage us.
- Are we locked into a long contract?
- Terms are agreed in writing before you start, including notice periods. Ask for the specifics during your proposal review so there are no surprises.
- Are there setup or hidden fees?
- Anything chargeable is listed in the written proposal. If it is not in the scope document, it is not billed.
Onboarding & transition
- How long does it take to get started?
- Timelines depend on your systems, payer mix and access approvals. We map your workflow, agree SLAs and set up secure access before any live claim work begins, so day-to-day patient care is not disrupted.
- What do you need from our team?
- Access to your practice management or EHR system, your fee schedule and payer list, a sample of recent claims and denials, and one point of contact for questions.
- Who is our day-to-day contact?
- You get a named account manager, plus a dedicated team who learn your specialty rules and payers rather than a rotating pool.
Compliance & security
- How do you protect patient data?
- We work to HIPAA-aligned processes with role-based access, restricted work environments and access controls agreed with you in writing before the engagement starts.
- Will you sign a Business Associate Agreement?
- Yes. A BAA is part of the standard contracting process.
- Where is the work performed?
- Delivery is through our managed teams, including our operations in India, working under the access and security terms set out in your agreement.
Technology & reporting
- Will you work inside our existing EHR or practice management system?
- Yes — we work in your system rather than asking you to migrate. We map the workflow during onboarding so your team's screens and processes stay familiar.
- What reporting will we receive?
- Weekly operational reporting and a monthly review covering collections against charges, AR aging, denial categories and recovery progress, with a call to walk through it.
- Do you handle credentialing and payer enrollment?
- Yes — new provider and practice enrollments, CAQH setup and attestation, re-credentialing tracking and payer follow-up.
Specialties
- Do you have experience with our specialty?
- We bill across surgical, procedural and primary care specialties — from cardiovascular surgery, neurosurgery and orthopaedics to family practice, paediatrics and dermatology. Tell us your specialty in the audit request and we will confirm the team who would run your account.
- How do you keep up with specialty coding and payer rules?
- Coders are assigned by specialty and your account team maintains payer-specific rule sets that are updated as policies change, with coding review built into the full revenue cycle service.
Still have a question?
Get a custom quote for your specialty and practice size, or ask us directly on a short call.
No-cost revenue check
See exactly what your practice is leaving on the table
Our billing assessment team reviews a sample of your claims, denials and aging AR, then walks you through the findings. Most practices are surprised by the first slide.
- A claim-level look at what is being denied and why
- Aged AR you can still recover, quantified in dollars
- Coding and fee schedule gaps costing you per visit
- A plain-English action plan you can keep either way
Prefer to talk first? Call 630-430-1040
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Questions first? Read the billing FAQ or build a custom quote.