Healthcare practice guide
Billing, Books, and Payroll for Independent Physician Practices
Clean claims, a real close calendar, and a provider-level view of what each panel earns.
Independent primary care and specialty groups lose money in three quiet places: eligibility that was never re-verified, coding that undercharges the visit that actually happened, and aged claims nobody worked past day 60. We run the billing and the books together, so the revenue you earn and the revenue you record finally match.
Your practice
Set once — every healthcare tool below pre-fills from it and it stays with you for this visit.
- Clean claim rate target
- 95%+
- Days in A/R target
- Under 35
- Denial rate benchmark
- 5-8%
First-pass acceptance without manual rework
Measured on total A/R, not just current
Above 10% signals an intake or coding problem
Where the money leaks
Front-desk eligibility
Coverage that lapsed between scheduling and the visit is the single most common preventable denial. We verify at scheduling and again at check-in.
Under-coded visits
Documentation that supports a higher level of service but was billed lower is unrecoverable after timely filing closes. We audit a sample every month.
Aged A/R past 90 days
Claims sitting past 90 days collect at a fraction of face value. We work the queue oldest-first with payer-specific appeal packets.
How we run it
- 1
Eligibility and benefits
Verified before the visit, re-checked at check-in, with a written note on patient responsibility.
- 2
Charge capture and coding review
Every encounter reconciled to the schedule so no visit goes unbilled.
- 3
Claim scrub and submission
Payer edits applied before submission; rejections handled same day.
- 4
Denials and appeals
Root-caused by reason code so the same denial does not repeat next month.
- 5
Month-end close
Collections, A/R, and payer mix reconciled to the ledger by business day five.
Payers we bill every month
- Medicare Part B
- State Medicaid and managed care plans
- Blue Cross Blue Shield plans
- UnitedHealthcare
- Aetna
- Cigna
State rules we work under
Medicaid programs, payer portals, and payroll rules change at the state line. Pick your state for the specifics.
AHCCCS (Arizona Health Care Cost Containment System) · Phoenix, Scottsdale, Mesa
State billing detailMaineCare · Portland, Bangor, Lewiston-Auburn
State billing detailNJ FamilyCare · Newark, Jersey City, Princeton
State billing detailNorth Dakota Medicaid · Fargo, Bismarck, Grand Forks
State billing detailOregon Health Plan (OHP) · Portland, Salem, Eugene
State billing detailApple Health · Seattle, Bellevue, Tacoma
State billing detailTexas Medicaid · Houston, Dallas–Fort Worth, Austin
State billing detail